Detailed Procedure Information

Breast reconstruction encompasses a range of surgical techniques designed to restore the shape and appearance of the breast following partial or complete removal due to cancer treatments such as mastectomy or lumpectomy. This reconstructive process can help patients regain symmetry, confidence, and a sense of wholeness after breast cancer surgery.

Why Consider Breast Reconstruction Surgery?

If you have undergone or are about to undergo mastectomy or lumpectomy, breast reconstruction may be an important step in your healing journey. It’s vital to consult with a qualified aesthetic plastic surgeon before your cancer surgery, as the cancer treatment approach directly influences reconstruction possibilities.

• Restores the natural contour and symmetry of your breasts.
• Improves self-esteem and body image.
• Eliminates the need for external prostheses or breast forms.
• Offers comfort in clothing and swimwear.
• Helps reduce reminders of breast cancer and surgical procedures.

Factors to Consider Before Undergoing Reconstruction

• Reconstruction involves additional surgeries and recovery periods.
• Your overall health, including cardiovascular status and blood circulation, impacts outcomes.
• A history of smoking or immune disorders can increase complication risks.
• Previous or planned radiation and chemotherapy affect timing and techniques.
• Reconstructed breasts generally have reduced or altered sensation compared to natural breasts.

Discuss your tailored options thoroughly with your surgeon to understand potential risks and expected results.

Selecting a Surgeon

Choosing the right surgeon for breast reconstruction is a critical step in your treatment plan. Look for a surgeon who is board-certified in plastic surgery, has extensive experience in breast reconstruction, and whose aesthetic sensibilities align with your expectations.

Key Factors to Evaluate Your Surgeon

• Proper qualifications, certifications, and training.
• Specialized experience in reconstructive breast surgery.
• Access and willingness to provide before-and-after photographs.
• Your comfort and communication with the surgeon.
• Membership in professional bodies such as The Aesthetic Society.

During your consultation, expect a comprehensive evaluation where the surgeon will review your medical history, cancer treatment plans, and aesthetic goals. They will assess your breast tissue, skin quality, and overall health to recommend the best reconstruction approach. Don’t hesitate to ask questions about the procedure, recovery, risks, expected outcomes, and costs.

If you require assistance in locating a certified and experienced breast reconstructive surgeon, our clinic can provide resources and referrals tailored to your needs.

Preparing for your Procedure

Proper preparation before your breast reconstruction surgery greatly impacts the quality of your experience and outcomes. Your surgeon will provide personalized instructions, but below are general recommendations to help you prepare physically and mentally.

Preoperative Preparation

• Complete any pre-surgical tests such as blood work, chest X-rays, or ECGs as instructed.
• Cease smoking well in advance to promote optimal healing and reduce complications.
• Avoid medications and supplements that increase bleeding risks, including aspirin, anti-inflammatories, and certain herbs.
• Stay adequately hydrated before and after surgery.

Recovery Planning

Arrange for support at home during your recovery. Non-strenuous activities such as meal preparation and assistance with household responsibilities will facilitate your healing and reduce stress.

Home Setup Recommendations

• Prepare your living area for easy access to necessities, minimizing the need to bend or reach.
• Stock up on soft, comfortable, and loose-fitting clothing that opens in the front or buttons easily.
• Create a comfortable resting space with pillows to support your back, legs, and arms.
• Designate a convenient spot for drains, medications, and personal items to be within reach.

Day of Surgery Expectations

• Your procedure will take place in a licensed surgical facility, employing monitoring and anesthesia administered by qualified professionals.
• Surgery duration typically ranges between two and six hours, depending on the method chosen.
• General anesthesia is standard, though intravenous sedation or local anesthesia may be options in select cases.
• After surgery, you will be cared for in a recovery area until awakening and stabilization.

Your surgeon will communicate all necessary preoperative details and what to expect immediately after the procedure to help you feel confident going into surgery.

Aftercare & Recovery

The recovery process following breast reconstruction varies with the chosen technique. Implant-based reconstruction tends to have a shorter and less painful recovery, whereas flap procedures can require more intensive healing due to multiple surgical sites.

Typical Recovery Timeline

• Implant-based patients often resume most daily activities within two to three weeks.
• Flap-based reconstruction patients may require longer recovery depending on the extent and donor site involvement.

Your surgeon will provide instructions about managing drains, recognizing symptoms, medication schedules, and activity limitations.

What to Expect During Recovery

• Initial grogginess and fatigue as anesthesia effects wear off.
• Localized swelling, redness, and some pain controlled with prescribed medications.
• Temporary use of compression garments and drainage tubes to facilitate healing and reduce swelling.
• Gradual return to arm movement aided by prescribed exercises to restore range of motion.
• Regular follow-up appointments to monitor healing, drain removal, and scar management.

