Breast Reconstruction

Overview

Being diagnosed with breast cancer or having a genetic predisposition to breast cancer can be physically and emotionally traumatic. The removal of a breast (mastectomy) often adds to the psychological trauma. Breast reconstruction following the surgical removal of a breast can help a woman cope with this stress and regain a sense of normalcy.

The breast reconstruction specialists at UPMC’s Department of Plastic and Reconstructive Surgery use state-of-the-art techniques that can create a natural-looking breast and help patients regain a positive body image.

When patients are diagnosed with breast cancer and want immediate breast reconstruction, UPMC plastic surgeons work as part of a multidisciplinary team that includes:

• Surgical oncologists
• Radiation therapists
• Oncology physicians and nurses

Breast reconstructions can be done as an autologous tissue reconstruction, which uses the patient’s own tissues to reconstruct a new breast mound, with a breast implant, or a combination of the two.

Who Is a Candidate?  

If you already had a mastectomy, or are anticipating a mastectomy, you may be a candidate for breast reconstruction. In general, age is not a limiting factor. If you are healthy enough to undergo a surgical operation, you are most likely a candidate for one of the breast reconstruction techniques outlined below. 

Risks

All surgical procedures carry risks. In addition to risks associated with anesthesia, the risks vary greatly between the different procedures but all procedures are considered major surgery. Not every person is a candidate for breast reconstruction, and your risks may be greater or different than those of other patients. Your plastic surgeon will review all potential risks and complications with you prior to surgery. 

Types of Breast Reconstruction Surgery

Autologous (flap) reconstruction

An autologous, or flap reconstruction, technique uses your own tissues to recreate a breast after a mastectomy. Autologous reconstructions can appear more natural than implant reconstructions, and tend to be more durable, thereby possibly avoiding additional operations.

• Transverse rectus abdominus myocutaneous (TRAM) flap — The surgeon relocates a flap of skin, fat, blood vessels, and muscle from your abdomen to the breast area. This procedure also can be done as a free flap in which blood vessels are reconnected to vessels in the chest.
• Deep inferior epigastric perforator (DIEP) flap — The surgeon removes only your skin and fat, and spares the abdominal wall muscles, which results in a shorter recovery time and less abdominal muscle weakness. If your anatomy is appropriate, the surgeon may opt to perform this procedure instead of the more conservative TRAM flap procedure.  
• Other microvascular reconstructive options include variations of these flap procedures — SIEA, SGAP, TUG, and Reuben.

Prosthetic implant reconstruction

The use of saline or silicone implants can be an excellent option for breast reconstruction. If you do not require radiation therapy, and lack sufficient autologous tissue in your lower abdomen to create adequate breast volume, you may be a good candidate for this type of reconstruction.

Following a mastectomy, surgeons insert a skin expander beneath your skin and chest muscle. Over the course of several weeks, surgeons adjust the expander and eventually perform a second operation to insert the implant and reconstruct the surrounding skin and areola. If you do not require a tissue expansion, you can receive a breast implant immediately following the mastectomy. Breast implant technology has improved greatly over the past decade, and good reconstructions are achieved in most patients.

Partial breast reconstruction/oncoplastic breast reconstruction

Many women with breast cancer are able to be treated with breast conservation therapy (BCT), in which the tumor is removed via segmental mastectomy (lumpectomy) followed by radiation therapy. Although many patients heal well with acceptable cosmetic results, some develop abnormal breast contours, shapes, or asymmetries. Prior to the surgery, potential cosmetic problems from BCT can be anticipated in some women, especially if the tumor is larger, if the breasts are small to moderately sized, or if the area of tissue removal is in a cosmetically sensitive location.

Partial breast reconstruction can be helpful in many women who have unsatisfactory results after BCT. In this approach, a variety of techniques are used to improve shape, contour, and size discrepancies between the breasts. 

Oncoplastic breast reconstruction refers to the use of multiple techniques being done simultaneously with the segmental mastectomy, so that reconstruction can be done immediately. 

Before the Procedure

Your plastic surgeon will speak with you about your goals, take an in-depth history of your cancer diagnosis, and perform a detailed physical examination to help you arrive at a decision about which breast reconstruction method is best for your particular situation.

Some of the specific instructions you’ll receive about preparing for surgery include:

• Smoking cessation
• Medications to avoid
• When to take your prescribed medications
• Proper washing techniques
• Restrictions regarding eating and drinking the night before surgery

Where Will the Surgery Be Performed?  

The surgery is performed in a hospital, and the length of stay depends on the type of procedure that is performed. You must be driven to and from the hospital by a friend or family member.

Type of Anesthesia

Primary breast reconstruction is performed under general anesthesia. Smaller second stage and touch-up procedures may often be performed under sedation or with local anesthetic alone.

Breast Reconstruction Surgery Recovery

Patients who have implant-based breast reconstruction and patients having oncoplastic reconstruction usually stay one night in the hospital. Autologous breast reconstruction patients typically stay in the hospital three or four days after surgery. All patients are out of bed the day after surgery, and walking in the halls within a few days. 

Short-term Recovery

In most cases, patients who have implant-based breast reconstruction and patients having oncoplastic reconstruction return to normal activities (walking, stairs, grocery shopping, and driving) within a week after surgery. They may return to work about two weeks after surgery. 

Autologous breast reconstruction patients also return to normal activities quickly, within a week or two after surgery. They generally return to work after four weeks.

Most patients will have restrictions on lifting for a period of time, and they can drive when they are no longer taking pain medications. Showering is permitted after two to three days, but may take longer if drains remain in place. Vigorous physical activity is limited for several weeks following surgery.

Anticipated Results

The main goal of breast reconstruction is to create breast symmetry while wearing clothing. Many patients are able wear clothing more comfortably following surgery, including bathing suits. Your plastic surgeon will discuss the different techniques available, and help you decide which one fits your individual needs and lifestyle.