Breast Reconstruction after a Mastectomy

Dr. Dana has a growing reputation of being one of the top female breast reconstruction surgeons in Palm Beach. Breast Reconstruction has become a cornerstone of our practice, and we make it our mission to help our patient's look and feel beautiful.

We pride ourselves on connecting with our patients, and continually striving to give them the best experience possible. We hope you find all of the answers you might be looking for on this page, or that you will contact us if you have any further questions.

 

Breast reconstruction after a mastectomy

Breast reconstruction after a mastectomy has typically required two stages. During the first stage of breast reconstruction surgery, a temporary implant (called a tissue expander) is inserted under the chest muscle. It is gradually filled with saline (IV fluid) after surgery through a needle that’s inserted into a special part of the expander. 

In order to get more fluid into the expander at the time of the first surgery, Allografts are sewn to the bottom of the muscle to make more room. The allograft also provides more coverage for the bottom of the implant. Complications of implant reconstruction with radiation are almost 50%, and the allograft can decrease some of these complications (capsular contracture, exposure of the implant and wound healing problems).

Some Breast Reconstruction Surgeons in Florida use allograft so an implant can be placed at the time of surgery (single stage reconstruction surgery). This can only be done if the skin is in good condition after mastectomy. If the blood flow to the skin is poor, the traditional technique of slowly inflating the implant will need to be used.

If radiation is going to be needed, tissue expanders can be placed followed by flaps or implants, depending on how the skin recovers from radiation.

If you decide to have breast reconstruction surgery, you will always be scars and other signs of the breast reconstruction process. Also, it is important to keep in mind that no one starts with symmetric breasts. Several operations may be needed, including surgery to the non-cancerous breast, to get the best result possible.

Immediate or Delayed Reconstruction


Breast reconstruction surgery can be performed at the time of mastectomy or any time afterward. Some women feel better waking up from their mastectomy with the process already started, and some need years to reach a decision about reconstructing their breast.

Cancer treatments after mastectomy, like chemotherapy and radiation will factor into decisions about how and when the breast is reconstructed. The decision is one you make with your team of doctors. There are positives and negatives with each approach, and there is no correct choice. 


Techniques for Breast Reconstruction After a Mastectomy
  • Tissue expander/implant based Breast Reconstruction Surgery
  • Flap reconstruction – using your own tissue
Tissue Expander / Implant Based Breast Reconstruction After a Mastectomy

Following mastectomy, a tissue expander is placed under your skin and chest muscle. Once the incisions have healed, saline solution is injected weekly to gradually fill the expander over several weeks or months (depending on the size of the expander and how well you tolerate the fillings).

After the skin and muscles have been stretched, a more permanent implant is inserted. A saline or silicone implant can be used (for more information about implants…link to breast aug). This surgery is usually an outpatient surgery with a much faster recovery than the first surgery. It is much less common, but some women do not require tissue expansion before receiving an implant, and the implant can be inserted during the first surgery.

Flap Reconstruction After a Mastectomy

For patients who do not want to have prosthetic implants or who have radiation damage to the chest that makes using an implant too risky, tissue from other parts of the body, such as the back, abdomen, or buttocks, can be used to make the breast mound.

In some cases, the tissue is left attached to blood vessels and simply repositioned to the breast. Other times, it is completely detached from the blood supply and transplanted to the chest using microsurgery.

Sometimes an implant is used with flap reconstruction for additional volume. There will be scars at both the tissue donor site and on the reconstructed breast, and the initial recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about problems with an implant like rupture or capsular contracture down the line.

Risks associated with breast reconstruction
  • Infection
  • Bleeding/hematoma
  • Implant related complications
  • Donor site related complications
  • Effect on cancer recurrence
Infection


Despite the use of sterile methods and the use of antibiotics around the time of surgery, every surgery has a risk of infection. When infection occurs, the implant may need to be removed in order to treat the infection. The implant could be replaced after several weeks to restart the process.

Smoking and radiation both increase the likelihood of an implant infection since they both interfere with the blood supply to the skin.

Hematoma


If bleeding after surgery is significant enough, it can result in a hematoma. If one of your breasts is more painful and becomes larger, call the office immediately. You may need surgery to stop the bleeding and clear out the clotted blood to prevent possible problems, such as slow recovery, infection, and capsular contracture.

Implant related complications:
Capsular Contraction


When an implant is placed, your body forms a fibrous layer of scar tissue around the implant called a capsule. Sometimes, an abnormally thick capsule forms around the implant, as the capsule contracts, the breast gets tight and firm, and starts to look round. Capsular contraction can be fixed surgically, but there is a chance it could recur.

Rupture


There’s a risk of about 1% per year that your implant will rupture. With saline implants, the fluid is absorbed by your body and the breast will deflate over several hours. With silicone implants, you may not notice a rupture if the gel stays within the scar tissue capsule. If it leaks out, you may notice a change in the shape of your breast or you may feel lumps.

If you have silicone implants, the FDA recommends an MRI every two years starting three years after your implant surgery to detect rupture. Your insurance will usually not cover the cost. The two main suppliers of breast implants, Mentor and Inamed (Allergan), both have warranties that cover the cost of new implants and even the payment of your surgical fees if your implant ruptures.

Rippling


Visible fluid waves can occur. They are most common with saline implants in women with a small amount of fat and thin skin.

Implant Malposition


Implants can migrate too high, too low, too far toward the middle of the chest, or off to the side. These problems can be minimized at the time of surgery by careful dissection of the implant pocket and after surgery by following the aftercare instructions closely.

Donor site related complications from Breast Reconstruction:

There is a risk of wound healing complications or fluid collections at the donor site after flap reconstruction. Smoking increases these risks. If severe enough, these problems could require further treatments, including surgery.

When the tissue is taken from the abdomen, there is also a risk of developing either an abdominal bulge or a hernia after surgery, even years later. This is because the lining of the abdominal wall, called the fascia, has to be cut in order to move the tissue. Even when it is repaired appropriately, some women will develop complications, possibly requiring further surgery.

Effect of Breast Reconstruction Surgery on Cancer Recurrence and Screening

Wound healing problems after breast reconstruction have the potential to delay chemotherapy, so the type and timing of your reconstruction will be planned with your future treatment in mind.

Breast reconstruction has no known effect on the recurrence of disease in the breast, and it does not generally interfere with chemotherapy or radiation treatment should cancer recur. When breast cancer recurs, it is often superficial (on the skin), so reconstruction generally does not affect the ability to diagnose a recurrence.

Expected Recovery after Breast Reconstruction Surgery

You will have drains after your surgery to prevent a fluid collection at the surgical site. If you undergo reconstruction with a flap, there will also be drains at the donor site. They stay in place for 1-3 weeks after surgery and are removed when the amount of fluid draining out is low enough.

You will be in the hospital at least overnight. Patient with implant based breast reconstruction generally stay 1 or 2 days, and patients with flap reconstruction may stay as long as a week. You will feel tired and sore for a week or two after reconstruction, and there will be activity restrictions based on the type of surgery you have.

It may take you as long as 6-8 weeks to fully recover from flap surgery, and about 2-4 weeks from implant based surgery.

 Your breast will be fairly numb after surgery. Over time, sensation may return, but it is different for every person. Most scars will fade over a year or two, but they'll never disappear entirely.