Special Considerations for Flap Reconstruction

• Longer hospital stay may be necessary.
• Restricted lifting and strenuous activity, often for several weeks.
• Soreness at the donor site and the reconstructed breast is normal but temporary.

Close coordination with your surgeon and adherence to recovery guidelines will promote the best outcome and minimize complications.

Results

Breast reconstruction aims to restore the natural appearance and feel of the breast, which can profoundly impact emotional and physical well-being.

Longevity of Reconstruction Results

Implant reconstructions typically provide durable results; however, implants may require replacement over time due to aging, rupture, or shifting. Autologous tissue reconstructions from flaps age naturally relative to the donor site tissue and may change over time with weight fluctuations and gravity.

• Implant-based reconstruction usually maintains shape well but may differ from natural breasts in feel and mobility.
• Flap reconstruction offers a more natural texture, though donor site scars and contour changes may be present.
• Fat grafting can augment shape and symmetry but may need repeat sessions for maintained volume.

Regular follow-up with your surgeon is essential to address any concerns and to maintain optimal aesthetic results over time.

Incisions and Scars

Scarring is an inevitable part of breast reconstruction, but surgical techniques aim to minimize visible marks and optimize aesthetic outcomes. The extent of scarring depends on the type of procedure, incision placement, healing characteristics, and surgeon skill.

Common Scar Locations

• Inframammary fold (under the breast) to conceal implant-based surgery incisions.
• Around the areola when skin-sparing or nipple-sparing mastectomies are performed.
• Donor sites for flap procedures, such as the abdomen, back, or buttocks.

Some patients have long incisions on the chest due to the mastectomy itself. When reconstruction is immediate, surgeons often preserve as much breast skin as possible to reduce scar size and improve implant or flap coverage.

Scar Management Tips

• Keep scars moisturized using recommended ointments or silicone gel sheets.
• Perform gentle scar massage as directed to improve texture and flexibility.
• Avoid excessive sun exposure to scars to prevent discoloration.
• Consult your surgeon about treatments for stubborn or hypertrophic scars, including revision surgery or laser therapy.

Although scars fade and become less conspicuous over time, they will not disappear completely.

Safety Considerations

Breast reconstruction surgery has a strong safety profile when performed by an experienced board-certified plastic surgeon, but like all surgeries, it carries some risks.

General Surgical Risks

• Reactions to anesthesia.
• Infection or bleeding.
• Fluid accumulation beneath the skin (seroma) or blood pooling (hematoma).
• Changes in sensation or numbness.
• Formation of scar tissue or poor wound healing.

Specific Risks Related to Breast Reconstruction Include:

• Fat necrosis or cyst formation in flap reconstructions.
• Blood clots in legs or lungs.
• Partial or total tissue flap loss, especially in flap surgeries.
• Complications at donor sites such as hernia or delayed healing.
• Implant complications including rupture, displacement, or capsular contracture.

Some concerns have been raised regarding breast implants and rare lymphomas (Breast Implant-Associated Anaplastic Large Cell Lymphoma – BIA-ALCL). It remains a very rare condition, and the risk is significantly outweighed by the benefits of reconstruction. Your surgeon will discuss the latest safety information with you to assist in an informed decision.

Following your surgeon’s pre- and postoperative instructions carefully minimizes complication risks and enhances safety.

Associated Costs

Breast reconstruction can be financially supported by insurance for qualifying patients, particularly those recovering from breast cancer surgery. US federal law mandates insurance coverage for breast reconstruction following medically necessary mastectomies.

Insurance and Coverage Details

• Most insurance plans must cover reconstruction post-cancer diagnosis.
• Preventive mastectomy for high-risk patients, such as those with BRCA gene mutations, often qualifies for coverage.
• Reconstructive procedures unrelated to cancer typically are not covered insurance benefits.

Cost Factors

Reconstruction expenses vary depending on several factors:

• Type of reconstruction (implant-based, ADM-assisted, or flap surgery).
• Geographic location and provider fees.
• Extent of surgery (unilateral vs. bilateral).

The order of costs typically ranges from least to most expensive as:

• Implant-based reconstruction
• Implant reconstruction combined with acellular dermal matrix
• Tissue flap reconstruction using your own natural tissue

During your consultation, your surgeon will provide a comprehensive breakdown of expected costs and discuss financing options if needed. Remember, surgical expertise and quality care should be prioritized over cost when making your decision.