Breast Reconstruction

Breast cancer can be a life changing diagnosis. In the beginning, you may feel very overwhelmed with all the steps of treatment, and all the decisions you have to make. Later on, you may be questioning the decisions you did make and wondering if you can make a change. The good news is, it is never too early or too late to explore your options and Dr. Mason will meet you wherever you are on your journey toward healing.

What is breast reconstruction?

Breast reconstruction is the process of restoring a near normal appearance to breasts that have been fully or partially removed or have a natural deformity.

Who needs breast reconstruction?

Any woman who has a deformity of their breast can be a candidate for breast reconstruction. The most common reason women need breast reconstruction is for the deformities caused by breast cancer treatment. In most women with breast cancer, part or all of the breast may need to be removed. This leaves a deformity that can be a constant reminder of your diagnosis. You may feel like you have lost an important part of yourself and your femininity. Dr. Mason wants every woman to feel whole and believes that breast reconstruction is a crucial part of the recovery process.

What are the different options for breast reconstruction?

Breast reconstruction options are chosen based on your body, health, lifestyle, desires, and stage of treatment. Reconstruction is a choice, not a requirement. If you don’t want it, you don’t have to have it! But women have been found to do better in all aspects of life when they do have breast reconstruction. Everyone’s priorities are different. You may want the simplest and fastest option, or the most long lasting and natural. There are many different choices and Dr. Mason will help you sort through them to come up with the perfect plan for you.

Oncoplastic lumpectomy

If you have a new breast cancer diagnosis and have not yet had any surgical treatment, you may be a candidate for an oncoplastic lumpectomy. This procedure is coordinated between your breast surgeon and Dr. Mason.

What is an oncoplastic lumpectomy?

An oncoplastic lumpectomy means that your cancer treatment is done in a plastic surgical way to leave the best breast shape possible. The lump is removed by the breast surgeon, and the remaining breast tissue is rearranged by the plastic surgeon to prevent deformities. Often this is done by using the same incisions to remove the lump as if the surgery were a breast reduction or breast lift. The patient is left with a smaller breast often with a better shape than they had before the procedure. And the good news is insurance will cover a similar procedure on the opposite breast so they can both be symmetric. If you do not have a large enough breast to tolerate a reduction, you may need volume replaced using an implant or your own tissue.

Who can have an oncoplastic lumpectomy?

In order to have an oncoplastic lumpectomy, you have to be a good candidate for breast conserving therapy. This is something you can discuss with your breast surgeon. It depends on the size and location of your tumor. If you have very small breasts and will not have a lot of tissue left after a lumpectomy, you may not be a good candidate for breast conserving therapy.

Reconstruction with implants

Implant based breast reconstruction is the most commonly performed type of breast reconstruction. It can be done either at the same time as a mastectomy (immediate reconstruction), or it can be delayed until whenever are ready (delayed reconstruction).

What is immediate breast reconstruction with implants?

If you are ready to make a decision on breast reconstruction, immediate reconstruction is the way to go. This is because you will have fewer total surgeries, and your cosmetic outcome is often better. The first surgery is done at the same time as your mastectomy. Your breast surgeon will remove the breast tissue, and then Dr. Mason will use an implant to fill the empty space under the breast skin.

If you are happy with slightly smaller breasts, Dr. Mason can put in the permanent implant in this surgery. This will be your only major surgery and you should only need minor touch up surgeries if you desire in the future.

If you want larger breasts, or if the skin does not look healthy after the mastectomy, Dr. Mason will put in what is called a tissue expander. This is like a deflated balloon that is filled with saline injections in the office. The filling process generally takes about 3 months. Once you have reached your desired size, it is time for your second surgery. In the second procedure the tissue expander is removed through your old incision, and the permanent implant is put in its place. As in all breast reconstruction surgeries, you may need a touch up procedure in the future.

What is delayed breast reconstruction with implants?

Delayed breast reconstruction is a great option for women who have already had a mastectomy, or who are not ready to make their choice about breast reconstruction at the time of their mastectomy. Many women only wish to focus on treating their cancer, and want to think about breast reconstruction later, and that is absolutely fine.

Delayed reconstruction with implants must be done in two stages. The first surgery involves opening up the chest skin and placing a tissue expander underneath. This is like a deflated balloon that is filled with saline in the office to slowly stretch the skin back out into the shape of a breast. This filling process takes about 3 months. Once your breasts are at the size you desire, you will have your second surgery. In this procedure the tissue expander is removed, and a permanent implant is put in its place. This is your last major procedure, but you may need another touch up in the future.

Reconstruction using your own tissue (DIEP or TRAM flap)

If you want the most long lasting and natural appearing reconstruction, you should consider using your own tissue! Although the surgery is more extensive and the recovery is longer, many women find the benefits are worth it.

What is a DIEP or TRAM flap?

DIEP (deep inferior epigastric artery perforator) flaps and TRAM (transvers rectus abdominus myocutaneous) flaps are the most common ways to reconstruct breasts using your own tissue. Basically, they take the same tissue from your belly that is usually thrown away after a tummy tuck and use it to create breasts instead. So you get rid of the extra belly fat, and gain two new breasts! The fat and skin are kept alive by taking their blood supply and hooking it up to an artery in your chest. Since it is your own body tissue, it gains and loses weight with you, ages with you, and never needs to be replaced.

