Breast reconstruction is surgery to rebuild a breast after the breast has been removed for treatment of cancer. A plastic surgeon uses a balloonlike expander and a silicone implant or your own body tissue to rebuild the breast. The implant may be a silicone shell filled with saline (saltwater) or silicone gel. Or your surgeon may use tissue from other parts of your body to reconstruct the breast.
You may choose to have your breast rebuilt after you have had a mastectomy to remove your breast. Breast reconstruction may be started when you have the mastectomy or at any time afterwards. You may need 2 or 3 operations before the reconstruction is complete.
You may accept your changed appearance and choose not to have the operation to reconstruct the breast. Or you may decide to wear a breast form (also called a prosthesis) inside your bra. You should ask your healthcare provider about your choices.
There are many support groups for women who have had mastectomies. These support groups are usually made up of former cancer patients. Contacting one of these groups can help you learn what to expect from the surgery and give you emotional support.
Talk to your provider about the size and shape of breast you would like to have. Silicone implant reconstruction and tissue reconstruction produce different results. You may need surgery on the other breast to give the best match in size and shape. Ask your surgeon about this.
Plan for your care and recovery after the operation. Find someone to drive you home after the surgery and stay with you for a night or two. Allow for time to rest and try to find other people to help you with your day-to-day duties.
Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. This is especially important if you choose to have reconstruction using tissue from another part of your body.
If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery. Don’t take other nonprescription medicines that contain aspirin in the week before surgery.
Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.
You are given a general anesthetic. A general anesthetic relaxes your muscles, puts you to sleep, and keeps you from feeling pain.
The surgeon puts a balloonlike expander under your skin and chest muscles in the area where your breast was removed. The expander is inflated with saline to stretch the skin. More saline is injected into the expander every few weeks. The stretching takes many weeks, depending on how much skin there is and how much it needs to be stretched.
When the skin has stretched to the right size, you will have the next operation. You will be given an anesthetic and then the surgeon may replace the expander with an implant under your skin. The implant is a shaped silicone bag filled with saline or silicone gel.
Or, instead of an implant, you and your surgeon may decide to use tissue from your belly or back to reconstruct the breast. Skin from the lower belly or back with the attached muscle is moved to the chest, and blood vessels are attached to the skin and muscle under the arm. This is a more complicated procedure than implant reconstruction but may give a better cosmetic result. Talk with your surgeon about which procedure would be best for you.
As the final step, the surgeon may reconstruct the nipple and areola (the dark patch of skin around the nipple). The surgeon may use tissue from the reconstructed breast or a graft of skin from your underarm or groin. Sometimes tattooing is done instead of or in addition to the tissue graft.
You may be in the hospital for 24 hours if you have an expander placed under your skin. If a tissue flap is used to rebuild your breast, you may be in the hospital several days.
You will have drainage tubes through your skin for a few days after surgery. The tubes remove fluid from the area where you had surgery. Your surgeon will tell you how to care for these drains and arrange for you to come to the office for their removal. You will also get instructions for caring for your wound.
Most surgeons have specific preferences about bandages, and many have a special bra for use after reconstruction surgery.
Your surgeon will give you medicine for pain when you leave the hospital. Usually a nonsteroidal anti-inflammatory medicine (NSAID), such as ibuprofen, will relieve most of the pain. NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.
A prescription drug, such as codeine, may be used for more severe pain.
Take the anti-inflammatory medicine even if you do not have pain for the first day or two. Use the codeine at the first sign of pain not relieved by the anti-inflammatory drug. It is easier to prevent pain with pain medicine than to relieve it once it gets severe.
If you were regularly taking estrogen hormone medicine before the surgery, ask if you should keep taking it after the surgery. Estrogen is usually stopped after breast cancer surgery, and often an anti-estrogen medicine is prescribed. Ask about this and all other medicines that you were taking before surgery. Find out if or when you should start taking them again.
It’s common to feel tired and sore for up to 2 weeks after surgery. You can do light activity within a few days after surgery. You should avoid overhead lifting, strenuous sports, and sexual activity for 3 to 6 weeks.
It is especially important to follow your healthcare provider's instructions about activity if your reconstruction was done with the tissue transfer method. Avoid tight clothing, such as a regular bra. Tight clothes might reduce blood supply to the surgery area. Check with your healthcare provider before choosing a bra.
You can go back to your regular diet as soon as you wish. A healthy diet with plenty of fruits, vegetables, and extra fluids will help you heal and help avoid constipation. Constipation is common after surgery, especially when a narcotic, such as codeine, is needed for pain relief. If diet and extra fluids are not enough to avoid constipation, then a nonprescription laxative may be used. Check with your healthcare provider if constipation keeps being a problem.
In addition to the scar from the removal of the breast, you will have a scar on your back or abdomen if skin and muscle tissues were taken from these areas. Scarring is permanent, but in time, the scars are less noticeable as they flatten and lighten in color. Reconstruction cannot restore normal sensation to the breast, but sometimes some feeling does return.
When you have completely recovered from surgery, you should have regular checkups, including yearly mammograms of your other breast, to look for any recurrence of breast cancer.
Ask your healthcare provider what steps you should take and when you should come back for checkups.
You will have a more normal figure. This may help you feel better about yourself after removal of your breast.
Risks of breast reconstruction include:
There have been some special concerns about the safety of implants filled with silicone gel. After rigorous scientific review, the US Food and Drug Administration (FDA) determined that the implants are safe and effective for breast reconstruction in women of any age. For more information on breast implants and their safety, see the FDA Web site: http://www.fda.gov/cdrh/breastimplants/index.html.
You should ask your provider how the risks apply to you.
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