Breast Reconstruction
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What is Breast Reconstruction Surgery?
If your breast cancer treatment involves partial or total removal of one or both breasts, reconstructive surgery can help restore their look and shape. Breast reconstruction can also help boost your confidence and return a sense of normalcy after treatment.
Types of Breast Reconstruction
Several types of reconstruction surgery are available to rebuild breasts and breast structures following mastectomy or lumpectomy. Your Mercy doctor will help you find out what’s right for you. There are two main types of breast reconstruction surgery.
The two main types of breast reconstruction surgery include:
- Implants or prosthetics – Breasts can be rebuilt using silicone or saline implants which are inserted underneath the skin or chest muscle following a mastectomy.
- Autologous tissue reconstruction (or flap surgery) – Breasts can also be rebuilt using autologous tissue, tissue from other parts of your body.
Implants and autologous tissue may be used together in breast reconstruction. In the final stage, a nipple and areola can be recreated if they weren’t preserved during the mastectomy.
Reconstructive surgery may be done at the time of your mastectomy or lumpectomy, which is known as immediate reconstruction. Or, you might need to wait until your other cancer treatments are finished, which is known as delayed reconstruction.
What to Consider with Breast Reconstruction
You and your Mercy doctor should discuss all breast reconstruction options. Factors that may affect the type of reconstructive surgery you receive include:
- Breast size and shape
- Availability of autologous tissue (your own tissue)
- Location and size of the tumor in the breast
- Age and health condition
- History of past surgeries
- Surgical risk factors like smoking and obesity
Radiation Therapy
If you need radiation therapy after your mastectomy or have medical conditions that impact healing, you may need to delay breast reconstruction.
Type of Breast Cancer
The type of breast cancer you have can also be a factor. Inflammatory breast cancer usually requires more extensive skin removal, which can make immediate reconstruction more challenging.
Your hospital stay after breast reconstruction surgery is generally two to five days. You’ll have drainage tubes in place to remove excess fluids from the surgical site, and your Mercy doctor will decide when it’s safe to remove them. You’ll also have stitches (sutures), but they’ll likely be absorbable and won’t need to be removed.
Be sure to give yourself plenty of time to heal. It can take six weeks or more to get back to your normal activities after breast reconstruction surgery.
Breast reconstruction can be a positive next step after breast cancer surgery. It brings balance back to your appearance, making you feel more confident in clothing and swimwear.
Scars
After surgery, your breasts will have scars, but they usually fade over time. If you have flap surgery, you’ll also have a scar at the site where the tissue was removed.
Additional Surgeries
Your new breasts will look different from your natural breasts and won’t have the same sensations. And you may need to have your nipple and areola reconstructed using skin grafts or 3D nipple tattooing.
If you had just one breast reconstructed, its size and shape might not match your opposite breast. You may be able to reduce, enlarge or lift your remaining breast to create an even look.
Minor revision surgeries such as fat grafting may also be required later.
A Patient’s View of Breast Reconstruction
Hear from breast cancer survivor Nicole Goodall, who received a double mastectomy, and her Mercy Clinic plastic surgeon, Louis Brunworth, MD. Experience Nicole’s path from breast reconstructive surgery to recovery.
Breast Reconstruction Options
If you’re thinking about breast reconstruction, it’s important to learn about the options and techniques available. Knowing your options can help you decide if breast reconstruction is right for you — in recovery and beyond.
Breast Reconstruction with Implants
Implants are devices filled with silicone or saline that help restore shape to your breasts after mastectomy. This type of breast reconstruction requires two or more surgeries and several visits after your initial surgery to prepare your body for the implants.
Surgery & Recovery
In the first stage of breast reconstruction with implants, a balloon-like tissue expander is placed under your skin or muscle. After you’re fully healed from this procedure, your Mercy surgeon injects saline into the tissue expander every week to stretch the skin or muscle.
In the second stage, the tissue expander is removed and replaced with a permanent breast implant.
Potential risks with implant surgery include:
- Bleeding
- Scarring that creates a hard tissue capsule (capsular contracture), resulting in pain or shape changes
- Reaction to anesthesia
- Rare risk of anaplastic large cell lymphoma, an immune system cancer
- Differences in breast size or appearance (asymmetry)
- Pain or changes in breast sensation
- Deflation or rupture of the implant
- Infection or problems with incisions healing
- Need for future surgery to remove the breast implant
You and your Mercy doctor should also discuss the following:
- If you have larger breasts, you may need reduction surgery on the opposite breast to create a more even look.
- If you’ve had radiation therapy to the chest, the skin and tissues needed for successful implant surgery may be affected.
Autologous Breast Reconstruction
In autologous (or flap) reconstruction, a tissue flap containing skin, fat, blood vessels and sometimes muscle is taken from another part of your body and used to rebuild the breast.
If you’re having flap reconstruction on only one of your breasts, your Mercy doctor may recommend genetic screening for breast cancer to find out if you’re at high risk of developing cancer in the opposite breast. If another breast reconstruction is needed later, surgical options are more limited because tissue can only be taken from the abdomen once.
Surgery & Recovery
Flaps used for breast reconstruction often come from your abdomen or back, but they can also be taken from your thighs or buttocks. Depending on their source, they’re either pedicle or free flaps.
With a pedicle flap, the flap stays connected to the body and is tunneled under the skin to the breast area. Since the blood supply remains connected, no microsurgery is required.
A free flap is disconnected from the body and blood supply, then moved to the breast area. Microsurgery is required to reconnect the blood supply.
Types of abdominal and back flaps include:
- DIEP flap – A free flap from the abdomen that contains skin, blood vessels and fat – but no muscle.
- Latissimus dorsi (LD) flap – A pedicled flap from the middle and side of the back.
- SIEA flap (also known as SIEP flap) – A free flap from the abdomen. It’s like a DIEP flap, but it includes a different set of blood vessels and doesn’t require cutting the abdominal muscle.
- TRAM flap – This flap can be either pedicled or free, comes from the lower abdomen and includes muscle.
Flaps from the thighs or buttocks are used if you don't have enough abdominal tissue to reconstruct a breast, or you’ve had major abdominal surgery. These types of flaps include:
- IGAP flap – Tissue comes from the buttocks and contains only skin, blood vessels and fat.
- PAP flap – Tissue comes from the upper thigh and doesn’t include muscle.
- SGAP flap – Tissue comes from the buttocks but includes a different set of blood vessels than used in an IGAP flap. The SGAP flap only contains skin, blood vessels and fat.
- TUG flap – Tissue comes from the upper part of the inner thigh and includes muscle.
Potential risks with autologous breast reconstruction include:
- Necrosis (or tissue death) of transferred tissue due to insufficient blood supply
- Infection or problems with wound healing
- Bleeding
- Seroma (fluid collection)
- Pain or changes in breast sensation
- Loss of sensation from tissue removal
- Reaction to anesthesia
- Differences in breast size or appearance (asymmetry)
You and your Mercy doctor should also discuss the following:
- If you need radiation therapy to the chest after breast reconstruction, it can create complications with flap surgery.
- Transplanted tissue needs an adequate blood supply to survive. If you smoke or have diabetes, vascular disease or connective tissue disorders, you’re at higher risk for complications with flap surgery.
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