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Breast reconstruction is plastic surgery to rebuild a breast. It is usually done after a mastectomy (removal of the breast) has been done to treat cancer. Reconstruction generally requires several stages. The first stage may be done at the time of mastectomy (immediate reconstruction) or at some point after the mastectomy (delayed reconstruction). Breast reconstruction can be done using an implant or tissue expander followed by placement of an implant. Breast reconstruction can also be done using a tissue flap taken from another part of the body.
Breast Reconstruction With Implant
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The goal of the procedure is to create a reconstructed breast that appears as similar to the natural breast as possible.
Complications are rare, but no procedure is completely free of risk. If you are planning to have a breast reconstruction, your doctor will review a list of possible complications which may include:
Some factors that may increase the risk of complications include:
Silicone-filled breast implants are not designed to last a lifetime. They typically need to be removed within 10 years. Your risk for complications increases the longer you have the implants.
The following may be done:
In the days leading up to the procedure:
General anesthesia is most often used for this procedure. It will block pain and keep you asleep through surgery.
When you are asleep and no longer feel any pain, a breathing tube will be placed.
A breast implant is the simplest form of reconstruction. It can be done at the time of mastectomy if there is enough skin left on the chest wall. This one-stage, immediate breast reconstruction procedure involves inserting a breast implant where the breast tissue was taken out. The implant can be a silicone shell filled with sterile salt water (saline) or silicone gel. Alloderm or another type of treated skin may also be used to improve the appearance of the reconstructed breast. This type of reconstruction may provide an improved appearance of the breast without resorting to the use of skin and muscle tissue flaps. It is becoming the method of choice in immediate breast reconstruction.
Two-stage reconstruction is done if your skin and chest wall tissues are tight and flat. A tissue expander (temporary implant) is slipped under the skin, and the skin is closed. The expander can then be filled with saline. Over a few weeks, more saline is gradually put into the pouch with a needle. The skin overlying the pouch slowly expands as the pouch grows in size. Some doctors leave this expander in place as the actual implant. Others will replace the tissue expander with a saline or silicone gel implant. This replacement requires additional surgery.
If you want the size, shape, and color of your nipple and areola reconstructed, another surgery may be needed. The nipple can be reconstructed using local tissue. The areola can be reconstructed using skin from the inner thigh. Proper coloring is achieved through tattooing.
More complicated types of breast reconstruction involve using muscle and skin flaps from the abdomen, back, or other parts of your body.
The transverse rectus abdominis muscle (TRAM) flap procedure takes tissue and muscle from the lower abdomen and creates a breast shape. It is then moved to the chest area. Skin, fat, blood vessels, and abdominal muscles are removed, resulting in a tummy tuck. Two types of TRAM flaps exist:
Other procedures include:
After the operation, you will be taken to the recovery room for observation.
About 2-6 hours
Anesthesia prevents pain during surgery. You may experience pain after the surgery and during the healing process. You will be given pain medication.
You may be in the hospital up to a week if your procedure is done at the same time as a mastectomy. If there are any complications, your hospital stay may be longer.
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:
If you have a tissue expander, you will need to have additional saline added gradually. Your doctor will set the schedule.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
There are also steps you can take to reduce your chances of infection such as:
When you return home, follow these steps:
After you leave the hospital, contact your doctor if any of the following occurs:
In case of an emergency, call for emergency medical services right away.
Canadian Breast Cancer Foundation
The Canadian Society of Plastic Surgeons
Nahabedian MY. AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. Plast Reconstr Surg. 2009;124(6):1743-1753.
Namnoum JD. Expander/implant reconstruction with AlloDerm: recent experience. Plast Reconstr Surg. 2009;124(2):387-394.
Breast reconstruction. Breastcancer.org website. Available at: http://www.breastcancer.org/treatment/surgery/reconstruction. Updated September 4, 2014. Accessed September 8, 2014.
Silicone gel-filled breast implants: updated safety information. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm260235.htm. Published June 22, 2011. Accessed September 8, 2014.
7/1/2011 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed. FDA provides updated safety data on silicone gel-filled breast implants. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm260235.htm. Published June 22, 2011. Accessed September 8, 2014.
Last reviewed August 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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