Breast Reconstruction

A person with breast cancer may need surgery to remove part or all of one or both breasts. Breast reconstruction can help cancer patients regain a sense of normalcy.

The breast reconstruction experts at UPMC's Department of Plastic and Reconstructive Surgery use state-of-the-art techniques to create natural-looking breasts.

UPMC plastic surgeons work as part of an expert team to rebuild the breast during breast cancer surgery. This team includes:

Cancer doctors and nurses.
Cancer surgeons.
Radiation doctors.

What is Breast Reconstruction?

Breast reconstruction is plastic surgery to restore the shape, size, symmetry, and look of your breasts after breast cancer surgery. You may need or want this done after:

Mastectomy. This surgery removes one or both of your breasts. A surgeon may do a breast removal to take out cancer or reduce the risk of getting cancer.
Lumpectomy. This surgery removes part of your breast because of breast cancer.

Is Breast Reconstruction Right for Me?

Breast reconstruction may be right for you if:

You will have a breast removal or lumpectomy as part of your breast cancer treatment.
You have already had a breast removal or lumpectomy.
You are healthy enough to undergo more surgery. In general, age is not a limiting factor.
You have help taking care of yourself after surgery.

You may not be a good candidate if:

You don't want to go through more surgeries.
You are in poor health.
You have certain lifestyle factors, such as smoking, that may make it longer to heal from surgery.
You don't have enough extra tummy/thigh tissue and don't want implants. (Implants may be your only option if you've had tummy/thigh surgery in the past.
You don't have help to take care of yourself after surgery, and you will need it.

Alternatives to breast reconstruction

Some people who have one or more breasts removed choose to remain flat after their breast removal. If you don't want to rebuild the breast, talk to your surgeon about options. They can lessen scarring and create the best flat look.

You may also wear a prosthetic breast in your bra instead. This can help even out your shape.

The rebuilding process you choose will also depend on whether your insurance covers changes to a healthy breast.

Types of Breast Reconstruction

Breast reconstruction may include one of the following surgeries.

Autologous (flap) reconstruction

An autologous, or flap, reconstruction uses your tissues to create a breast. The results from this surgery can look and feel more natural than implants. They are often more durable, so they may not require more surgeries.

There are several types:

Pedicled Transverse rectus abdominus myocutaneous (pTRAM) flap. The surgeon relocates a flap of skin, fat, blood vessels, and muscle from your abdomen to the breast area.
Microsurgical abdominally-based flap reconstruction: The surgeon removes only your skin and fat, sometimes with a small amount of muscle, to rebuild the breast. This results in a shorter recovery time and less abdominal muscle weakness. These flaps are called msFTRAM, DIEP, or SIEA flaps and vary in amount of muscle inclusion.
Microsurgical thigh-based flaps: These include PAP flaps, TUG flaps, and LTP flaps.
Other Microsurgical Flaps: GAP flaps, Lumbar flaps

Prosthetic implant reconstruction

Many people choose saline or silicone implants. Prosthetic implants are an excellent option if one or both of the following are true:

You don't have enough autologous tissue in your lower abdomen to create a new breast.
You don't need radiation therapy.

For a reconstruction with an implant, surgeons may insert a skin expander during the breast removal surgery. Over several weeks, they adjust the expander. When the pocket is large enough, surgeons insert the implant and rebuild the skin and areola.

Some people don't need tissue expansion and can have a breast implant during or right after the surgery.

Partial or oncoplastic breast reconstruction

Many people with breast cancer can choose breast-conserving surgery. That's when surgeons remove only the part of the breast with the tumor, commonly called a lumpectomy.

A lumpectomy for breast cancer is often followed by radiation therapy. If you choose lumpectomy, your surgeon will talk to you about how these treatments change the look of the breast. Many people heal well from these treatments.

However, some have abnormal breast shapes. The breast that got the lumpectomy may look uneven next to the healthy breast. There are many ways to improve the shape, contour, and size of the breasts.

With partial breast reconstruction, additional surgeries fix the look of the breast. Oncoplastic means the plastic surgeon uses plastic surgical techniques to modify the breast to camouflage the lumpectomy defect.

Choosing the Option That's Right For You

Before planning any breast reconstruction, your surgeon will:

Speak with you about your goals.
Take an in-depth history of your cancer and other health history.
Perform a detailed exam.

This can help you decide which breast surgery method is best for you.

Questions to ask your breast surgeon

These questions may help you decide which reconstruction may fit your needs best:

Are you certified by the American Board of Plastic Surgery (ABPS)?
Will plastic surgery get in the way of chemotherapy or radiation therapy?
Can I have reconstruction right away or do I need to wait? What are the pros and cons of each option?
What options are available to me? What are the pros and cons?
What's the average cost of each type, and will my insurance cover it?
How many breast surgeries have you, the surgeon, done each year?
What results can I expect? Will my new breast look similar to my healthy breast?
Do I need surgery on the other breast so they both look alike? And will insurance cover that?
Can I have my nipple recreated, and how is this done?
How long will a breast implant last? What changes can I expect over time and with aging?
How will I know if it's ruptured?
What type of implant will you use: smooth or textured, saline or silicone?
What pain, scarring, or other changes can I expect on my stomach from flap surgery?
Will I have any feeling in my rebuilt breast, and how will they feel to touch?

Preparing for surgery

To prepare for surgery, the team will let you know:

When to stop smoking if you smoke.
What medicines to avoid.
When to take your prescriptions.
Proper cleaning and care for your wounds.
When to stop eating and drinking before surgery.

Where do I go to have reconstruction?

The main surgery for your breast reconstruction will happen in a hospital. Your length of stay depends on the surgery.

For surgery, a friend or family member must drive you to and from the hospital. You cannot drive yourself.

Type of anesthesia

You'll get general anesthesia for primary breast surgery. This is when medicines put you to sleep. For shorter second-stage and touch-up work, you get sedation and local numbing.

Breast reconstruction recovery

How long you will need to stay in the hospital for recovery depends on your surgery:

You will likely go home the same day as implant reconstruction and oncoplastic reconstruction.
You may spend three days in the hospital after autologous (flap) surgery.

You'll be out of bed and walking the day after surgery, and sometimes the day of surgery.

Short-term recovery

When you can go back to normal life depends on the type of surgery.

For implant-based and oncoplastic reconstruction, most people return to normal life within 1-2 weeks after surgery. They may return to work about two weeks after surgery.
For autologous (flap) breast reconstruction, people return to normal life 2-3 weeks after surgery. They often return to work after four weeks.

You can start driving again when you are no longer taking prescription pain medicine and your range of motion and reaction time are returned to normal. Your surgeon will tell you when you can take a shower.

You'll need to limit vigorous activity for several weeks following surgery. Most people shouldn't lift things for some time.

Planned Results

The main goal of breast surgery is to make the two breasts look the same when covered by clothing. Although often reconstruction can achieve symmetry even in a bathing suit, this result cannot be guaranteed due to the number of factors beyond the surgeon's control that maty affect results.

Risks and Safety

Breast reconstruction is a major surgery. Like all surgeries, it includes the risks of anesthesia and post-surgical infection. Each type of surgery also comes with risks.

Plastic surgery is not a good option for every person. You may face unique risks due to your health history. Your plastic surgeon will review these risks before surgery.

For the best results, choosing the right plastic surgeon is important. UPMC plastic surgeons work as part of your cancer care team. So, they know your health history and your goals.