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Breast Reconstruction

 

What is breast reconstruction?

Breast reconstruction is a procedure in which a plastic surgeon uses an expander, an implant, or body tissue to try to rebuild a breast when you have a mastectomy (removal of the breast). You may choose to begin breast reconstruction when you have the mastectomy or at any time after the mastectomy. You may need 2 or 3 operations before the reconstruction is complete.

The implant may be a silicone shell filled with saline (saltwater) or silicone gel. Saline implants seem to not have as many possible side effects as silicone gel implants. Another alternative is for your doctor to use tissue from other parts of your body to reconstruct the breast. Another choice is to not have the operation and accept your changed appearance, or to wear a prosthesis, or artificial aid, inside your bra. You should ask your doctor about these choices.

 

When is it used?

This operation is designed to rebuild the breast. It will not prevent or cure cancer.

It may help you to remember that although this operation can reshape your breasts, it may not change how you think of yourself.

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How do I prepare for breast reconstruction?

There are many support groups for women who have had mastectomies. These support groups are usually made up of former cancer patients and can provide needed emotional support.

Discuss with your doctor the size and contour of breasts you would like to have.

Plan for your care and recovery after the operation. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow the instructions provided by the doctor. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

 

What happens during the procedure?

For the mastectomy and reconstruction of the breast, you are given general anesthesia. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

After removal of your breast, the doctor places an expander (a balloonlike object) underneath your chest muscles. The expander is inflated to try to stretch the skin. The stretching takes many months, depending on how much skin there is and how much it needs to be stretched.

When the skin has stretched to the right size, you will have the next operation. The doctor will replace the expander with an implant under the skin flap. This implant is a shaped bag or packet that is filled with saline or silicone. Instead of an implant, your doctor may use tissue from your abdomen or back to build the flap that will reconstruct the breast.

As the final step, the doctor may reconstruct the nipple and areola (the dark patch of skin that surrounds the nipple) with tissue from the reconstructed breast or with a graft of skin from your underarm or groin. Sometimes tattooing is done instead of or in addition to the tissue graft.

 

What happens after the procedure?

You may be in the hospital 24 hours if an expander was placed. If a tissue flap was used to reconstruct your breast, you may be in the hospital 3 to 6 days. It may take 3 or 4 weeks to heal completely. The doctor will arrange for follow-up appointments to check your progress.

In addition to the scar from the removal of the breast, you will have a scar on your breast, and maybe your back, underarm, or abdomen if skin was taken from these areas.

You should have regular checkups, including mammograms, to look for any recurrence of breast cancer.

Ask your doctor what other steps you should take.

 

What are the benefits of this procedure?

You will have a more normal figure and may feel better about yourself. It is easier to get dressed because you do not need a removable breast prosthesis.

 

What are the risks associated with this procedure?

Risks of breast reconstruction include:

  • There are some risks associated with general anesthesia. You should discuss these risks with your doctor.
  • You may develop a hematoma, which is a collection of blood or a blood clot from a leak in a blood vessel that may form within hours after surgery in the pocket where the implant has been placed. This may cause swelling, pain, and bruising. A large hematoma may need to be drained surgically.
  • An implant may harden and be painful.
  • Your reconstructed breast may be hard or lumpy.
  • Your reconstructed breast may feel too firm.
  • Your reconstructed breast may become infected around the implant.
  • Your new nipple and areola will be numb. They may not look the same as your other nipple.
  • Your breasts may be unequal in size, shape, position, or contour. You may want further surgery on one or both of the breasts to try to make them similar.
  • Your breasts may droop.
  • A capsule may form around the implant. That area may become firm or tender and need regular massage.
  • Your arm and shoulder movements may be restricted or painful. You may need to do range-of-motion exercises to regain normal movement.
  • An implant may rupture or deflate, which may require another surgical procedure to remove the implant.

There have been some special concerns about the safety of implants filled with silicone gel. Possible risks of silicone-gel implants include:

  • An implant may rupture and silicone may leak inside and outside the breast.
  • Small amounts of silicone may leak out of an implant over a long period, even if the implant doesn't rupture. These small amounts of silicone may cause some women to develop autoimmune diseases such as arthritis, lupus, or scleroderma.

The U.S. Food and Drug Administration (FDA) stresses that there is no conclusive evidence that these risks happen. However, the FDA has issued rules limiting the use of implants with silicone gel until more studies are done. According to FDA regulations, you can have a silicone-gel implant if you need to reconstruct your breast after cancer surgery or for another medical condition. Before you can have a silicone-gel implant, you must agree to two things:

  • First, you should discuss the possible risks with your doctor and sign an informed consent form. The consent form states that your doctor has explained all the possible risks and that you understand them.
  • Second, you must agree to enroll in a special clinical study so that the FDA can get reports on your progress. The FDA hopes that the data gathered from the studies will help find out what the risks are.

You should ask your doctor how these risks apply to you.

 

When should I call the doctor?

Call the doctor immediately if:

  • The skin over the breast becomes irritated or starts to peel off.
  • You have redness or unusual drainage from the cuts.
  • You have fever or unexpected pain.

Call the doctor during office hours if:

  • You have questions about the procedure or its result.
  • You want to make another appointment.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Special Instructions:

Do not wear an underwire bra.


Copyright © Clinical Reference Systems 2003
Adult Health Advisor

 

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