Many breast cancer survivors — and, increasingly, those who undergo preventive mastectomies because they are at high risk for breast cancer due to genetic predispositions — are seeking reconstructive breast surgery to rebuild their breasts.
Reconstruction of a breast that has been partially or completely removed is possible through a combination of plastic surgery techniques that not only creates a new breast but also can dramatically improve a woman’s self-image, self-confidence and quality of life. The results of breast reconstruction can be relatively natural in appearance and feel; however a reconstructed breast will never look or feel exactly the same as the breast that was removed.
Breast reconstruction typically involves several procedures performed in multiple stages. It can begin at the same time as mastectomy or may be delayed until a patient has healed from mastectomy and recovered from any additional cancer treatments that may be necessary. It is important that a woman feel ready for the emotional adjustment involved; much like losing a breast, it takes some time for a woman to accept the results of breast reconstruction.
What is breast reconstruction?
Breast reconstruction is achieved through several reconstructive plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy and may include:- Flap techniques that reposition a woman’s own fat and skin to create or cover the breast mound
- Tissue expansion that stretches healthy skin to provide coverage for a breast implant
- Surgical placement of a breast implant to create a breast mound
- Grafting and other specialized techniques to create a nipple and areola
- A discussion of your goals and an evaluation of your individual case
- The course of treatment recommended by Dr. Guarda, including procedures to achieve breast symmetry
Evaluation
Overall health and personal outlook can greatly impact the outcome of your surgery. These will be carefully evaluated in consultation with your plastic surgeon. The success of your procedure, safety and overall satisfaction requires that you:- Honestly share your expectations
- Fully disclose health history, current medications, the use of vitamins, herbal supplements, alcohol, tobacco and drugs
- Commit to precisely following all of your plastic surgeon’s instructions
Safety
By making the decision to consult with your plastic surgeon and following all the instructions given, you are taking an important step in helping to assure your safety. Your plastic surgeon is certified by The American Board of Plastic Surgery(,) or The Royal College of Physicians and Surgeons of Canada”‘). This certification designates surgeons who are specifically trained in plastic surgery of the face and entire body. Dr. Guarda will carefully explain your body breast reconstruction plan. Prior to any surgery, you will be given specific instructions that may include:- Pre-surgical considerations, diagnostic testing and medications
- Day of surgery instructions and medications
- Specific information related to the use of anesthesia
Possible risks of breast reconstruction include bleeding, infection or poor healing. Flap surgery includes the risk of extreme tissue loss and a loss of sensation at both the donor and reconstruction site. The use of implants carries the risk of breast firmness (capsular contracture) and implant rupture. All surgery carries risks associated with anesthesia. These risks and others will be fully discussed prior to your consent. It is important to understand that breast reconstruction can produce remarkable results, however it cannot exactly match a breast lost to mastectomy. Even with revision procedures on the opposite breast, symmetry between the breasts will not be perfect. However, your appearance under most clothing and swimsuits can be quite natural and balanced. It is important that you address all your questions directly with your plastic surgeon. It is natural to feel some anxiety, whether anticipation for the outcome of breast reconstruction, or preoperative stress. Discuss these feelings with Dr. Guarda. A consultation with Dr. Guarda is the first step to learn how breast reconstruction can restore your breast’s appearance. A consultation is designed to fully educate you about your options for breast reconstruction in a supportive, non-pressured environment, and will include:
- A discussion of your goals and an evaluation of your individual case
- The course of treatment recommended by Dr. Guarda, including procedures to achieve breast symmetry
Progress and healing
Initial healing from breast reconstruction will include swelling and discomfort at the donor site for flap techniques. Medication may be prescribed to control the discomfort. A support bra will be recommended around the clock during initial healing of the reconstructed breast. It is important to cleanse any incision sites and apply ointment as directed. Follow all instructions carefully; this is essential to the success of your outcome. A return to light activity is possible as soon as you feel ready, usually within a few days of surgery. In many cases non-removable, absorbable sutures are used for closure in flap techniques or with implant insertion. If removable sutures are used, these will be removed within two weeks following surgery. You may be ready to return to more normal activity at this time, so long as you do not engage in any heavy lifting or vigorous exercise.
Healing will continue for several weeks as swelling dissipates and breast shape and position refine. Continue to follow your plastic surgeon’s instructions and attend follow-up visits as scheduled to monitor your results
The final results of breast reconstruction following mastectomy can help you feel physically and emotionally fulfilled. Over time, some breast sensation may return, and scar lines will improve, although 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 again. Careful monitoring of breast health through self-exam, mammography and other diagnostic techniques is essential to your long term health.