Breast Reconstruction

breast reconstruction, breast cancer, breast implants, silicone, saline, TRAM flap, DIEP, graweWhether you were just diagnosed with breast cancer or you have already been through your treatments, you are searching for answers about reconstruction. There is a lot to know and we will take you step by step through the entire process so that you can make the right decisions for YOU.

Let's Start at the Beginning

  1. You do not have to have reconstruction. If you choose not to have reconstruction, you can wear a special bra to give you a female contour.  Or, you can do nothing at all.
  2. You do not need to have reconstruction now. You can have breast reconstruction at the same time as your breast removal surgery, or if you choose to wait, you can have it at a separate time (delayed reconstruction).
  3. Your insurance covers breast reconstruction. A national law was passed that requires insurance companies that cover breast reconstruction to also cover all parts of breast reconstruction. Insurance will also cover procedures to make your opposite breast match your reconstruction breast such as breast augmentation, breast lift, and breast reduction.

There are two main types of breast reconstruction –

Implant Based-Reconstruction

Using your Own Tissue (Autologous Breast Reconstruction)

There is not a specific type of breast reconstruction that is right for everyone. Each type of breast reconstruction has its advantages and associated risks. Take time to decide what works best for your situation and what fits into your life. Dr. Grawe will help direct you to the right choice of breast reconstruction for you.

IMPLANT BREAST RECONSTRUCTION

Implant-based breast reconstruction uses a saline or silicone implant to rebuild a natural looking breast. The procedure can be done at the same time as the mastectomy (breast removal surgery) or can be done at a later time when your cancer medical treatment is completed.

HOW IT WORKS:

Consultation and Planning:

Once you decide on mastectomy (removal of the breast) with your breast surgeon, you will come in for a Reconstruction Consultation. At this meeting, we will go over the types of breast reconstruction and make a plan specific to your medical picture and your personal goals. We will choose what breast size you want to be (bigger, smaller, or the same). And we will coordinate surgery with your breast surgeon. (Contact ROXY Plastic Surgery today at (614)764-7699)

The Surgery:

After the removal of your breast, there is not enough skin to create a similar sized breast. This tissue needs to be moved from another part of your body (Autologous Reconstruction) or the skin on your chest can be expanded to create a new breast. Implant based breast reconstruction has 2 parts: The expansion phase and the permanent implant with final touches phase.

The Expansion Phase:

At the time of your mastectomy (removal of the breast), a tissue expander will be placed underneath your chest muscle (pectoralis). The tissue expander is a temporary implant that can be filled to expand the tissue on your chest and create a breast shape (the breast mound). The Expander is then filled with saline (salt water) at the end of surgery. You will have a drain on each side to remove clear pink fluid from your surgery site. This drain is easily removed at your next office visit.

At your follow-up visits, a magnet is used on the outside of your skin to find the fill-port on the expander and saline is injected into the expander. Little by little, your expander is filled until you achieve the breast size you like.

You are then ready for stage two.

The Permanent Implant:

At a separate, outpatient surgery, the tissue expander is exchanged for a permanent, more natural-looking and natural-feeling implant. This is done through your same scar so no new scars are made. This surgery lasts about an hour and a half and you can go home the same day. Usually, drains are not used. After your recovery, you are ready for nipple reconstruction.

Click here to learn more about the implants used.

Recovery

Tissue expander surgery does not add any time to your hospital stay.  After mastectomy (breast removal), patients typically stay in the hospital for 1-2 days.  The nurses at the hospital will give you pain medicine, make sure you are not nauseated and can eat, and teach you how to take care of your drains and bandages before you go home.

At home you should not lift anything heavier than a gallon of milk for at least 2 weeks after surgery.  You should walk around after surgery and NOT stay in bed.  This is important to prevent blood clots.  You may shower 48 hours after surgery.  You should eat a healthy diet and as much protein as possible to promote good healing.

You may drive and return to work when you are no long taking prescription pain medicine.  Most people are able to return to a light duty job 1-2 weeks after surgery and sooner after the permanent implant surgery.

Remember that everyone is different.  Recovery times and progression is not the same for everyone.  The times stated are typical for healthy individuals healing from this surgery.  The normal progression of healing may be different for those with health problems, smokers, and those who have unforeseen complications after surgery.

