What it is
Breast reconstruction is a procedure that rebuilds a woman’s breast shape after a mastectomy.
Ideal breast reconstruction candidates are women who were previously mastectomy patients, having received the mastectomy as a result of a cancer diagnosis or as a preventive measure if they carry the breast cancer gene. Immediate breast reconstruction following a mastectomy is preferred to obtain the best cosmetic outcome when possible.
For some patients, in particular patients who will not be receiving post-mastectomy radiation treatments, breast reconstruction surgery can be executed in tandem with a mastectomy surgery. The most common method of breast reconstruction is tissue expander reconstruction, which involves two stages. In stage one of tissue expander breast reconstruction, a temporary implant called a tissue expander, is positioned under the muscles of the breast reconstruction patient’s chest. Tissue expander breast reconstruction patients return to the doctor every one to two weeks to receive saline injections to expand the temporary implant to create a space for a permanent implant and a breast-like shape; the procedure can be performed in the doctor’s office for a period of several weeks to a few months and takes only a few minutes each time. Once the desired expansion is achieved, stage two of the tissue expander breast reconstruction commences with the substitution of a permanent implant for the temporary expander implant. During stage two, fat grafting and breast pocket release are often performed at the same time as expander exchange for implant to improve the aesthetic outcome. Stage two is most often done as an outpatient surgery.
The second most common breast reconstruction method is flap reconstruction, a one-stage procedure. This breast reconstruction surgery uses abdominal (Transverse Rectus Abdominis Myocutaneous, or TRAM) or back (latissimus) tissue to reconstruct the patient’s breast. Breast reconstruction patients who undergo a TRAM flap reconstruction also will have skin tightening of the abdomen as a result.
Nipple reconstruction is often done as the final stage for expander/implant reconstruction and flap reconstruction. This surgery involves using the reconstructed breast skin to create a nipple and areolar reconstruction with tattooing. Often times fat injections and lateral breast liposuction is done during this stage to improve the breast shape. This surgery is also done as an outpatient.
Risks associated with breast reconstruction may include resulting asymmetries in the breast which could require subsequent surgeries to address. Other breast reconstruction surgery risks may vary depending on the specific procedure performed. In tissue expander reconstruction, infection is possible. Breast reconstruction patients who receive a latissimus flap reconstruction could experience fluid collection; TRAM flap reconstruction patients may be susceptible to abdominal bulge or hernia. Flap reconstructions can cause muscle weakness that may be noticeable to very athletic breast reconstruction patients; in particular, some TRAM flap reconstruction recipients may experience loss of abdominal strength.
Depending on the type of breast reconstruction received, patients can expect to leave the hospital one to six days after surgery. Tissue expander breast reconstruction recipients may expect a two-to-four week recovery period, while latissimus flap patients may recover in four weeks, and TRAM flap patients may have a six-week recovery time. All breast reconstruction recipients should refrain from vigorous sports, heavy lifting, or sexual activity during their recoveries. Breast reconstruction does not restore feeling in the reconstructed breast, though some may return. Bruising and swelling may occur as a result of breast reconstruction but will subside within two months. Breast reconstruction patients should continue to perform monthly manual self-breast exams to check for potentially cancerous lumps in the breast.