Breast Reconstruction

Breast reconstruction surgery can help to raise a woman’s self-esteem and level of confidence. This procedure is designed to create the appearance of natural-looking breasts that were surgically removed due to a mastectomy (after the removal of breast tissue) or another illness. Reconstructed breasts are nearly identical to the size and shape of real breasts, and may also involve the creation of a new nipple and areola (the darker area surrounding the nipple).

There are several things to know when considering breast reconstruction, and because it is not a simple procedure to undergo, a patient may be required to visit Dr. David Kim’s office several times. The entire process make take up to a full year.

Ideal Candidates

Dealing with an illness and losing a breast can be emotional, which is why many women need time to evaluate their decision before they are ready to undergo breast reconstruction. As with all cosmetic procedures, it is important that the patient be free from mental and physical illness. Women with obesity or high blood pressure may also be advised to wait. For a patient wishing to undergo breast reconstruction, it is important that her cancer be eliminated first.

What to Expect From This Procedure

It is important to be very frank with your surgeon about your expectations and concerns; this is important to determine the best course for surgery. There are two types of breast reconstruction surgery: the use of an implant or the use of a tissue flap. Both procedures be done directly following a mastectomy or after a period of time.

Breast Reconstruction Using Implants

Implants

Either silicone-gel or saline implants can be used for breast reconstruction. Each type of implant has potential risks and uncertainties, so it is important to discuss your options during your consultation with Dr. Kim. When used for breast reconstruction, the size and shape of an implant is usually determined by the size of your natural breast (exterior cover can be smooth or textured).

Procedure

If breast reconstruction is performed immediately after a mastectomy, your plastic surgeon will place the implant in the pocket that is left from the removed breast tissue. The  length of time for this surgery will depend on the length of time of the mastectomy – the prior breast surgery. Breast reconstruction is usually performed under general anesthesia.

If breast reconstruction is performed long after the natural breast was removed, and the skin and underlying tissue is flat, a pocket will need to be created for the implant. In order to create a sufficient opening, a tissue expander will be placed under the skin and muscle to make a pocket. This will take 30 minutes to a full hour and will be performed while the patient is relaxed and numb (with a sedative under local anesthetic). The tissue expander, which is like a balloon, will be filled with a saltwater solution. Over time, your doctor will gradually increase the amount of liquid in the expander through a tiny valve mechanism. Once the tissue has stretched to the desired size, a secondary surgery will be performed to remove the tissue expander and insert a more permanent implant (some expanders are meant to be left in place as the final implant). The incision will be closed with stitches.     

Breast Reconstruction using Flap Reconstruction

Flaps

To successfully recreate a natural-looking breast, a skin “flap” using tissue from another area of the body – such as the stomach, back, thighs, or buttocks – can be used. This flap consists of skin, fat, muscle, and blood supply; tunneled under the skin to create the breast mound or removed and reattached to create a pocket for the implant.

Procedure

For the tunneled technique, a flap of skin will remain partially attached to its original blood supply. It will be tunneled under the skin to create the breast mound. This procedure is typically performed under general anesthesia and can only be performed on women who have the excess skin and fat to do so.

If you decide to have a flap of skin removed and attached to create a breast mound, the flat can be taken from several places. First, your surgeon will mark an area of skin for the flap. This skin, fat and muscle will be surgically removed; the muscle at the donor site will be stitched together and the skin will be closed. Second, an incision will be made on the chest and the flap will be immediately attached to create a breast mound.

Both flap procedures will leave a scar where the flap is taken and a scar where the flap is attached; these scars may fade over time. Dr. Kim will help patients better understand the details regarding their options with breast reconstruction and the overall process.

Possible Risks

Bleeding, fluid collection resulting in excess swelling, excess scar tissue, and infection are all potential risks of surgery. If an implant is inserted, there could be problems with rupturing and subsequent leaking or capsular contracture (when the pocket that the implant sits in begins to contract making the breast feel hard). If a flap is attached, dead tissue (necrosis) may develop or there may be problems associated with the donor site. Correction of these problems typically require additional surgeries.

Recovery

Both implant and flap surgeries will require stitches to close the incisions; some of these stitches will need to be removed in about a week.

After the initial phase, you will be sore, and you may be swollen in the chest area and other areas, depending on the type of reconstruction you underwent (discomfort can be managed with medication). Over the next several weeks, you may have gauze or bandages that will need to be changed, and you may have to wear compression garments. Finally, you will need to re-frame from strenuous activity, including lifting.

Breast reconstruction can take a year to completed (including recovery time), depending on what procedures you are having done. It will leave permanent scars, and you may notice substantially less sensation in the reconstructed breast.