What Is Breast Reconstruction Surgery?

Breast reconstruction surgery is a procedure/s to rebuild your breasts after they've been removed (usually from cancer). Because of advances in breast reconstruction surgery, many women undergoing breast removal choose to have their breast(s) rebuilt.

Medical, surgical, and radiation therapy treatments for breast cancer have increased the number of breast-sparing procedures available. But some breast cancer patients may still need a mastectomy (removal of the breast(s)). Some women need to have their breasts removed because of other diseases.

Considering Reconstructive Breast Surgery?

The decision to have reconstructive breast surgery is a very personal one. It depends a lot on how you think you will feel after a mastectomy. If you might feel uncomfortable with a flat chest or wearing a false breast (called a prosthesis), you may want to consider reconstructive surgery. Or you may choose not to have any extra surgery.

Breast reconstruction often takes place in stages, and many women will need more than one operation to complete the process.

Breast Reconstruction Post-Surgery

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Implant-Based Breast Reconstruction

Implant-based breast reconstruction uses either saline or silicone implants. This option is a good choice for women whose chest tissue has healed normally after a mastectomy and don’t need any radiation therapy.

Some patients can also use autologous tissue (the patient’s own tissue) as well as implants in the reconstructive process. Your surgeon will help you make the decision about which options are best for you.

Surgical Risks Specific to Implant-Based Reconstruction

Most women won’t have any complications with their reconstruction surgery; however, we want our patients to be informed about the possible risks of this procedure.

These risks include the following:

  • Asymmetry—Reconstructed breasts often sit higher on the chest and are not as soft as normal breasts. There may also be differences in size between a reconstructed and a native (original) breast. Your surgeon can discuss surgical options with you to determine the best way to improve the overall symmetry of your breasts.
  • Capsular contracture—Capsular contracture happens when your body reacts to a foreign material inside it. Your body will form a fibrous membrane, called a capsule, around the implant. Contracture is the most common side effect of using breast implants for reconstruction and is usually minimal if it occurs.
  • Deflation—If you choose a saline implant for breast reconstruction, the valve on the implant can fail, which will allow the saline to leak out. While the saline, or salt water, will be reabsorbed by the body, you will have to have the implant replaced in another procedure.
  • Reduced sensation—After your mastectomy, you may have noticed less sensation in the skin of your chest. The process of expanding and placing your implants may also cause new or additional changes in sensation. These changes may be temporary or permanent. If you lose sensation in your chest, your nerves can recover in one to two years. (85 percent of women who have breast reconstruction will regain their sensation.)
  • Wrinkling—Some patients notice wrinkling of the implant underneath their skin. Some women can feel the edge of their implant. These problems are usually mild and don’t need to be treated. The wrinkles usually improve with time; rarely they may need to be corrected with another surgery.

Implants & Breast Cancer

There is no evidence of a link between getting breast implants and developing breast cancer. If cancer does develop in a reconstructed breast, it is more likely because the previous breast cancer has come back (reoccurred) instead of a new malignancy (new case of breast cancer) forming.

Silicone Rubber Inside the Body

Both saline and silicone implants use silicone. In the 1990s there were concerns from the legal industry, media, and FDA about using silicone gel in the body. There does not, however, appear to be a link between silicone implants and an increased risk of connective tissue disorders or breast cancer in women.

Tissue-Based/Flap Reconstruction

Tissue-based reconstruction is also called flap reconstruction and often uses tissue from your back or abdomen. Commonly used flaps are the:

  • Latissimus flap (using the latissimus dorsi muscle), and
Abdominal flaps, such as the:
  • DIEP flap (deep inferior epigastric perforator flap) or
  • TRAM flap (transverse rectus abdominus myocutaneous flap).

DIEP & TRAM Flap Reconstruction (Abdominal Free-Flap)

During flap reconstruction, surgeons will take an abdominal flap from a section of your lower abdomen (belly). Abdominal flaps include your skin, fat, and sometimes muscle. Surgeons can use an abdominal flap to reconstruct breasts in women who have extra abdominal tissue.

During breast reconstruction, surgeons often use free flaps, a flap that is transferred along with its blood supply (a small artery and vein) from the abdomen to the chest where it is reattached to a small artery and vein.

Types of abdominal flaps include the:

  • DIEP flap (deep inferior epigastric perforator flap), and
  • TRAM flap (transverse rectus abdominus myocutaneous flap).

