Breast reconstruction is a type of plastic surgery performed in women who have had mastectomies or partial mastectomies, usually performed for cancer.
The outcome will depend on the surgeon performing the mastectomy, the plastic surgeon performing the reconstruction and the type of breast. To obtain a good result, we take into account the size, shape, and the desired appearance in order to improve the self esteem, confidence and quality of life of all women who are going through this very stressful time.
There are two main types of reconstruction:
1) Implant based reconstruction: expanders(inflatable “balloons”) or implants are used under the skin or muscle simulating the natural shape of the breast. Implant based reconstruction is the most common way to reconstruct breasts due to its safety, efficacy and surgical convenience. It adds approximately 2 or 3 more hours to the mastectomy procedure and it is performed in the same setting as the mastectomy.
2) Flaps: skin, fat, and sometimes muscle can be used in the breast for reconstruction. This type of surgery has the advantage of using your own tissue to give volume to the breasts. The downside is that requires a longer surgery time, adding several to many hours more to accomplish in addition to the mastectomies. It also creates another surgical site and the hospitalization is longer.
Radiation: the need for radiation might affect the choice of reconstruction, and may require additional surgery corrections to skin contractions a result of the radiation. We follow our patients weekly during radiation to optimize the tissue healing during treatment and have better final results. If you are having radiation, you most likely will need a second surgery with fat graft to bring non radiated tissue to the radiated site and make the skin softer.
Number of surgeries: Most of patients will have at least 2 surgeries, even with immediate direct implant technique. You should expect to have most of your breast shape in the first procedure but the second procedure is when we can do detail work with skin reshaping and/ or fat graft.
Nipple preservation: there are two indications for nipple removal: 1)cancer concerns, when the tumor is very close to the nipple and there are no safe margins or 2)cosmetic concerns, when the nipples are too low and an implant placement will be above the nipple, giving a “snoopy dog” appearance. In this case, you will have the option to have the nipples reconstructed later or tattooed. State of the art tattoo artists now can provide excellent 3-D nipple tattoos.
Drains: You will have drains from the first surgery. If expanders are used, expect two drains from each breast. If implants are used, usually one drain from each breast is normal.
Bra: We recommend the use of front closure soft cotton bra that can acommodate post surgical swelling.
Sensibility: the skin won’t have the same sensibility as before the surgery either tactile or erogenous. We always perform nerve blocks during the surgery which helps with the pain in the first 24 hours. However, as you heal, you might feel pain in the borders of the breast due to the mesh that is used to hold the implant. This pain generally improves within 3 months. Additional arm pain is usually due to lymph node dissection and can improve with time or vibration therapy.
Scars: scars are permanent but improve with time. Final scar maturation takes 1 year or more. The location of the scars will depend on the type of cancer you have, the nipple location and the breast size. We are very concerned with the cosmetic outcome and will guide you towards the best scar outcome with oils, microneedling and lasers.
Insurance: Breast reconstruction is a women’s right. The Women’s Health and Cancer Rights Act (WHCRA) helps protect many women with breast cancer who choose to have their breasts rebuilt (reconstructed) after a partial or full mastectomy. This federal law requires most group insurance plans that cover mastectomies to also cover breast reconstruction. It was signed into law on October 21, 1998. The United States Departments of Labor and Health and Human Services oversee this law.
Under the WHCRA, mastectomy benefits must cover:
- Reconstruction of the breast that was removed by mastectomy
- Surgery and reconstruction of the other breast to make the breasts look symmetrical or balanced after mastectomy
- Any external breast prostheses (breast forms that fit into your bra) that are needed before or during the reconstruction
- Any physical complications at all stages of mastectomy, including lymphedema (fluid build-up in the arm and chest on the side of the surgery)
We ensure your rights are being met. We are proud to participate in this important work with women and we are committed to give you and your family the best care and most advanced state of the art options available.