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Breast Reconstruction Surgery: What to Expect

If you’ve decided to have breast reconstruction surgery after a mastectomy, you likely will have questions about what to expect and how to pick the surgery that’s best for you: breast implants or a tissue flap procedure. 

First Steps

It’s important to assemble an oncology team that includes a breast surgeon and plastic/reconstructive surgeon as soon as possible after your breast cancer diagnosis. Patients sometimes wait until after their mastectomy to meet with a reconstructive surgeon. Don’t put this off. It’s best for our breast surgeon and plastic surgeon to create a plan together. 

When you meet with your doctors, you should go over any health or treatment challenges that might affect reconstruction efforts and create a realistic timeline that leaves plenty of room for rehabilitation and rest. 

Some questions you may want to ask: 

●  Will I need expanders? Depending on the amount and elasticity of skin left after the breast is removed, a temporary tissue expander — a “balloon” filled with saline — and drains may be needed to make room for the implant or as a first step toward flap reconstruction. 

●  Will reconstruction be immediate or delayed? While in some cases both the mastectomy and the first stage of reconstruction can be done at the same time, sometimes a pause is required between surgeries. This includes time for expanders to stretch the skin for implants. If future treatments include radiation or chemotherapy, the second stage of reconstruction is usually delayed until those therapies are complete. 

Choose the Surgery That’s Best for You 

Breast implants. This involves inserting a flexible silicone shell that comes in a variety of shapes and sizes. They can be placed under (retro-pectoral) or on top of (pre-pectoral) the chest muscle, depending on how you’d like your finished breasts to look. Implants will have one of two different fillers: 

●  Saline: Filled with sterile saltwater, saline implants have been in use the longest of all implant types. Although they have a slightly higher rate of rupture (up to 10 percent during the first 10 years after insertion), because saline is natural and easily absorbed, they can offer peace of mind in the case of a rupture. 

●  Silicone gel: Gel implants, also called form-stable implants, tend to feel a bit more like natural breast tissue and will keep their shape even if the shell is cut or broken. They are firmer than regular implants and might be less likely to rupture but do require ongoing screening. 

Tissue flap procedure. Also known as autologous tissue reconstruction, flap reconstruction uses your own tissue (skin, fat and occasionally muscle) to form a breast shape. Called a “flap,” the tissue is taken from your belly, back, buttocks or inner thigh and attached in a complex surgical procedure similar to an organ transplant. A few options include:

  • Deep inferior epigastic perforators (DIEP) flap - takes skin and fat from the lower abdomen, along with its blood vessels, to mold a new breast

  • Superficial inferior epigastric perforator (SIEA) flap - similar to DIEP, it involves taking tissue from the lower part of the abdomen but does not use vessels from stomach muscles

  • Profunda artery perforator (PAP) flap - uses tissue (no muscle) from the inner thigh

  • Lateral thigh (LTP) flap - uses skin and fat from the outer thigh

  • Superior gluteal artery perforator (SGAP) flap - uses tissue from the hips or top of the buttocks 

Implants offer minimal scarring and a less-complicated surgery, but they are not a lifelong solution and may have to be removed or exchanged over time. Flap reconstruction offers a more holistic option using your own body’s tissue, but the surgery, scarring and recuperation time is more invasive. 

Guidelines for Faster Recovery 

After reconstructive surgery, your doctor will prescribe medication to help ease pain and avoid infection. You’ll have to limit physical activity, particularly arm and chest movement, and you’ll want to avoid moderate or heavy lifting. You also will have to skip baths for the first week as stitches heal. 

Your recovery could take from a couple weeks to a couple months, depending on the procedure and how your body reacts to it. Be sure to call your doctor if there is any unusual redness, swelling, pain or drainage.



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