Breast Reconstruction

The choice to have breast reconstruction after loss of a breast is very personal. Many women tell us that loss of a breast is a very emotional experience and that reconstruction makes them feel whole again. Other women are more practical and just want to fit into clothes, especially swimming suits that are designed for women with breasts. Still other women can’t imagine having surgery they don’t need to have. So as stated earlier, this is a very personal choice.

Breast reconstruction is achieved through several reconstructive options that attempt to restore a breast to near-normal shape, appearance and size following mastectomy. Although breast reconstruction can rebuild your breast, the results are highly variable. A reconstructed breast will not have the same sensation and feel as the breast it replaces. There will always be visible incision lines on the breast whether from reconstruction or mastectomy.

For women who have lost only one breast, an additional procedure will likely be required on the opposite side to improve symmetry. That may involve breast implants, breast reduction or breast lift. You can read about those in other sections of this website.

Federal law requires insurance companies to cover breast reconstruction and procedures to improve symmetry of the opposite breast.

The Procedures:

There are two main categories of breast reconstruction techniques. The main difference is whether the reconstruction is done with or without a breast implant. The other main choice is whether to do the reconstruction at the time of the mastectomy (immediate reconstruction) or do delayed reconstruction.

Reconstruction with an implant may be done with a single procedure that places a breast implant under the skin and muscle of the chest. This technique is the easiest and fastest technique but many women are not good candidate for this technique to the their body shape, previous surgery or radiation.
Implant reconstruction is often done as a staged procedure that begins by placing a tissue expander that is gradually inflated with weekly injections in the office. The expander is a high-tech empty balloon that is used to expand the skin and muscle the same way the skin of the abdomen gradually expands with pregnancy. The expander is later removed and replaced with a breast implant.
“Flap” reconstruction means that another part of your body is moved to the chest to reconstruct a breast. One of the most common flap reconstructions is a TRAM flap that uses muscle, fat and skin from the abdomen to reconstruct the breast. This has the added benefit of a tummy tuck that flattens the abdominal wall.
To further complicate things, a flap is sometimes used in combination with a flap. A latissimus dorsi muscle flap uses muscle, fat and skin from the back that is moved into the mastectomy site and remains attached to its donor site, leaving blood supply intact. The latissimus flap usually requires an implant to be added for volume, as it is a relatively thin portion of the body.

These procedures frequently involve the use of acellular dermal matrix such as AlloDerm. AlloDerm is human dermis with all of the cells removed.

It is impossible to cover all of the possibilities for reconstruction on the website. Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. Some patients have scars from previous surgeries that prevent the use of some muscle flaps. The best way to learn what is available is to schedule a personal appointment. We schedule extra time to discuss breast reconstruction so that we can give you our full attention and provide you the most information we can to help you make the best decision. We encourage you to bring your spouse/partner, daughter or friend to help you listen and decide what will best meet your needs.

Expected Side Effects:

Given the wide variety of procedures for reconstruction, it is not possible to list all of the side effects and risks but in general the following applies:

Pain
Scars
Fatigue

Risks:

Asymmetry
Poor healing resulting in conspicuous scarring or skin loss
Bleeding or fluid collection under the skin which could require more surgery
Infection – requiring removal of the expander or implant
Bleeding – requiring additional surgery
Blood clots in the legs leading to blood clots in the lungs
Death related to anesthesia

The subject of breast reconstruction is broad and ever changing. It is too extensive to cover completely in this space. You may find additional information at PlasticSurgery.org or BreastReconstruction.org.

Learn More About the Procedure

Click below to learn what to do before and after the procedure.

Before Your Procedure

Prior to surgery, you will have a pre-operative office visit.