Risks and Considerations

Advantages of Implant-based Reconstruction:

  • Shorter surgery – 1-2 hours
  • Faster recovery – go back to regular life faster such as working or caring for children
  • Perky breasts – your reconstructed breast(s) will not sag and will always be youthful looking

Disadvantages of Implant-based Reconstruction:

  • Weekly office visits – although the visits are quick, you will come weekly for fills
  • Perky breast – may not match your other breast or your body
  • Not as natural looking/feeling as using your own tissue (Autologous Reconstruction)
  • Implant based problems (see risks below) including the risk of capsular contracture.

RISKS:

With every surgery there are risks involved including bleeding, infection, blood clots, pain, scarring, delayed healing and need for further surgery.  Here are some complications specific to tissue expansion:

  • Infections in the presence of a tissue expander/implant are harder to treat than infections in normal body tissues.  If an infection does not respond to antibiotics, the device may have to be removed.
  • Capsular Contracture: Scar tissue, which forms internally around the tissue expander/implant, is normally soft and you cannot feel it but, it can tighten and make the breast round, firm, and possibly painful. Excessive firmness of the breasts can occur soon after surgery or years later and is not predictable. Radiation treatment to the chest wall greatly increases the risk of capsular contracture. This problem often requires surgery to treat.
  • Skin wrinkling: Visible and palpable wrinkling of the expanders and breast skin can occur. This wrinkling is normal and expected in the expander and gets better as the expander is inflated. It may also be possible to feel the tissue expander fill-valve. The permanent implant may also be seen or felt. This occurs more often with saline implants and less often with silicone implants.
  • Implant Problems: Implants of all types are manufactured products and can fail. They can deflate which causes them to change shape. This is repaired with further surgery to replace the implant. If they get infected, they may have to be removed.

AUTOLOGOUS RECONSTRUCTION

There are many techniques for using your own tissue to reconstruct your breast.  This can be done at the same time as the mastectomy (removal of the breast) or in a delayed fashion sometime after the breast removal.

TRAM Flap – Transverse Rectus Abdominus Muscle Flap

HOW IT WORKS:

Consultation and Planning:

Once you decide on mastectomy (removal of the breast) with your breast surgeon, you will come in for a Reconstruction Consultation. At this meeting, we will go over the types of breast reconstruction and make a plan specific  to your medical picture and your personal goals.  We will choose what breast size you want to be (bigger, smaller, or the same).  To be a candidate for TRAM Reconstruction, you must have excess abdominal tissue and this will be assessed at your consultation. We will coordinate surgery with your breast surgeon.

The Surgery

After the removal of your breast, there is not enough skin to create a similar sized breast.  This tissue needs to be moved from your belly (TRAM) or the skin on your chest can be expanded to create a new breast (implant-based reconstruction).

The TRAM surgery uses the skin, fat, and muscle from your abdomen to create a soft, natural-appearing and looking breast on your chest.  The resulting scar is similar to a c-section  or tummy tuck scar.  This surgery takes about 3-4 hours.  You will have a drain in your abdomen and possibly your chest.

Recovery

You will stay in the hospital for 3-4 days after surgery.  During this time, the nurses will check your new reconstructed breast to make sure that the blood supply to the new breast (TRAM Flap) is good so that the tissue can survive in its new location.  .  The nurses at the hospital will give you pain medicine, make sure you are not nauseated and can eat, and teach you how to take care of your drains and bandages before you go home.  The drains will be removed at your follow-up office visit.

At home you should not lift anything heavier than a gallon of milk for at least 2 weeks after surgery.  You should walk around after surgery and NOT stay in bed.  This is important to prevent blood clots.  You may shower 48 hours after surgery.  You should eat a healthy diet and as much protein as possible to promote good healing.

You may drive and return to work when you are no long taking prescription pain medicine.  Most people are able to return to a light duty job 2-3 weeks after surgery and may start exercising after 6 weeks.

Remember that everyone is different.  Recovery times and progression is not the same for everyone.  The times stated are typical for healthy individuals healing from this surgery.  The normal progression of healing may be different for those with health problems, smokers, and those who have unforeseen complications after surgery.

