Breast Reconstruction
Definition |
Body Parts Involved |
Reasons for Procedure |
Complications |
What to Expect |
Outcome |
Call Doctor If
Definition
Plastic surgery to rebuild a breast, usually done after a mastectomy (removal of the breast) has been performed to treat cancer. Reconstruction is often done in several stages. The first stage may be done at the time of mastectomy (immediate reconstruction) or at some point in time after mastectomy (delayed reconstruction).
Parts of the Body Involved
- Breast
- Sometimes muscles and/or skin flaps from abdomen, chest, or back
- Sometimes skin grafts from inner thigh and/or armpit
Reasons for Procedure
To rebuild a natural-appearing breast after a breast has been removed to treat cancer
Risk Factors for Complications during the Procedure
- Obesity
- Smoking
- Bleeding disorder
- Malnutrition
- Chronic illness or debilitation
What to Expect
Prior to Procedure
Your doctor will likely do the following:
- Physical exam
- Blood tests
- Electrocardiogram (ECG, EKG) – a test that records the heart's activity by measuring electrical currents through the heart muscle
- Mammogram
In the days leading up to your procedure:
- Arrange for a ride to and from the procedure
- Arrange for help at home after the procedure
- The night before, eat a light meal and do not eat or drink anything after midnight
- You may be asked to shower the morning of your procedure, and you may be given special antibacterial soap to use
During Procedure - IV fluids, sedation, anesthesia
Anesthesia - General
Description of the Procedure - The simplest form of reconstruction can be done at the time of mastectomy if there is enough skin left on the chest wall. A small pouch is slipped under the skin, and the skin is closed. The pouch can then be filled with a saline (salt water) solution. Over weeks, more saline is gradually put into the pouch via a needle, and the skin overlying the pouch slowly expands as the pouch grows in size. This apparatus is called a "tissue expander." Some surgeons leave this expander in place as the actual prosthesis, while others will replace the tissue expander with a saline breast implant. This replacement requires surgery.
Still another surgery may be necessary to add tissue to take the place of the nipple and areola. The skin for this purpose is usually removed from the inner thigh, and proper pigmentation is achieved through tattooing.
Other, more complicated types of breast reconstruction involve using muscle and skin flaps from the abdomen or back.
After Procedure - If you have a tissue expander, you'll need to have additional saline added gradually according to a schedule set by your surgeon.
How Long Will It Take? 2-3 hours after mastectomy for the breast reconstruction
Will It Hurt? Anesthesia prevents pain during surgery. You will experience pain after the surgery and during the healing process, but you'll be given pain medication to help relieve this pain.
Possible Complications:
- Bleeding
- Infection
- Implant may harden
- Abnormal scarring
- Painful and/or restricted arm and shoulder motion
- Uneven appearance to breasts, either due to position or size
- If silicone implants are used, the implant may harden, rupture, or leak
- Some studies have suggested that silicone implants can cause autoimmune reactions in susceptible people, resulting in arthritis, lupus, or scleroderma
- Presence of an implant may make cancer detection (through mammogram and/or self-exam) more difficult
- Newly reconstructed breast will not have nerve sensation
Average Hospital Stay - About a week when performed in conjunction with mastectomy
Postoperative Care:
Managing pain and nausea. You might require anti-nausea and pain medications. You may be nauseated for a few hours after surgery, and may not be able to eat normally. Therefore, you may continue to receive fluids and sugar through an IV. For several days after surgery, you may need to eat a lighter, blander diet than usual.
Preventing blood clots. You may be given special compression stockings to wear after surgery, to decrease the possibility of blood clots forming in your legs.
Improving lung function. You may be asked to use an incentive spirometer, to breathe deeply, and to cough frequently, in order to improve lung function after general anesthesia.
Outcome
The reconstructed breast will appear somewhat normal, although there may be some asymmetry between the newly reconstructed breast and the other, natural breast. Some women want improved symmetry, and therefore undergo further surgery on one or both breasts to achieve this.
Call Your Doctor If Any of the Following Occurs
- Redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site
- Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
- Signs of infection, including fever and chills
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Your implants grow hard, or you believe that they are leaking
- Joint pain, fatigue, stiffness, rash, or other new symptoms
- Pain and/or swelling in your feet, calves, or legs, sudden shortness of breath or chest pain
SOURCE:
Textbook of Surgery, 15th ed. W. B. Saunders Co, 1997.
Last reviewed February 2001 by Medical Review Board
