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Breast reconstruction is plastic surgery to rebuild a breast. It is usually done after a mastectomy (removal of the breast) has been done to treat cancer. Reconstruction generally requires several stages. The first stage may be done at the time of mastectomy (immediate reconstruction) or at some point after the mastectomy (delayed reconstruction). Breast reconstruction can be done using an implant or tissue expander followed by placement of an implant. Breast reconstruction can also be done using a tissue flap taken from another part of the body.
Breast Reconstruction With Implant
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The goal of the procedure is to create a reconstructed breast that appears as similar to the natural breast as possible.
Complications are rare, but no procedure is completely free of risk. If you are planning to have a breast reconstruction, your doctor will review a list of possible complications which may include:
Some factors that may increase the risk of complications include:
Silicone filled breast implants are not designed to last a lifetime. They typically need to be removed within 10 years. Your risk for complications increases the longer you have the implants.
General anesthesia is most often used for this procedure.
Once you are asleep and no longer feel any pain, a breathing tube will be placed.
A breast implant is the simplest form of reconstruction. It can be done at the time of mastectomy if there is enough skin left on the chest wall. This one-stage, immediate breast reconstruction procedure involves inserting a breast implant where the breast tissue was taken out. The implant can be a silicone shell filled with sterile salt water (saline) or silicone gel. Alloderm or another type of treated skin may also be used to improve the appearance of the reconstructed breast. This type of reconstruction may provide an improved appearance of the breast without resorting to the use of skin and muscle tissue flaps. It is becoming the method of choice in immediate breast reconstruction.
Two-stage reconstruction is done if your skin and chest wall tissues are tight and flat. A tissue expander (temporary implant) is slipped under the skin, and the skin is closed. The expander can then be filled with saline. Over a few weeks, more saline is gradually put into the pouch with a needle. The skin overlying the pouch slowly expands as the pouch grows in size. Some doctors leave this expander in place as the actual implant. Others will replace the tissue expander with a saline or silicone gel implant. This replacement requires additional surgery.
If you want the size, shape, and color of your nipple and areola reconstructed, another surgery may be needed. The nipple can be reconstructed using local tissue. The areola can be reconstructed using skin from the inner thigh. Proper coloring is achieved through tattooing.
More complicated types of breast reconstruction involve using muscle and skin flaps from the abdomen, back, or other parts of your body.
The transverse rectus abdominus muscle (TRAM) flap procedure takes tissue and muscle from the lower abdomen and creates a breast shape. It is then moved to the chest area. Skin, fat, blood vessels, and abdominal muscles are removed, resulting in a tummy tuck. Two types of TRAM flaps exist:
Other procedures include:
After the operation, you will be taken to the recovery room for observation. You will then be transferred to your hospital room to begin your recovery.
If you have a tissue expander, you will need to have additional saline added gradually. Your doctor will set the schedule.
About 2-6 hours
Anesthesia prevents pain during surgery. You may experience pain after the surgery and during the healing process. Pain medicine will be given to help relieve pain.
The surgery typically requires up to a week's stay when done at the same time as a mastectomy. If there are any complications, your hospital stay may be longer.
Be sure that you follow-up with your doctor. For silicone gel implants, you will need routine MRI screenings to check for ruptures (tears or holes in the implant). The screenings are typically done three years after surgery and every two years after that.
After you leave the hospital, contact your doctor if any of the following occurs:
In case of an emergency, call for medical help right away.
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Canadian Breast Cancer Foundation
The Canadian Society of Plastic Surgeons
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Last reviewed September 2013 by Michael Woods, MD, Michael Woods, MD
Last Updated: 9/30/2013