In many cases, women are not entirely sure of their options after cancer and mastectomies. Breast reconstruction is a surgical process which helps to reshape and redefine the breasts through various plastic surgical methods. Although this surgery gives the look of natural breasts and can mentally help you regain your confidence to heal, there are certain aspects that will not be the same as before.
For example, a reconstructed breast will not have the same sensations and feeling as the breast it replaces does. Incision lines from surgeries and plastic surgery will be present for life. During certain surgeries where skin is grafted from a donor site on your body, you will also have scars there. Most often, those places are more hidden, like the back, abdomen or buttocks.
Recent studies have revealed that 89% of cancer patients want to see examples of breast reconstruction surgery results before committing to or undergoing their own cancer treatments. In the United States this year, less than a quarter of women being treated for various types of breast cancer knew of the wide range of breast reconstruction options available, which is about 23%. Only 22% of women are familiar with the quality of outcomes that can be expected after surgery, and only 19% more understand that the timing of their treatment for breast cancer and the matched timing of their decision to undergo reconstruction greatly impacts their options and results (ACS).
Types of Reconstruction Available
Reconstruction can either be done immediately at the time of the mastectomy or delayed until a later time. This decision is most often prompted by the stage of your cancer, and your medical care teams decision on how you might recover.
Immediate reconstruction has proven to be a safe option for many women. With this type of surgery, the breast mound creation is done at the same time as the mastectomy. This has proven to help minimize the negative effects on self-image immediately after surgery, which helps with self-esteem. Immediate reconstruction also requires fewer anesthetics and anesthesia to get through the surgery, which is a bonus for your body. If you think an immediate reconstruction is for you, please consult your physician or medical care team to discuss.
Generally, delayed reconstruction is done months after the initial mastectomy, and after other cancer treatments have been finished. Usually, this time frame is six to nine months following the completion of radiation therapy to allow the body and chest skin to recover and heal before another surgery for reconstruction.
There are three different types of breast reconstruction:
- Autologous Reconstruction which is done by building a breast mound with tissue from another part of your body.
- Autologous Tissue with Implant
- Reconstruction using Implants in which an implant filled with silicone gel or saline to recreate the breast mound is used.
Your medical care team and plastic surgeon will discuss these methods and help you choose the option that will be best for your outcome and health. If only one breast is affected, it alone may be reconstructed, and, in some cases, a breast lift or augmentation is done on the other breast to help “match” them to your body.
Breast reconstruction using implants often requires an expander to be placed to make room for the implant itself. After your mastectomy, a temporary tissue expander is placed in the breast to create the soft pocket that will eventually hold your permanent implant. Once this process is complete, the expander will be removed, and the implant put in. If you are having this type of reconstruction, here is a baseline estimate for how many days and recovery times expected.
- Hospital Stay for Mastectomy and Expander: 1 to 2 days
- Recovery Time after Mastectomy and Expander: 4 to 6 weeks
- Hospital Stay for Implant Exchange: outpatient
- Recovery Time after Implant Exchange: 1 to 2 weeks
If you are having your implants placed directly after your mastectomy, you will not need a tissue expander. This method can make recovery time and surgical times much less but can also result in more surgeries down the road. Here is the estimated time you as the patient will spend in the hospital and recovering with this method.
- Hospital Stay: 1 to 2 days
- Recovery Time: 4 to 6 weeks
If you are having Flap reconstruction, which is the most common method of tissue reconstruction, you will have tissue removed from one place of your body and moved to help create a breast shape after a mastectomy. Usually, this skin is removed from the abdominal muscle, but can also be taken from the back, thighs, and buttocks.
If the skin is removed from the abdomen, the scar will most likely extend from hip to hip. Hospital stay time is 2 to 5 days, and recovery time can be several weeks to several months.
If your doctors choose to do an abdominal free flap procedure, your hospital stay will be 3 to 5 days and recovery time remains several weeks to several months.
If your procedure uses tissue from your back, the latissimus dorsi flap is created, and the most commonly combined with implant surgery. In this procedure, the muscle flap with or without attached skin is removed from the back and implanted into the breast. The scar left on the back can most often be covered with a bra strap, and the breast will have a feeling of real skin and smoothness. With this procedure, the hospital stay is 1 to 3 days, and recovery time is listed at several weeks.
If your flap reconstruction removes tissue from your buttocks, your hospital stay will be on the longer end at 5 days, and recovery time is several weeks. This is a bit more difficult than the other flap reconstruction options and can be harder to shape into a breast.
Thigh tissues used as flap reconstruction will take 3 to 5 days in the hospital, and several weeks for recovery. The tissue is most often removed from the inner thigh and reattached using microsurgery to the breast. The scar left on the thigh is generally hidden.
Breast Reconstruction Risks and Safety
Any decision you make to have a breast reconstruction after mastectomy is a very personal one. You will have to decide if the benefits will help you to reclaim your confidence and self-image, along with self-esteem. You’ll have to weigh all of the options, hospital stay time, and healing time.
The risks associated with breast reconstruction as the same as any other major surgery. Your surgeon and doctors will cover all of the information with you, and you will be required to sign off on the information and risks once you have learned them. The direct risks from breast reconstruction are bleeding, infection, incisions that are slow to heal, and anesthesia risks. There are also certain risks that come specifically with flap reconstruction, which includes total or partial loss of the flap and further loss of sensation at the site of the flap. Using implants, either saline or silicone gel, carry a risk of rupture or hardening, losing the real-feel of breasts.
Breast implants and reconstruction do not impair breast health. If you have questions about breast reconstruction please contact your oncologist, physician or medical care team to make an appointment to cover all of your options.