WHAT IS BREAST RECONSTRUCTION SURGERY?
One in eight women is expected to develop breast cancer. Many of them have had a mastectomy, double mastectomy or radiation therapy during the course of their breast cancer treatment. For these patients, and for individuals who have sustained injury to the breasts or suffer from genetic breast defects, breast reconstruction surgery can be an effective means of recreating breasts that look and feel natural, and can help patients to see themselves as they were before their illness.
WHAT ARE THE OPTIONS FOR BREAST RECONSTRUCTION?
Patients undergoing breast reconstruction after mastectomy may elect to have their breast reconstruction performed at the same time as the mastectomy (immediate reconstruction), or months after the mastectomy (delayed reconstruction).
There are a number of techniques that can be utilized during breast reconstruction surgery. There are three different categories of breast reconstruction:
- Implant based breast reconstruction
- Flap based breast reconstruction
- Combined implant and flap breast reconstruction.
WHAT IS IMPLANT-BASED BREAST RECONSTRUCTION?
Implant based breast reconstruction can involve two different options. The first includes a two-step reconstruction involving placement of breast expanders in the breast defect to be able to stretch the tissue with gradual fillings, which are typically done on a weekly basis in an office setting. A second surgery is performed once the desired expansion has been complete, to replace the expanders with more long-term breast implants that are typically silicone gel implants.
Another option is a direct to implant breast reconstruction with no pre-expansion. Dr. Sinno’s goal will be to help you understand your options in order to make an informed decision for your implant breast reconstruction.
WHAT IS FLAP-BASED BREAST RECONSTRUCTION?
Flap based breast reconstruction in North America generally includes the DIEP (deep inferio epigastric perforator) flap and the TRAM (transverse rectus abdominus myocutaneous) flap procedures. Surgical flap techniques are often employed when patients are not left with sufficient breast tissue to support a breast implant after mastectomy or radiation therapy. During a flap procedure, the patient’s own skin, fat and/or muscle (one’s own tissue or “autologous tissue” is typically taken from a donor site in the abdomen) are repositioned to cover and/or create the breast mound.
WHAT IS COMBINED IMPLANT AND FLAP BREAST RECONSTRUCTION?
Combined implant and flap breast reconstruction is a third option that can involve using the back muscle (latissimius dorsi) coupled with an implant to help achieve the desired breast reconstruction.
After assessing your clinical situation, anatomy and personal preferences, Dr. Sinno will choose the reconstruction technique best suited to your unique medical needs and the fulfillment of your surgical goals.
The duration of your post-surgical recovery period will depend upon the specific surgical techniques employed during your procedure and your body’s unique capacity to heal itself.
Do I have to stay overnight after implant based breast reconstruction?
Implant based breast reconstruction surgery generally takes one to two hours, after which, you may be released (depending on your medical condition and health state) to a friend or family member and may return home to continue your recovery. If the breast reconstruction is performed on the same day as the mastectomy, your general surgeon may decide to keep you overnight.
When do the bandages of breast reconstruction have to be removed?
Dr. Sinno and his team will apply a special dressing and initial bandages that should be kept dry and clean for the first week. At that point, the bandages will be removed and your post-operative state will be evaluated.
Wearing bras should be avoided until the first bandages are removed. Bras with metal underwire should be avoided for six weeks after surgery.
Surgical drains are usually placed in the reconstructed breast after implant-based reconstruction. This can be essential to drain extra fluid accumulation and seromas. The surgical team and nursing staff will typically provide you with post-operative drain teaching. You will also have appropriate follow-up as an outpatient for your drain maintenance and drain removal. Surgical drains are typically removed when there is less than 20-30 cc draining per drain per 24 hours for three consecutive days.
When can I shower after implant based breast reconstruction?
The bandages usually are removed within a week after surgery. Dr. Sinno recommends that all bandages should remain dry and clean after your surgery until your first follow-up appointment. Showers should be avoided until authorized by Dr. Sinno. This is usually after all the bandages are removed at the first port-operative visit. Until then, sponge baths are recommended.
White non-scented shampoo and soap are recommended to be used along with running water on the incisions, after the bandages are removed and when given medical authorization to do so.
When can I exercise after implant based breast reconstruction?
You will be advised to refrain from moving your arms above your shoulders immediately following your breast reconstruction procedure. This is usually advised for a two-week duration.
Dr. Sinno recommends that patients refrain from all activities that may increase their heart rate or blood pressure including exercise, sexual activity, stressful situations, etc. in the first week after surgery.
However, it is recommended that patients walk and perform their usual activities within the limitation of the medical advice given and their tolerance for their comfort. No lifting more than 10 lbs. (4 kg) is recommended for at least two weeks after the surgery.
Sleeping on your stomach should be avoided for at least two weeks after surgery.
When can I drive after implant based breast reconstruction?
Patients are recommended not to drive when taking narcotic pain medications and when having bulky dressings that may hinder their normal reflexes and reactivity.
You may experience some swelling and bruising that will peak two to three days after your surgery, and usually subsides within two to six weeks. Post-operative swelling, pain, bruising and duration may differ, depending on the patient and the extent of the breast lift.
In the case of expander breast reconstruction, you will be expected to be able to start your expander filling in the clinic after your two weeks post-operative date.
In the case of direct to implant reconstructions, swelling can take six weeks to subside. Dr. Sinno advises his patients that final results should be expected at the one year point post-operative period, when all scars and incisions should be mature along with the implant pocket placement.
Depending on the type of your autologous flap breast reconstruction, you will likely have to stay a few days in the hospital. Dr. Sinno and his team will provide you with a comfortable and safe post-operative environment. They will also help you to understand the details of your recovery.
All medical and surgical procedures have inherent risks and potential complications associated with them. It is imperative that you understand the potential risks, complications and consequences that can arise after the medical or surgical procedure you undertake. This understanding will better allow you to be able to provide informed consent, based on the comparison to the potential benefit of the desired procedure.
Although the materialization of inherent risks is rare and developing complications is unlikely, these are real events that can occur. Dr. Sinno will help you to understand the risk/benefit profile of your desired procedure.
HOW MUCH DOES A BREAST RECONSTRUCTION COST?
A breast reconstruction procedure is highly tailored and the price is determined upon consultation.