Breast Reconstruction (Post Mastectomy)

Mastectomy or breast removal, total or partial, is often followed by breast reconstruction. Sometimes reconstruction can begin as part of the same procedure. Still, breast reconstruction is a complex procedure and should be undertaken only after careful consideration, discussion with your physician and full understanding about what is involved. Always ask your surgeon if there is anything you don’t understand.

There are many reasons why women may wait to have breast reconstruction after a mastectomy. It may be too soon after the experience of cancer and the resulting surgery to consider all the options in reconstruction. Emotions and anxiety may still be issues. Others may have had enough surgeries for a while. Still others may be advised to wait while preparations are being made for the complexities of reconstruction, such as developing excess skin. In any case, it does no harm to wait and the time can be used for more thorough consideration.

About the Procedures
You and the surgeon will discuss your condition, health, age, personal anatomy, and your goals and expectations. It’s best to have a frank exchange and understand that reconstruction is intended to improve your condition, appearance and well-being…but not achieve perfection.

Generally, a saline-filled implant is used to form the breast mound. The nipple is formed and added in a second procedure. To make room for the implant, one approach is to create excess skin by inserting a balloon expander. The surgeon will gradually add fluid to the balloon over time to stretch the skin and force it to grow. When the balloon is large enough, it will be removed and replaced by the implant. Some expanders are designed to be the implant as well.

A second technique is to remove a portion of skin from elsewhere on the body to form a flap of tissue with which to reconstruct the breast. This may come from the back, abdomen or buttocks. The flap consists of tissue, fat, and muscle with its blood supply. In one approach, this material is tunneled under the skin from the back, for example, to form the pocket for the insert or to form the breast mound itself. Another technique removes the flap material from its original location and transplants it at the breast site. This requires microvascular surgery. The flap technique without an implant is complex and takes longer to heal, but it is totally natural. Additional procedures may be needed to adjust the breast after healing or to ensure breasts are more symmetrical.

Breast reconstruction is performed in a hospital and recovery there will last two to five days followed by a week or two of recovery at home. Recovery time is less if flaps are not involved. Physical and sexual activity should be avoided for three to six weeks. Scars will fade with time, but never totally disappear. Sensation of some kind may return, but it will not be the sensation of the natural breast. The appearance of your reconstructed breast will not be identical to your other breast, but in most cases the differences will be noticeable only to you.