Surgical Risks Specific to Abdominal Free Flap Reconstruction

Most women don’t have complications (or problems) during their flap reconstruction surgeries. However, we want our patients to be informed about the possible risks of this procedure. These risks include the following:

  • Delayed wound healing—Using tissue flaps requires us to make incisions on your back, abdomen, or other areas. This means there are other areas on your body that will need to heal. In some cases, patients take longer to heal because of inflammation, infection, wound tension, decreased blood flow, smoking, or external pressures. If the healing is delayed, we may need to surgically alter the scar.
  • Hernia/Abdominal bulge—When a surgeon uses abdominal tissue, there is always a risk (chance) that tissue or muscle in the abdomen may become weak. This could cause a bulge in the abdomen or a defect or opening, called a hernia. A hernia must be repaired by surgery.
  • Necrosis/Flap loss—When a tissue flap is used for reconstruction, the flap may sometimes not survive. The tissue may die, which is called necrosis or death of the cells. The chance of this happening is very small, only 1–2%; however, if the tissues die, a patient will need more surgery to remove the dead tissue and reposition the rest of the tissue.
  • Reduced blood flow—Sometimes blood circulation to the flap is reduced because the blood vessels have been surgically connected. Your doctor can use an ultrasound to detect this. Patients may require additional surgery to reestablish blood flow.
  • Seroma (fluid collection)—Sometimes a pocket of fluid, or seroma, forms under the skin—even though surgeons place drains under your skin to collect this fluid. To drain the seroma, we may have to remove the fluid by inserting a needle into the pocket to collect the fluid or apply a compression dressing (like an abdominal binder).
  • Umbilical (belly button) complications—Sometimes your belly button may be deformed because of how tissue was rearranged during surgery to remove the abdominal flap. In rare cases, this may cause delayed healing or tissue death near your belly button that will need reconstructive surgery later.

Latissimus Flap Reconstruction

During a latissimus flap reconstruction, surgeons will take a flap of tissue from your back that’s made up of fat and muscle with or without skin. The flap will stay attached to its blood supply and is tunneled under the skin from your back to your chest. Surgeons will make an incision (or cut) along the bra line on your back.

This type of surgery is often used along with a tissue expander or an implant. In some cases, latissimus flap reconstruction can be used alone to create a small volume breast.

Surgical Risks Specific to Latissimus Flap Reconstruction

Most women will not have complications (problems) during latissimus flap reconstruction. However, we want our patients to be informed about the possible risks of this procedure. These risks include the following:

  • Back asymmetry—The latissimus dorsi muscle is part of the curve of your back. Removing a flap from one side of the back may cause a small difference in appearance or symmetry of the back.
  • Delayed wound healing—Surgeons take latissimus flaps from your back. You will have a surgical incision (cut) on your back that will need time to heal. In some cases patients do not heal quickly because of inflammation, infection, wound tension, lowered blood circulation, smoking, or outside pressure. If healing is delayed, we may have to surgically alter the scar.
  • Muscle weakness—For most patients, losing some function of the latissimus dorsi back muscle will not affect their day-to-day life or activities. Most patients do notice some weakness on the side of their back where the flap was removed, but this usually heals with time. There are cases, however, where patients have a small level of disability while doing activities like rowing or swimming.
  • Necrosis/Flap loss—When a tissue flap is used for reconstruction, the flap may not survive (necrosis or death of the cells). The chance is very small, one to two percent; however, when it happens more surgery is needed to remove the dead tissue and reposition the remaining tissue.
  • Seroma (fluid collection)—Sometimes a pocket of fluid, or seroma, forms under the skin—even though surgeons place drains under your skin to collect this fluid. To drain the seroma, we may have to remove the fluid by inserting a needle into the pocket to collect the fluid or apply a compression dressing (like an abdominal binder).

Stages of Breast Reconstruction Surgery

Breast reconstruction surgery takes place in two stages:

  1. Placing the tissue expander and
  2. Reconstructing the breasts after the tissue is expanded.

Stage One: Placing the Tissue Expander

In stage one of breast reconstruction, your medical team will need to prepare your chest tissue for the final reconstruction. Surgeons will place a tissue expander underneath your chest wall muscles to slowly expand the tissue in preparation for either implants or tissue based reconstruction.

Your doctor may also use an acellular dermal matrix to provide additional support for the tissue expander. An acellular dermal matrix is a type of collagen graft that is placed over the tissue expander to reinforce (or support) the tissue. It can be made from either human or animal tissue.

There are no live cells in this graft. It provides support and acts as a framework for the patient’s own tissue and vessels to grow into.

Filling the Tissue Expander After Surgery

About three weeks after surgery, when you’ve had some time to heal, we will begin to fill the tissue expander with more fluid. This procedure is called expansion. It will stretch your chest skin and tissue over the expander and prepare it for stage 2 of reconstruction. Most patients have weekly expansions until their breasts reach the size they want.

Surgical Risks with Tissue Expanders

  • Infection—Infection can happen when a tissue expander is placed under the skin and muscle. Antibiotics often solve the problem, but serious infections may require removing the expander.
  • Breakdown of the incision line—If the incision line breaks down, we may have to remove fluid from the expander and re-suture the incision (stitch up the cut). The tissue expander may also have to be temporarily removed.
  • Necrosis of the skin—Necrosis is the death of cells, in this case in the skin. It is caused by tissue trauma or the loss of circulation. If this happens, an area of skin may need to be removed surgically.
  • Expander failure—Rarely, the expander fails for mechanical reasons. In some cases, we may need to replace your expander.