Risks and Considerations

Advantages to TRAM Flap surgery:

  • Soft natural appearing breast, can mimic your natural breast well
  • No implant or foreign objects used
  • Similar to a tummy tuck

Disadvantages to TRAM Flap surgery:

  • Longer operation and hospital stay
  • Abdominal scars

RISKS:

With every surgery there are risks involved including bleeding, infection, blood clots, pain, scarring, delayed healing and need for further surgery.  Here are some complications specific to TRAM Flap Reconstruction:

  • Partial or Total Flap Loss: When your abdominal tissue is placed in a new area, it has to learn how to adapt to living in that location, meaning it needs enough blood to survive.  When it doesn’t get all the blood it needs, a part of it might need to be removed in another operation.  Very rarely does the entire flap loose its blood supply and need to be removed.
  • Fat necrosis: Sometimes some of the fat doesn’t get enough blood supply and that portion of the reconstructed breast becomes firm or hard to touch.  The only way to make this firmness go away is to remove it, which requires an operation.
  • Asymmetry: Human breasts are not symmetrical.  After breast reconstruction, the reconstructed breast may be bigger or smaller, perkier or less perky than the other breast.  An operation on the natural breast can be done to better match the reconstructed breast if this happens.  Insurance covers the matching surgery as well as the breast reconstruction.

LATISSIMUS DORSI Flap (LD Flap)

HOW IT WORKS:

Consultation and Planning:

Once you decide on mastectomy (removal of the breast) with your breast surgeon, you will come in for a Reconstruction Consultation.  At this meeting, we will go over the types of breast reconstruction and make a plan specific to your medical picture and your personal goals.  We will choose what breast size you want to be (bigger, smaller, or the same).  To be a candidate for an LD Flap Breast Reconstruction, you will need to have excess back tissue and this will be assessed at your consultation.  We will coordinate surgery with your breast surgeon.

The Surgery:

After the removal of your breast, there is not enough skin to create a similar sized breast.  This tissue will need to be moved from your back.  Dr. Grawe will make some marks on your back and your chest in the preoperative area which will be used as a plan in surgery.

After the breast tissue is removed, you will be turned to your side while you are still sleeping.  A small oval of skin and the underlying Latissimus Dorsi muscle will be removed from your back and tunneled over to your chest.  The back area will be sutured closed in a straight line and then you will be turned over to your back again.

Usually an implant or tissue expander is also used under this tissue to create a larger breast. (click here for more information on tissue expanders and implants). The LD flap helps create a very natural looking breast and camouflages the implant below.  Drains will be placed in your back and must remain there for 2-4 weeks.  This surgery takes about 3 hours.

Recovery:

You will stay in the hospital for 1-3 days after surgery.  During this time, the nurses will check your new reconstructed breast to make sure the blood supply to the new breast (LD Flap) is good so that the tissue can survive in its new location.  The nurses at the hospital will give you pain medicine, make sure you are not nauseated and can eat, and teach you how to take care of your drains and bandages before you go home.  The drains will be removed at your follow-up office visit.

At home you should not lift anything heavier than a gallon of milk for at least 2 weeks after surgery.  You should walk around after surgery and NOT stay in bed.  This is important to prevent blood clots.  You may shower 48 hours after surgery.  You should eat a healthy diet and as much protein as possible to promote good healing.

You may drive and return to work when you are no longer taking prescription pain medicine.  Most people are able to return to a light duty job 2-3 weeks after surgery and may start exercising after 6 weeks.

Remember that everyone is different.  Recovery times and progression is not the same for everyone.  The times stated are typical for healthy individuals healing from this surgery.  The normal progression of healing may be different for those with health problems, smokers, and those who have unforeseen complications after surgery.

Risks and Considerations

Advantages of Latissimus Dorsi Reconstruction:

  • Fairly short surgery – 2-3 hours
  • Fairly fast recovery – 2-3 weeks
  • Perky breast with soft natural look and feel

Disadvantages of Latissimus Dorsi Reconstruction:

RISKS:

With every surgery there are risks involved including bleeding, infection, blood clots, pain, scarring, delayed healing and need for further surgery.  Here are some complications specific to Latissimus Dorsi Flaps:

  • Tissue expander type problems (link to TE recon page) with weekly office visits
  • Implant based problems (see risks below) including the risk of capsular contracture.
  • Use of an implant and another scar from the back donor site.