At this visit, we will: Take your payment and answer any questions you may have regarding the procedure. At this time, Dr. Frost may not be available, but if you would like to speak with him again, please let us know and we will schedule this visit when he is available. Provide you with any prescriptions that you may need for after surgery. We encourage you to have these prescriptions filled prior to your surgery to avoid having to stop at the pharmacy after your procedure. Please let us know if you have any specific pain medication requests, and we will try to prescribe the medication that works best for you. Make arrangements for any necessary pre-operative evaluations that need to be performed, such as blood tests, pregnancy testing, EKG, etc.

Diet and Medications:
Please, DO NOT eat or drink ANYTHING after midnight prior to your surgery. This is VERY important. Your surgery will be CANCELLED if you eat or drink anything after midnight. The only exception is a sip of water with any medications that you must take. Generally, you should take high blood pressure and heart medications. Do NOT take arthritis medications and do NOT take diabetic medications (including insulin), unless specifically instructed to do so.

Bathing and Clothing Prior to Surgery:
Please take a shower and use antibacterial soap the night before and the morning of your surgery. Wear loose fitting, comfortable clothing such as a front button shirt and loose pants since these items are easier to put on and take off after surgery.

After Your Procedure

Diet:
Take it slow and easy with your diet. Start with clear liquids and simply advance as tolerated. It is normal to have some nausea from the anesthetic and pain medication, but by taking it easy, this should quickly resolve.

Activity:
Take it easy, Walking is good, bouncing is bad. A good rule of thumb is: “If it hurts, don’t do it.” You may feel like you cannot stand up straight. Feel free to walk bent-over for the first week or so. You will be able to stand straight (and proud) soon. As you start to feel stronger, you may gradually increase your activity. Do not plan to drive for 2 to 3 weeks since restricted movement may limit your response time in an emergency. Do not do any abdominal exercise for at least a month to six weeks. Actually, if we tighten the muscles enough, you may never do another sit-up again!

Pain:
We want to help limit your pain as much as possible, but we will not be able to take it all away. The goal of pain medication is to prevent pain, so do not wait until you are really hurting to take your medication. Follow the directions on your prescription to stay ahead of the pain and experience the highest level of pain relief possible. Narcotics can cause constipation, so drink plenty of water, eat fruit and use an over-the-counter laxative, if needed.

Post-Operative Dressings and Bathing:
Leave your compression bandages on day and night. There will be plenty of time to examine your results later, but no peeking right now. Sponge-bathe. There will be tape across the incision that will stay on while showering, so simply shower over the tapes that cover the incision and pat them dry. There will be changes over the months following your surgery, so do not judge the results too early.

Before and After Examples

Photo	Information
	BEFORE Age:47 Concern:Breast cancer left side with concern for right side disease Treatment:Bilateral mastectomies, tissue expanders with later implants Implants:Allergan High Profile Round Silicone; 475 cc Note:Patient declined nipple reconstruction
	AFTER
	BEFORE Age:69 Concern:Desires reconstruction 1 year after mastectomy and reconstruction Treatment:Left breast lift; Right breast reconstruction with expander followed by implant and later nipple reconstruction Implants:Allergan Moderate Profile Round Silicone; 475 cc
	AFTER
	BEFORE Age:49 Concern:Ductal Carcinoma in Situ recurrent after lumpectomy; requested smaller breasts Treatment:Bilateral mastectomies, tissue expanders with later implants Implants:Allergan Moderate Profile Round Silicone; 500 cc Note:Patient declined nipple reconstruction
	AFTER
	BEFORE Age:63 Concern:Thirteen years after left mastectomy for breast cancer Treatment:Right breast reduction; Left breast reconstruction with expander followed by implant Implants:Allergan Highly Cohesive Anatomically Shaped Silicone; Size 580 cc Note:Patient declined nipple reconstruction
	AFTER
	BEFORE Age:73 Concern:Mastectomy 30 years earlier. Tired of weight of prosthesis Treatment:Left breast lift; Right breast reconstruction with expander followed by implant and later nipple reconstruction Implants:Allergan Highly Cohesive Anatomically Shaped Silicone; Size 580 cc Note:Patient previously fitted breast prosthesis for mastectomy patients
	AFTER