Who can have a DIEP or TRAM flap?

In order to have these procedures, it is important to be in good health and able to withstand a long surgery. You also need to be at a healthy weight to lower your risk of complications. You do need to have enough extra belly fat and skin to make the breast size you desire.

When is a DIEP or TRAM flap done?

It can be done immediately at the time of mastectomy, or delayed.

If you want reconstruction started immediately, most of the time it is done in a staged fashion with tissue expanders placed at the time of mastectomy, and the DIEP or TRAM surgery done weeks or months later. This allows us to make sure the cancer is completely treated and ends up producing a better shaped breast.

It can also be done in a delayed fashion, even many years after the original surgery. It can be done for women who had no breast reconstruction, or who are having problems with their implants and want them replaced with their own tissue.

What should I do to prepare for breast reconstruction?

The most important things to do are to avoid smoking and being around those who smoke, and to be at a healthy weight. Smoking and being too overweight increase your risk of complications very significantly. You can talk to Dr. Mason about your risks. If you need time to deal with these issues, you can always start with treating the breast cancer, and delay reconstruction until you are ready.

What happens at the initial consultation?

During the initial consultation, you will be asked about your medical history to ensure you are in good health and a candidate for breast reconstruction. You will then discuss breast reconstruction options and what your goals are. Dr. Mason will examine you and discuss the right surgery for your body. Remember, there is no one-size-fits-all. Dr. Mason will customize a plan just for you.

What happens on the day of surgery?

We know this will be an important day for you, and some anxiety is very normal. Just remember that you’re taking a step towards recovery and you’re in the hands of caring experts. You will have a scheduled arrival time on the day of surgery. The hospital or surgery center team will be expecting you and check you in upon arrival. Please do not eat the morning of surgery. Dr. Mason will come to talk to you before surgery and mark your skin where the incisions will be. These will be as discussed in your agreed upon treatment plan. She will make sure there have been no changes. You will also meet your anesthesiologist. From there, you will go back to the operating room, and the anesthesiologist will put you to sleep. The length of the surgery is very variable depending on the procedure you are having. After the surgery is completed, you’ll be taken to the recovery area. What happens next depends on the procedure you have had:

Oncoplastic lumpectomy: Most patients are able to go home on the same day. While you are taking narcotics pain medication, you will not be able to drive, so you will need to arrange for someone to pick you up.

Mastectomy with tissue expanders or implants: Some patients are able to go home immediately after surgery, while some need to spend the night in the hospital. This decision is made by your breast surgeon, so talk to them about their plan beforehand.

DIEP or TRAM flaps: These are long surgeries and after the procedure you will be taken to the intensive care unit for hourly monitoring of your breasts for the first night. The next day you will be able to eat and get out of bed, and will usually be transferred out of the ICU to a regular bed. Patients will generally spend about 3-4 days in the hospital after surgery.

Second stage for permanent implants or touch up surgeries: These later stage surgeries are always outpatient surgeries so you can go home the same day. While you are taking narcotics pain medication, you will not be able to drive, so you will need to arrange for someone to pick you up.

This is a good time to switch your mindset to “let them look after me for a while,” as you will need your rest.

What will happen after surgery?

Oncoplastic lumpectomy: You will see results immediately. Keep in mind that your body will continue to improve as it heals for the next several months. Swelling and discomfort will of course vary, but the recovery rules apply to everyone. You will need to rest and take about 2 weeks off of work. It may be as much as six weeks before you are fully recovered and back to your normal routine. This is the time for you to relax, heal, and take care of yourself. It is important to stick with your scar care routine which Dr. Mason will teach you.

Immediate reconstruction with implants: You will wake up with your new reconstructed breasts and will see results immediately. But you will have a lot of bruising and swelling and it will take time for your tissue to heal and smooth out into its new shape. You will have drains that will generally stay in for 2 weeks. You will need to rest and take about 2 weeks off of work. It may be as much as six weeks before you are fully recovered and back to your normal routine. This is the time for you to relax, heal, and take care of yourself. It is important to stick with your scar care routine which Dr. Mason will teach you.

Reconstruction with tissue expanders: When you wake up, you will not be completely flat but will also not have your full-size breasts. You will have a lot of swelling and bruising, and tissue expanders tend to be hard and look boxy. Remember that is temporary! You will have 2 drains in place. After 2 weeks we will begin filling the tissue expander with saline in the office. This is done weekly until you have reached the size you want to be. Then you will schedule your second surgery when your tissue expanders will be taken out and replaced with permanent implants

DIEP or TRAM flap: After you get home from the hospital, you will need to stay flexed at the waist at all times for 2 weeks so that you don’t put tension on the incision on your abdomen. You will not be able to do any heavy lifting for 6 weeks. This is the time for you to relax, heal, and take care of yourself. Be patient! You have had a major surgery and healing takes time.

After any breast reconstruction, you can expect to need a touch up at some point. Usually we wait 6 months to allow your body to heal and smooth things on its own, and then make a decision from there. Touchup surgeries vary depending on your particular situation.

Do’s & Don’ts for a breast reconstruction

Do celebrate your decision. Do enjoy your new breasts. Do allow your confidence to skyrocket. Do take time to properly heal and take care of yourself. Don’t push yourself too hard. Don’t skip scar care