Breast Reconstruction

Breast Reconstruction Surgery Methods, Procedure, Recovery and After Care

Breast Reconstruction is surgery to rebuild the breasts after a mastectomy from either cancer, correction due to burns, or transgender conversion. Patients who would like to undergo Breast Reconstruction after a Mastectomy due to breast cancer need the permission or clearance of their previous mastectomy surgeon to ensure cancer has been treated completely, hence cleared for reconstruction surgery.

Breast reconstruction surgery

Good candidates for the Breast Reconstruction surgery, are: 

• Cancer patients who have completed their therapy and treatment
• Patients who need reconstruction surgery due to scars caused by an accident or burns.
• The Surgeon will then close the incision and bandage the wound with surgical tape and adhesive.Patients with no previous radiation treatments done to the breast areas.
• Patients with no active connective tissue disease like SLE, scleroderma, or rheumatoid disease.

Breast Reconstruction Options

1. Reconstruction with implants

In this type of surgery, the surgeon will use a saline-filled or silicone gel implant inserted inside the cavity beneath the muscle. In case of scarring or fragile skin, the surgeon may opt to use tissue expander before inserting the breast implants.

2. Reconstruction with flaps

 There are three types of breast reconstruction with flaps

• Transverse Rectus Abdominis Muscle flap (TRAM) – For this, the surgeon uses the patient’s skin, some parts of the rectus muscle, as well as the fat below the umbilicus along with the vascular pedicle. This is then moved to the breast area. While this technique is very reliable, the patient loses a portion of the rectus muscle and may experience weakness of the abdominal wall.

• Deep Inferior Epigastric Perforator Flap (DIEP) – For this, the surgeon uses fat and skin without muscle and moves these to the breast area using microsurgery. While this method helps preserve abdominal muscle function, there is a risk of vessel thrombosis due to the  microsurgery technique.
• Latissimus Dorsi Flap (LD-flap) and other flaps – The surgeon may opt to use alternative flaps based on the patient’s preference and/or physical limitations.

Breast Reconstruction Surgery Preparation

Prior to the Breast Reconstruction Surgery, patients should: 

• Consult with the surgeon to discuss goals and expectations, undergo necessary lab tests, and go through the medical evaluation process.
• Patients must stop smoking and drinking alcohol at least 2 weeks before the procedure.
• All blood-thinning medications like Aspirin, Ibuprofen, hormones, and some supplements must be stopped 2 weeks before the surgery.

Breast Reconstruction Surgery Postoperative Care

The following are post-surgery care reminders for both types of breast reconstruction surgery.

1. Reconstruction with implants

• Keep the bandages on for 7 days after the procedure.
• Stitches will be removed on the 7th day.
• Patients may need regular breast massage depending on the shape and type of implants used.
• Nipple and areola reconstruction may be done at a later stage.

2. Reconstruction with flaps

• For TRAM-flap patients, only engage in light activity and avoid all medium-heavy activity for at least 2 weeks after the procedure.
• For DIEP-flap with microsurgery patients, patients should stay in the hospital for at least 7 days after surgery and maintain limited activity for four weeks.

Potential Risks and Complications

The following are some of the possible risks and complications of Breast Reconstruction Surgery:

• Flap loss. Surgeons will choose the best possible flap for each patient. However, patients may experience poor healing and compromised blood supply due to previous treatments.
• Delayed wound healing
• Loss of sensation
• Bleeding, seroma, or hematoma
• Surgical wound infection
• Potential weakness of the abdominal wall
• Unfavorable surgical results – an unnatural look of breasts, uneven breasts, or asymmetry

Breast Reconstruction Recovery

Recovery from Breast Reconstruction surgery depends on which surgical technique was performed.

• Patients who opted for reconstruction with implants need approximately two weeks after surgery for recovery
• Patients utilizing tissue expanders need to increase the volume of the pocket gradually over the course of 4 to 6 weeks before the implants may be inserted.
• Patients who utilized reconstruction with flap have an average recovery time of about 2-4 weeks. However, there is a waiting time of 6 to12 months before proceeding to the secondary stage of the nipple and areola Reconstruction Surgery.