- Immediate reconstruction is reconstructive surgery that is done at the same time as mastectomy.
- Delayed reconstruction can be done at anytime after mastectomy. This is especially advised for women who require radiation therapy after mastectomy.
The Stages of Breast Reconstruction - First stage includes creating a breast mound. This is done with an implant expander or your own tissues.
- Second stage includes proper shaping of the breast mound and making the breasts appear similar. This may require more than one operation and can also include surgery to the opposite breast.
- Third stage includes nipple reconstruction.
CREATION OF THE BREAST MOUND Implant Reconstruction There are two types of implants currently used for breast reconstruction, saline-filled implants and silicone gel-filled implants. The silicone gel implants were just recently re-approved for cosmetic use, but they have always been available for reconstructive use. Implants may be placed immediately at the time of mastectomy or your doctor may have to utilize a two-stage reconstruction. The two-stage reconstruction would require placement of a tissue expander at the time of mastectomy. You would then come in to the office to have your tissue expanders filled to your desired volume. When you and your surgeon are happy with the size, you would be taken back to the operating room to have the tissue expanders removed and implants (silicone or saline) placed. Please be aware that implants may not last a lifetime, and that you may need additional surgeries because of your implants. You may also have local complications such as rupture, pain, capsular contracture, infection, or an unpleasing cosmetic result.  | | Reprinted by the permission of the American Cancer Society, Inc. from www.cancer.org. All rights reserved. |
Latissimus Dorsi Flap Reconstruction This procedure moves muscle and skin from your upper back when extra tissue is needed to help cover an implant, this is especially important if you have radiation. The flap is made up of skin, fat, muscle and blood vessels. It is tunneled under the skin to the front of the chest. DIEP (deep inferior epigastric artery perforator flap) Reconstruction The DIEP is a flap procedure that uses the fat and skin from the lower abdominal area (below the belly button) to reconstruct the breast. The procedure is done as a free flap meaning the tissue is completely detached from the abdomen and then moved to the chest area. This requires the use of a microscope to connect the blood vessels in the abdominal tissue to the chest wall. The procedure lasts anywhere from 8-10 hours and is done with the assistance of another surgeon. This procedure is a muscles-sparing procedure compared to the TRAM pedicle flap. This is a staged procedure. The goal of the first stage is to transfer healthy tissue from the abdomen to the chest area. The next stage is typically a symmetry procedure to make the breasts look as similar to each other as possible. This can also include a breast reduction or lift. The third stage is typically the nipple reconstruction and any other touch up work that needs to be completed.  |  | Reprinted by the permission of the American Cancer Society, Inc. from www.cancer.org. All rights reserved. |
Nipple and Areola Reconstruction The decision to complete the final stage of reconstruction is entirely up to you. This is done with any type of reconstruction and is a simple outpatient procedure. It is typically done anywhere from 3 to 6 months after your surgery when the wounds are well healed. The nipple is reconstructed from your existing breast tissue and is considered a local flap. The areola will be tattooed in a clinic setting after the nipple has had time to heal. Risks of Reconstruction Surgery - Bleeding
- Fluid collection with swelling and pain
- Infection usually will occur within the first two weeks after surgery. If an implant becomes infected, it may need to be removed. A new implant can be inserted at a later time.
- Scarring
- Need for additional surgeries to correct problems
- Problems with anesthesia
- Tissue necrosis (death) of part of the flap. This can happen after DIEP reconstruction and will cause hard areas in the new breast. These areas will often soften with time.
- Consequences of smoking: The use of tobacco causes constriction of the blood vessels and reduces the supply of oxygen and nutrients to the tissue. This in turn will cause problems with wound healing. We will not offer breast reconstruction to patients who are actively smoking. We will require that you stop smoking prior to surgery, and your surgeon will test you for nicotine.
- Capsular Contracture: This is a common problem for patients after implant reconstruction. The rate of contracture increases after a patient has radiation. This can make the breast feel very hard and can be painful. The implant may need to be removed or replaced if this problem becomes severe.
After Breast Reconstruction Surgery Hospital Stay: - Delayed implant reconstruction is typically an outpatient procedure.
- Implant reconstruction at the time of mastectomy is typically a 2-3 day hospital stay.
- DIEP implant reconstruction usually requires a 4-5 day hospital stay. Patients will spend the first night in the recovery room for close monitoring, and after that patients will be moved to a regular hospital room.
Recovery: - Patients should be able to return to normal activity about 6 weeks after surgery.
- Reconstruction does not restore normal sensation to the breast or nipples, but some feeling may return with time. Patients will commonly have a protective sensation but that is all.
- It may take as long as 1 to 2 years for scars to completely mature, but the scars will never completely go away.
- Patients will want to avoid any overhead lifting, strenuous sports, or activity against resistance for 6 weeks following reconstruction.
- Patients may be placed in a surgical bra after surgery. We ask that you wear your bra 24 hours a day for the first 3-4 weeks, and then you can wear it only during the day for the last 2-3 weeks. We ask that you wear a 100% cotton sports bra-like bra (similar to surgical bra).
- If patients have elected to have DIEP reconstruction then they will go home from the hospital with drains (2 in the abdomen and 1 or 2 in the breast). Please strip the drains a few times a day and record the output. The nurses in the hospital will show you how to do this.
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