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Breast Reconstruction

by Elizabeth Heubeck, MA

Anatomy and Physiology
A woman's breasts are composed of glandular tissue and ducts, fat, connective tissue, blood vessels, and lymph vessels. The glands produce and secrete milk for breastfeeding an infant.

Changes in the breast are common. A woman's breast tissue changes over the course of her lifetime. It also changes during her menstrual cycle or if she is taking hormones.

Treatments
Breast reconstruction may be performed using one of three techniques: A breast implant filled with a salt solution, or saline, a tissue flap, in which skin and other tissue is transferred from another part of the body to build a new breast, a combination of a breast implant and a tissue flap.

Breast reconstruction can be done at the time of a mastectomy, known as immediate reconstruction, or after a period of time, known as delayed reconstruction. You should discuss the decision to proceed with immediate versus delayed reconstruction with your surgeons.

Not all women who undergo a mastectomy choose breast reconstruction. Some decide to wear a breast form, or prosthesis, inside their bra. Breast forms come in a variety of shapes, sizes, and materials such as foam, cotton, and silicone.

Procedure
Preparations for breast reconstruction generally include: a complete physical exam, blood tests, Electrocardiogram mammogram.

In the days leading up to your procedure: Arrange for a ride to and from the hospital and for help at home as you recover. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, herbs, or dietary supplements, your doctor may recommend temporarily discontinuing them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor. Additionally, you may be asked to shower with special antibacterial soap the morning of the procedure.

For breast reconstruction using an implant, your surgeon will first place a balloon expander beneath the chest wall and close up the skin with stitches. Over the next several weeks, your surgeon will add a salt solution to the expander, which will stretch the skin and other tissues in the area.

For women having immediate reconstruction, a tissue expander may not be necessary and the final implant can be placed at the time of the mastectomy. If a tissue expander is used, it is later removed and replaced with a permanent implant.

The two most common tissue flap procedures are transverse rectus abdominus muscle flap, or TRAM, and latissimus dorsi flap, which refers to a muscle in the upper back.

In a TRAM reconstruction technique called a pedicle flap, your surgeon will take the flap and slide it under the skin to the breast area. Your surgeon will then shape the tissue into a natural looking breast and sew it into place. The flap remains attached to the original blood supply. An implant may be added to enhance the shape of the breast.

In another TRAM technique called a free flap, your surgeon will remove the flap and reattach it to the blood vessels in the chest area. This procedure takes longer because blood vessels need to be reconnected in their new location. An implant may be added to enhance the shape of the breast.

In a latissimus dorsi flap procedure, your surgeon will take a flap from the upper back and slide the tissue around through a tunnel under the skin to the breast area. He or she will then shape the tissue into a natural-looking breast and sew it into place.

If your surgeon needs to cut blood vessels, which is a rare occurrence, he or she will reattach them in the chest area using a microscope. Because tissue from the upper back contains little excess fat, your surgeon will likely insert an implant as well.

Immediate breast reconstruction begins during a mastectomy. Delayed reconstruction starts later. In either case, many patients undergoing reconstruction will require additional surgery to: add a nipple and areola; revise the shape or size of the reconstructed breast; perform surgery on the opposite breast to make them appear even.

Risks and Benefits
Possible complications of breast reconstruction include: bleeding, infection, hardening, rupturing, or leaking of the implant, abnormal scarring, painful and/or restricted arm motion, uneven appearance to the breasts, and/or lack of sensation.

Another potential disadvantage is that an implant makes it more difficult to detect cancer via a mammogram or breast self exam.

Breast reconstruction offers the following benefits: restores natural appearance of breast shape, reduces self-consciousness and improves self-esteem.

In breast reconstruction surgery, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.

After the Procedure
Immediately following surgery you: May have one or more drains temporarily left in place at your incision sites; will have some discomfort during the first few days, which usually responds to pain medication; will receive IV fluids for 1-2 days.

The length of your hospital stay will depend on the type of reconstruction procedure that you have. Patients who receive implants typically stay 1-2 days, while flap procedures require a stay of 3-6 days. Total recovery time also varies depending on type of procedure, but 4-6 weeks is average.

After your procedure, contact your doctor if you experience any of the following symptoms: fever or chills, redness, swelling, increasing pain, excessive bleeding, or discharge at the incision site, a feeling that the implants are hardening or leaking, nausea and/or vomiting that's uncontrolled with medications given by the hospital, cough, shortness of breath, or chest pain, pain or swelling in the feet, calves, or legs.

Sources:

  • Breast Reconstruction After Mastectomy. American Cancer Society.
    Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Breast_Reconstruction_After_Mastectomy_5.asp. Accessed August 8, 2004.
  • Breast Reconstruction. Breastcancer.org. Available at: http://www.breastcancer.org/tram_reconstruction2.html. Accessed August 8, 2004.
  • Understanding Breast Cancer Treatment: A Guide for Patients. National Cancer Institute. Available at: http://www.cancer.gov/cancerinfo/understanding-breast-cancer-treatment. Accessed August 8, 2004.


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Last Updated: Jun 3rd, 2009

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