BREAST
RECONSTRUCTION

During your consultation be prepared to discuss:

• Your surgical goals
• Medical conditions, drug allergies, and medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
• Previous surgeries

Your surgeon may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Examine your breasts and take measurements of their size and shape, skin quality, and placement of nipples and areolae
• Take photographs
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of breast reconstruction and any risks or potential complications

Prior to surgery, you may be asked to:

• Get lab testing or a medical evaluation
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding

Breast reconstruction surgery is typically performed in a hospital setting, may include a short hospital stay, and will likely use general anesthesia. Some follow-up procedures may be performed on an outpatient basis, and local anesthesia with sedation may be used. These decisions will be based on the requirements of your specific procedure and in consideration of your preferences and your doctor’s best judgment.

Types of Breast Reconstruction
Breast reconstruction surgery can be achieved through a variety of different techniques. The appropriate reconstructive procedure for you will be determined based on discussions with your surgeon, your body type, and prior therapy and/or surgical treatment.

Implant Reconstructions

• Expander/Implant

First, a temporary device known as a tissue expander is placed in the breast to create the soft pocket that will contain the permanent implant. Some surgeons may also use an acellular dermal matrix to assist with reconstruction. Once expansion is complete, the expander will be exchanged for the permanent implant during an outpatient procedure. In expander/implant reconstructions, patients can expect the following to occur with some exceptions:

• Hospital Stay (Mastectomy/Expander): 1 – 2 days
• Recovery Time (Mastectomy/Expander): 4 – 6 weeks
• Hospital Stay (Implant Exchange): Outpatient
• Recovery Time (Implant Exchange): 1 – 2 weeks

• Donor Site: Back

LD flap: The latissimus dorsi (LD) flap is most commonly combined with an implant. At the time of breast reconstruction, the muscle flap, with or without attached skin, is removed from the back and implanted in the breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape compared to an implant alone. The scar on the back can often be concealed under a bra strap. In LD flap reconstructions, patients can expect the following to occur with some exceptions:

• Hospital Stay: 1 – 3 days
• Recovery Time: Several weeks

Your plastic surgeon will talk to you about your breast reconstruction options. There are a number of different options for implants that may be used during your breast reconstruction.

Saline implantsare filled with sterile salt water. They can be filled with varying amounts of saline which can affect the shape, firmness and feel of the breast. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body. Saline implants can feel or look wrinkled in thin patients.

Silicone implantsare filled with an elastic gel. The gel feels and moves much like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket. A leaking implant filled with silicone gel may not collapse. If you choose these implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of breast implants.

Shape
Form-stable implantsmimic the natural shape of the breast and are shaped like a tear drop. They are thicker at the bottom and tapered toward the top.

They are usually filled with a cohesive gel. If they rotate, it may lead to a strange appearance. It is also usually necessary to have a longer incision with these implants.

Round implantshave a tendency to make reconstructed breasts appear fuller than form-stable implants. They also often will make the breast project out further away from the body. New high-profile options can lead to even more projection, if that is a concern for you. Because they are the same shape all over, there is less concern about them rotating out of place.

Texture
Textured breast implantsallow the scar tissue to stick to the implant, making them less likely to move around inside of the breast and get repositioned.

Smooth breast implantsmove around freely inside of the breast, which may give more natural movement. These implants also have an increased risk of rippling.

Your plastic surgeon will take into account your wishes and concerns and will choose the right breast reconstruction option for you.

Following your surgery, gauze or bandages will be applied to your incisions. An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid. A pain pump may also be used to reduce the need for narcotics.

You will be given specific instructions that may include how to care for your surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery?
• When will they be removed?
• Are stitches removed? When?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?

RESULTS

The results of breast reconstruction will be long-lasting, provided that you maintain a stable weight and general fitness. As your body ages, it is natural to lose some firmness, but most of your improvement should be relatively permanent.

Although good results are expected from your procedure, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Over time, some breast sensation may return, and scar lines will improve, although they’ll never disappear completely. There are trade-offs, but most women feel these are small compared to the large improvement in their quality of life and the ability to look and feel whole. Careful monitoring of breast health through self-exam, mammography and other diagnostic techniques is essential to your long-term health.

Healing will continue for several weeks as swelling decreases and breast shape and position improve. Continue to follow your plastic surgeon’s instructions and attend follow-up visits as scheduled.

Prices for breast reconstruction can vary.A surgeon’s cost may be based on his or her experience, the type of procedure used, and geographic office location.

Cost may include:

• Anesthesia fees
• Hospital or surgical facility costs
• Medical tests
• Post-surgery garments
• Prescription medication
• Surgeon’s fee

Breast reconstruction surgery after breast cancer is considered a reconstructive procedure and should be covered by health insurance. However, your coverage may only provide a small part of the total fee.

Your satisfaction involves more than a fee:
When choosing a plastic surgeon for breastreconstruction, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.

Plastic surgery involves many choices. The first and most important is selecting an American Society of Plastic Surgeons (ASPS) member you can trust. ASPS member surgeons meet rigorous standards:

• Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
• Pass comprehensive oral and written exams
• Graduate from an accredited medical school
• Complete continuing medical education (including patient safety) each year
• Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

Do not be confused by other official sounding boards and certifications.
The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name. By choosing a member of The American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly trained plastic surgeon who is board-certified by the ABPS or The Royal College of Physicians and Surgeons of Canada.