Stage Two: Implant Based Vs. Tissue Based Reconstruction

At this stage, your tissue expander has been filled to stretch the skin and muscle of your chest to prepare for your final reconstruction. Once expansion is finished and you have recovered from adjuvant cancer treatments, you will meet with your surgeon to discuss your goals and to determine the method of final reconstruction that will be best for you: implant based or tissue based reconstruction.

Breast Reconstruction With Implants

Implant based reconstruction, which uses either saline or silicone implants, can be a good option for women whose wounds are healing normally and don’t need any radiation therapy.

Breast Reconstruction With Tissue

Tissue based reconstruction, also called flap reconstruction, uses tissue from your back or abdomen. This type of reconstruction may be recommended for women who have had radiation, an infection, or a healing problem after surgery.

When surgeons use tissue from your back (called a latissimus flap), surgeons use your own tissue in combination with an implant. When surgeons use tissue from your abdomen, the abdomen tissue provides both the shape and volume of the reconstructed breast.

Reconstruction After Unilateral Mastectomy

For patients who have had a unilateral mastectomy (only one breast removed), a surgery on the opposite breast may be remaining to make the reconstructed breast and remaining breast look as similar as possible.

These procedures are:

Can Reconstructive Surgery Be Done at the Same Time as a Mastectomy?

One of the decisions you will be asked to make is whether you want your breast to be reconstructed immediately after your reconstruction, or if you want to wait (also called delayed reconstruction).

Immediate reconstruction means the first stage of breast reconstruction is performed on the same day as your mastectomy.

Delayed reconstruction means you have your mastectomy and start the reconstruction process later after your cancer treatments are finished.

Recovering from Breast Reconstruction

For a smooth recovery, you must follow your plastic surgeon's aftercare instructions. Learn what you can expect as your body heals after your breast reconstruction.

How Long Does It Take to Get Breast Reconstruction?

Timeline for Reconstruction Process

Meet With a Plastic Surgeon

Before your mastectomy procedure, we recommend that you meet with a plastic surgeon to discuss the reconstruction process and breast reconstruction recovery. Doing this will give you and your surgeon the most flexibility possible to make decisions about your reconstructive options.

With reconstructive surgery, you can choose to have stage one of the process started right at the time of your mastectomy or you can wait until later. This decision is something your plastic surgeon can help you make.*

Surgical Procedure

You breast surgeon will perform your double or single mastectomy. Your surgeon will place drains at the time of surgery. You may also begin stage one of the reconstruction process by having a tissue expander placed.

Stage One

A tissue expander is placed under your chest muscle during a surgical procedure.

A few weeks after surgery, when you have had time to heal, we will begin to fill the tissue expander with more fluid. The tissue expander will stretch your skin and muscle to help your body get ready for stage two of the reconstructive process.

We will generally see you in the clinic every one to two weeks until the expansion process is complete.

Stage Two

You will discuss implant versus tissue-based reconstructive options with your plastic surgeon.

In patients who have a one-sided mastectomy (only one breast removed), surgeons will usually perform procedures on the other (opposite) breast during the second stage of reconstruction.

Your surgeon will perform surgery to make sure both of your breasts look symmetrical and even.

Additional Procedures

After stage two of the reconstructive process is complete, you may consider other procedures, such as nipple reconstruction.

Total Timeline

Breast Reconstruction for Mastectomy Patients

The process will take three to four months if your wounds are healing normally and if you don't need any other cancer treatments.

Breast Reconstruction for Chemotherapy Patients

The reconstruction process often takes six or more months for patients who need chemotherapy after mastectomy. Patients need one to two months to recover from chemotherapy before undergoing any additional surgery.

Breast Reconstruction for Radiation Patients

The reconstruction process can take six to 12 months for patients who need radiation therapy. Patients need three months to recover after their last radiation treatment before having additional surgery.

The patient and surgeon must also plan final reconstruction by thinking about the long-term effects of radiation on the skin and underlying tissue.

*This timeline may differ based on individual patient circumstances and recovery times.

Hear From Our Patients

After being diagnosed with breast cancer, Terri Jones had a plan. “When it got to the idea of reconstructive surgery, all I knew is that I didn’t want anything foreign in my body,” Jones said. “I didn’t want implants and I thought that meant I wouldn’t have reconstruction at all.” After speaking to a friend who had breast cancer, Jones learned there are many more options when it comes to breast reconstruction than she realized. This meant she could make a choice right for her.

Read Terri's Story

Terri Jones, breast cancer patient

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