Plastic Surgery Blog

November 8th, 2017

Breast Reconstruction Frequently Asked Questions

If you have undergone a mastectomy or lumpectomy, or you are scheduled to have one in the near future, then you should be aware that there are a number of breast reconstruction options available. These procedures can restore your breasts to the size and shape they were prior to your cancer diagnosis. Here’s what you need to know before booking a consultation:

  1. Can I have mastectomy/lumpectomy and breast reconstruction at the same time?

In many cases, yes, this is possible. This procedure is known as Immediate Breast Reconstruction, and women often prefer this option because it’s more convenient. However, some women are not good candidates for Immediate Breast Reconstruction. Your overall health, the stage of your cancer, and the amount of available tissue you have all factor into whether or not you can combine mastectomy/lumpectomy and breast reconstruction. You will need to talk to your physician to determine your options.

  1. What types of breast reconstruction surgery are available?

The two main types of breast reconstruction surgery are implant reconstruction (where a conventional breast implant filled with gel or saline is placed into the breast pocket, restoring fullness) and autologous or “flap” reconstruction. Flap reconstruction involves removing tissue from another part of the body (usually the abdomen or thighs) and transferring it to the breast. Note that these two procedures are sometimes combined when the patient has had a lot of breast tissue removed, but this is rarely necessary.

  1. Which is better, implant or flap breast reconstruction?

Both procedures have advantages and disadvantages, so the answer to this question will depend on your personal needs and preferences. Flap breast reconstruction produces the most natural looking and feeling results, but it’s a larger operation. Because it involves two areas of the body rather than just one, flap reconstruction requires a longer hospital stay and the initial recovery period is longer. You will be in the hospital for three to four days rather than the one day needed for implant reconstruction. You will then spend four weeks recovering, as compared to one to two weeks. There is also the potential for more scarring with this procedure.

Implant surgery is easier to perform than flap reconstruction, but most patients report that even gel implants don’t feel exactly like natural breast tissue (though they are a close match). Likewise, while the initial healing period is shorter after implant surgery, you may need revision surgery later in life if you choose this option. While modern gel implants are fairly robust, there is a possibility of rupture after five to ten years. Finally, many women need to have tissue expansion performed before their implant can be placed. This is a time-consuming process that takes place over multiple (outpatient) appointments: First, a surgeon will place a specialized tissue expander implant into the breast cavity (usually immediately after mastectomy or lumpectomy). Then the patient will return 3-4 weeks later and have a bit more saline added to the expander implant. This action will be repeated weekly as needed, until the breast is ready for the insertion of the final (gel or saline) implant.

  1. Is breast reconstruction medically necessary?

No, this procedure is purely elective, so if you don’t want to go through another surgery, don’t feel like you must. However, most women find that they benefit psychologically from having breast reconstruction surgery. Not only can breast reconstruction help a woman feel more confident and feminine, it erases visual reminders of her cancer experience. Women who opt for breast reconstruction may therefore be better able to put cancer in the past and move on with their lives.

  1. Can I have my nipples reconstructed, too?

Yes. You should be aware, however, that nipple reconstruction is usually done as a second procedure (if the patient’s original nipple cannot be preserved during mastectomy/lumpectomy). You will therefore have to wait between two to three months before having your nipple reconstructed. Nipple reconstruction is done using a portion of the flap tissue, with coloration added via tattooing. It’s a minor procedure that can often be done in-office.

  1. Do I need to do anything special to prepare for breast reconstruction surgery?

You will usually need to have a thorough medical checkup, including blood work and possibly an assessment of the health of your heart and lungs. You will also need to arrange for help at home. You will not be able to walk normally or drive immediately after surgery, so arranging to have someone stay with you to assist with normal everyday tasks is strongly recommended. Plan to take at least two to four weeks off work.

If you have any further questions about breast reconstruction surgery or you’re interested in booking a consultation, feel free to contact us. We’ll be happy to help guide you on your path to total wellness.