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Breast Reconstruction After Mastectomy Review

Published by Dr. Brandon Richland, MD

“Every health professional that has seen my mastectomy and breast reconstruction performed by Dr Richland is shocked by how great it looks. They all say it is literally the best they’ve ever seen. He is literally a miracle worker. He takes time with you and listens to you. Most importantly, he does exactly what you want done. Dr Richland is AMAZING!!!”

Read the full Google Review here.

Understanding Breast Reconstruction

Breast reconstruction is a significant procedure for individuals undergoing mastectomy, offering restoration of the breast’s shape and appearance. It involves careful consideration of timing and methods.

Breast Reconstruction Overview

Breast reconstruction surgery aims to restore the form and look of breasts after a mastectomy, which is often performed as part of breast cancer treatment. Two primary types of reconstruction prevail: implant-based reconstruction (IBR) and autologous reconstruction (AR). IBR uses silicone or saline implants to recreate the breast mound, while AR uses the patient’s own tissue, frequently from the abdomen or back, to rebuild the breast.

Multiple factors influence the choice between IBR and AR, such as the patient’s body type, health status, and personal preferences. Breast surgeons are instrumental in discussing these options, taking into account the patient’s cancer treatment plan and any potential impacts on the reconstruction outcome.

Reconstruction Timing: Immediate Vs Delayed

The timing of breast reconstruction is subdivided into two categories: immediate reconstruction and delayed reconstruction.

  1. Immediate Reconstruction: Performed at the same time as the mastectomy. Many patients choose this option to avoid the experience of losing their breast shape and to reduce the number of surgeries. Screening for surgical risk factors, like smoking or being overweight, is critical before proceeding.
  2. Delayed Reconstruction: Conducted at a later date, sometimes after other cancer treatments have been completed. This option can be suitable for patients who need additional treatments such as chemotherapy or radiation therapy, which could affect the integrity of the reconstructed breast.

Each patient’s journey is unique, and the decision on the timing of breast reconstruction is made in consultation with the breast surgeon, considering the individual’s personal circumstances and medical requirements.

Reconstruction Techniques

Breast reconstruction after mastectomy offers several techniques, allowing patients to choose an option that best suits their individual circumstances.

Implant-Based Reconstruction

Implant-based reconstruction involves the use of breast implants to recreate the breast mound. This category typically includes two types of implants: silicone implants and saline implants. Initially, a tissue expander may be placed beneath the skin and chest muscle, gradually stretching the area to accommodate the final implant. Some techniques may also use an acellular dermal matrix to support the implant and create a more natural-looking breast shape.

Risks associated with implant-based reconstruction can include capsular contracture, where scar tissue tightly forms around the implant, or complications such as seroma (fluid accumulation), hematoma (blood pooling), and tissue death.

Autologous Tissue Reconstruction

Autologous tissue reconstruction is a technique that utilizes the patient’s own tissue, usually from the abdomen, back, thighs, or buttocks, to reconstruct the breast. Unlike implants, this approach may result in a more natural look and feel, as it uses the body’s own fat and skin, minimizing foreign-body reaction risks.

Flap Reconstruction Procedures

Flap reconstruction encompasses several procedures that use the patient’s own tissue to form a new breast.

  • DIEP flap: this involves transferring skin, fat, and blood vessels from the lower abdomen to the chest. It preserves abdominal muscles, potentially reducing recovery time and preserving abdominal strength.
  • TRAM flap: similar to the DIEP flap but includes abdominal muscle, which can lead to a longer recovery and possibly affect the abdominal wall strength.
  • Latissimus Dorsi (LD) flap: involves moving tissue from the upper back when there is insufficient abdominal tissue, or to supplement other reconstruction methods.

Flap procedures carry the risk of complications like seroma or hematoma, as well as the possibility of tissue death in the transferred flap.

Reconstructive Surgery Considerations

When considering breast reconstruction after mastectomy, patients need to evaluate various factors, encompassing candidacy for surgery, potential risks and complications, and setting realistic expectations for the outcomes.

Determining Candidacy for Surgery

Candidates for breast reconstruction typically undergo a thorough physical exam by a plastic surgeon to assess their health status and the viability of reconstructive options. Factors such as skin quality, available muscle and tissue, and the overall health of the patient play a crucial role in determining suitability for surgery. Some may require a tissue expander to prepare the area before constructing the reconstructed breast. Prospective patients are encouraged to seek a second opinion to confirm their options and readiness for the procedure.

Risk Factors and Complications

Surgery always carries risks, including the risk of anesthesia, infection, and blood clots. Specific to breast reconstruction, patients must consider the possibility of scar tissue formation, risk of complications such as implant failure or flap necrosis, and the ability of the body to heal properly. Surgical risk factors such as smoking or being overweight can significantly affect the recovery process and outcomes. It is important to discuss these with the plastic surgeon and to understand the side effects that may arise post-surgery.

Managing Expectations and Outcome

It is vital for patients to have realistic expectations about the surgery and the appearance of the reconstructed breast. The reconstructed breast may not have the same sensation or feel as the original breast, and there will be some degree of visible scar tissue. The goal of the plastic surgeon is to create a breast that looks balanced when clothed and to improve the patient’s body image. Recovery time can vary, and full recovery may take from several weeks to months. Patients should have a detailed discussion with their surgeon about the expected outcome and any post-operative side effects that may impact their quality of life.

Post-Surgical Recovery and Care

The recovery period following breast reconstruction surgery is a critical phase where patients aim for healing while managing comfort and addressing any complications.

Recovery Timeline and Healing Process

After breast reconstruction surgery, patients typically experience a hospital stay that can last from one to several days, depending on the type of reconstruction and the patient’s overall health. Swelling, bruising, and discomfort are common initially but generally improve within a few weeks. Fluid build-up in the breast or donor site, often accompanied by pain, is another potential aftermath to be monitored closely during this time.

  • Immediate postoperative period: Vital signs are closely monitored.
  • First few weeks: Dressings or bandages will be applied to the incision sites, and any drainage tubes will be monitored and eventually removed.

Loss of sensation in the reconstructed breast is common, and the return of sensation, if it occurs, may take months or even years. Scars are inevitable but will fade considerably over time.

Resuming Normal Activities and Lifestyle

The path back to normalcy varies for each individual. Usually, patients may:

  • Start light activities: within a few days post-surgery, as advised by the healthcare provider.
  • Return to normal activities: often after several weeks, with complete recovery usually taking place over several months.

Patients are advised to avoid strenuous activities, heavy lifting, and certain exercises until cleared by their surgeon. Long-term, patients can expect to return to their previous lifestyle, with possible recommendations for specific follow-up procedures, such as nipple reconstruction or areola tattooing, if desired. It’s vital to keep all follow-up appointments to ensure proper healing and address any concerns regarding surgical complications or recovery time.

Schedule Your First-Class Cosmetic Consultation with Dr. Brandon Richland, MD

Contact Dr. Richland today by visiting RichlandMD.com, scheduling a cosmetic consultation, or by calling 714-844-0398 or 949-997-2958 directly.

Cover Image Illustration by: Dr. Brandon Richland, MD