Breast Reconstruction After Mastectomy

Benefits of Breast Reconstruction

Breast reconstruction is performed to restore the shape, size, and symmetry of one or both breasts after treatment for breast cancer, benign breast tumors, accidents, or a congenital breast deformity.

The complexity of reconstruction will depend on the type of trauma sustained by the breast(s). The greater the trauma, the more involved the surgery.

Dr. Daniel Y. Maman is a nationally recognized expert in breast reconstruction surgery. He is pleased to offer the latest in cutting-edge surgical breast reconstruction techniques to patients at his NYC office. He has authored several book chapters in modern breast reconstruction textbooks, including Breast Reconstruction: Art, Science, and New Clinical Techniques. His research has also appeared in Plastic and Reconstructive Surgery.

H2: What Type of Breast Reconstruction Is Right for You?

Breast mounds can be reconstructed using implants, fat transfers, and autologous reconstruction techniques. Each method has its own advantages and disadvantages, and a patient’s personal preferences can be as important as their clinical needs in determining which option is right for them.

Regardless of the reconstruction technique used, beginning the reconstructive process at the same time as a mastectomy tends to yield the most favorable results. While each patient’s reconstruction follows its own timeline, you can generally expect a reconstruction to follow the steps below:

The patient will be given a medical device like a tissue expander or suction system.

The tissue on the chest will be gradually expanded to make room for the new breast mound.

Once the tissue is expanded to the desired breast size, Dr. Maman will reconstruct the breast using either implants, a fat transfer, or an autologous tissue transplant.

Breast implant reconstruction

Because it does not require harvesting tissue or fat from another part of the body, using implants to recreate the natural mound of the breast is the least invasive breast reconstruction technique. It is still more complicated than a simple breast augmentation, but you will not have multiple surgical sites healing at the same time.

Implant reconstruction is an excellent choice if you are not interested in using your own tissue or if your cancer treatment has left your skin, muscle, and breast tissue too damaged to be used successfully. Implant reconstruction usually looks like this:

A tissue expander (a special type of empty breast implant) is placed on the chest wall, usually in a pocket under the pectoral muscle but sometimes between the muscle and skin, at the end of the mastectomy surgery.

Over the next six to eight weeks, Dr. Maman will fill the tissue expander with either saline solution or air, adding more every few weeks to gently stretch the skin and tissue until the breast reaches the desired size.

One to six months after you have finished the tissue expansion process and completed your chemo/radiation therapy, Dr. Maman will place either a permanent breast implant, a fat transfer, or an autologous tissue transplant.

You can choose between implants filled with a silicone gel or saline solution. While both are safe, most patients choose silicone implants because they deliver results that are closer to natural breasts in terms of look and feel. You can read more about the types of implants on our breast augmentation page.

Fat transfer reconstruction

Fat transfer can be a good reconstructive option for patients who are repairing damage from a lumpectomy or other partial breast trauma.

The first step in a fat transfer reconstruction is to expand the tissue on the chest to make room for fat transfer. Unlike an implant reconstruction, a fat transfer reconstruction does not aim to create an empty cavity to fill later. Fat is a living tissue, and for it to survive the transfer, it needs to be placed in well-vascularized tissue.

Instead of using a tissue expander to separate and thin tissue, a fat transfer reconstruction utilizes an external suction system that you will wear on your chest multiple hours a day for up to three months. The suction cups slowly expand the tissue, increasing the blood flow to the area.

After the tissue is adequately expanded, Dr. Maman will perform liposuction, usually on the stomach or hips, to harvest fat. Once the fat is processed to remove debris, dead cells, and extra fluid, it is injected into the prepared tissue on the chest.

Advantages of fat transfer reconstruction include:

  • No risk of fat grafts being rejected
  • Minimal scarring
  • Shorter hospital stays and recovery time
  • Unwanted fat is minimized

The disadvantage of a fat transfer is that it often takes multiple sessions to reach your desired cup size. There is also a risk that your body will resorb some of the fat transfer, leaving you with a lumpy reconstruction.

Autologous breast reconstruction

Like a fat transfer, autologous reconstruction, also called perforator flap reconstruction, uses tissue from different parts of the body to create a new breast.

Autologous reconstruction is highly complex and requires advanced microsurgery techniques to be successful, but it also delivers long-lasting results that look, feel, and move like natural breasts. This technique is also more successful for delayed breast reconstruction or a revision of the original reconstruction.

A DIEP flap is the most common type of autologous reconstruction. In a DIEP flap surgery, Dr. Maman will make a long incision along the pubic line and remove a section of skin, fat, and blood vessels from the abdomen. This piece of tissue is shaped to form the breasts and connected to blood vessels in the chest, then the abdomen is closed using tummy tuck techniques.

Possible Challenges

If you’ve had or are considering breast reconstruction with implants, it’s important to know about the possible risks and maintenance required over time.

Breast implants usually don’t last a lifetime. It’s common for women who have implant reconstruction to have one or more additional surgeries at some point, either to address a complication or improve how their breasts look and feel. The longer you have implants, the greater your risk of having a complication. However, implants don’t have an expiration date and there’s no need to replace them unless you have a problem.

Breast implant reconstruction surgery carries many of the same risks as a mastectomy or other breast surgeries, such as:

  • bleeding
  • problems with anesthesia
  • infection around the treatment area
  • wound healing problems like hematoma (blood collecting in a surgical wound) or seroma (clear fluid collecting in a surgical wound)
  • unexpected scarring
  • implant rupture
  • implant displacement
  • capsular contracture

Before you decide whether to have breast implant reconstruction, you should talk with your medical team about the risks and benefits, and other options such as autologous (“flap”) reconstruction or no reconstruction (“going flat” or aesthetic flat closure).

If you have implant reconstruction, keep in mind that about once a year you’ll need to see a healthcare professional (such as a breast surgeon or plastic surgeon) who can check your implants for rupture and other problems.

Recovery Periods

You are likely to feel tired and sore for a week after implant surgery, or longer after a flap procedure (which will leave you with 2 surgical sites). Your doctor will give you medicines to help control pain and other discomforts.

Depending on the type of surgery you have, you will most likely be able to go home from the hospital within a few days. You may be discharged with one or more drains in place. A drain is a small tube that’s put in the wound to remove extra fluid from the surgery site while it heals. In most cases, fluid drains into a little hollow ball that you’ll learn how to empty before you leave the hospital. The doctor will decide when the drains can be safely removed depending on how much fluid is collected each day. Follow your doctor’s instructions on the wound and drain care. Also, be sure to ask what kind of support garments you should wear. If you have any concerns or questions, ask someone on your provider.