Reclaiming what was lost
Patients who have undergone lumpectomy or mastectomy due to breast cancer or for risk reduction may choose to have breast reconstruction to restore their appearance and confidence. While lumpectomy leaves a smaller breast deformity there are still options for reconstruction.
The two general options for reconstruction involve using an implant, or using your own tissue to recreate the breast. There are pros and cons to both methods and we will discuss these with you during your consultation.
Reconstruction and restoration
The timing of reconstruction has two terms, immediate and delayed. If your breast reconstruction occurs on the same day as your mastectomy this is an immediate reconstruction. If your reconstruction occurs at a date after your mastectomy, this is a delayed reconstruction. There are pros and cons of these approaches and we will be happy to discuss those with you.
If an implant based reconstruction is chosen a tissue expander will likely be placed first. This will sit in the breast pocket and over several weeks we will add saline to the device to expand your breast skin. Once that process has been completed you will return to the operating room and exchange the tissue expander for a permanent implant. The implant you choose may be saline or silicone.
When a surgeon moves your tissues from one part of the body to another that tissue is called a flap. If you choose to have your own tissue utilized for breast reconstruction there are different flaps (body tissue) that can be used. The two most common include the Latissimus dorsi muscle from your back and the skin/fat of your abdomen, named the Deep Inferior Epigastric artery Perforator flap (DIEP flap). If the Latissimus dorsi flap is used a tissue expander and later an implant is often placed deep to the flap to help augment the breast volume. If a DIEP flap is performed, implants are not usually placed as the abdomen usually allows adequate tissue volume to reconstruct a breast.
Nipple reconstruction can be performed but is not performed during your initial surgery to make sure your breast reconstruction has time to heal first.
What to expect after your procedure
Regardless of the reconstruction choice, drains will be placed and will be removed once the output is low enough.
In general an implant based reconstruction is a faster recovery and may or may not require a hospital stay depending on whether the reconstruction is immediate or delayed.
Flap reconstruction requires a hospital stay and the tissue will be monitored for appropriate blood flow. It is important that no compression is applied to the new breast reconstruction and no ice. This can decrease the blood flow in the new tissue and result in failure.
Some patients elect to have procedures performed months after their breast reconstruction. One common procedure is fat grafting to the breast which is harvested from the abdomen or thighs via liposuction. This helps increase volume in the breast and helps camouflage an implant further if needed.