Breast Reconstruction


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Breast Reconstruction

Breast Reconstruction
Are You A Good Candidate
Meeting With The Doctor
How The Procedure Is Performed
What To Expect After Surgery
Possible Side Effects And Risks
How Long Will The Results Last
Questions You May Have

Breast Reconstruction
New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast in cases where the breast had to be removed due to cancer or other disease. The first step in breast reconstruction is the creation of the breast mound. In some cases, this step can be performed during breast removal surgery so the patient wakes up with the breast mound already in place. Follow-up steps may include replacing a tissue expander with an implant or reconstructing the nipple areola region.

Post-mastectomy surgery can be a fairly complex procedure, but one that can dramatically improve your appearance and quality of life after breast removal surgery. The doctors at The Metropolitan Institute for Plastic Surgery specialize in all aspects of breast reconstruction. With their guidance and support, you can determine the best reconstruction approach for you and be assured of a safe surgery and the outcome that you desire.

Are You A Good Candidate for Breast Reconstruction?
Most mastectomy patients are good candidates for reconstructive breast surgery. The best candidates are women whose cancer has been entirely eliminated by breast removal surgery. It is also important that you fully understand the reconstruction options available to you, the impact of the procedures you are considering, and the results that can be achieved.

Meeting With The Doctor
You can begin to think about and plan your breast reconstruction surgery as soon as you feel comfortable doing so after you decide to undergo a mastectomy. The doctors at The Metropolitan Institute for Plastic Surgery will meet with you at length to discuss your reconstruction options and to ensure that you understand and feel comfortable with the procedure. They will also work closely with your breast surgeon to develop a breast removal strategy that will put you in the best possible position for breast reconstruction surgery.

During your initial consultation, the doctors and staff at The Metropolitan Institute for Plastic Surgery will evaluate your health and explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. They will also:

� Clearly discuss the potential risks of the procedure
� Explain which type of anesthesia will be used, where the surgery will be performed, and how long a hospital stay is required
� Outline in detail how the surgery is performed and what you can expect before, during, and after the procedure
� Provide detailed cost, payment, and insurance information
� Discuss with you the current FDA regulations governing the use of implants
� Answer all your questions

You will be asked to provide:
� Details about your medical history
� A list of all medications you currently take including over the counter medications such as aspirin, vitamins, and herbal supplements
� Information regarding your tobacco and alcohol consumption.

How The Procedure Is Performed
Breast reconstruction surgery usually involves more than one operation. The first surgery can either be performed at the same time as your mastectomy or after you have recovered from your breast removal surgery. If performed after your mastectomy, the first stage of your breast reconstruction will be performed at an area hospital chosen by you and your doctor and a stay of two to five nights may be required. Follow-up procedures such as nipple/areola reconstruction are usually performed at one of the region's premiere accredited outpatient-based surgical facilities -- the Center for Ambulatory Surgery, Inc. (CASI) -- or as an outpatient procedure at one of the area hospitals.

Many women are candidates for breast conservation based on tumor type and size. The plastic surgeons (link to About_Bio Drs.doc) at The Metropolitan Institute for Plastic Surgery work very closely with your breast surgeon to provide appropriate treatment of your cancer and the most aesthetic possible outcome. Oncoplastic rearrangement of your breast and chest tissue allows your breast surgeon to aggressively treat your cancer with cosmetically acceptable incisions and shape in mind.

For women who choose or require mastectomy, a number of reconstructive options exist. The simplest form of reconstruction entails placing a balloon expander under the skin and chest muscles at the time of the mastectomy. After the incisions are healed, the expander is periodically injected with a sterile saltwater solution. Once the expander has been filled to a sufficient size, a second surgery is performed to remove the expander, to place the permanent implant, and to adjust the pocket to shape the breast.

As another option, the doctor uses your own tissue to recreate the breast. The latissimus dorsi muscle from the back may be used in conjunction with an implant for one stage reconstruction of the breast mound. This option is especially valuable to women who do not have enough of their own tissue to recreate a breast mound that matches the native breast and do not wish to undergo the process of expansion.

The doctor may be able to complete the reconstruction with your own tissue alone. Tissue from another area of the body, usually the abdomen, buttocks, or thigh, is transferred up to the chest area. Sometimes it may remain attached to its own blood supply (pedicled) or fully detached and re-attached to new blood supply in the chest region using a microscope (free flap). The most common tissue used is the lower abdominal tissue or transverse rectus abdominis myocutaneous (tram) flap. Occasionally most, if not all, of the muscle may be preserved. This type of flap is called a muscle sparing or DIEP Flap. The doctors at The Metropolitan Institute for Plastic Surgery are particularly skilled in the micro vascular transfer of the muscle sparing or DIEP flap.

What To Expect After Your Surgery
Activity When

Hostpital Stay Two to Five Days

Stitches Removed Week to Ten Days

Shower or Bath Once Drains Are Removed

Back to Work One to Two Weeks After Surgery

Driving Usually Within Two Weeks After Surgery

Physical Contact With Breasts Four Weeks After Surgery

Strenuous Activity Three to Six Weeks After Surgery

Fading of Scars Several Months to One Year

Immediately After Your Surgery
You can expect to stay in the hospital from two to five nights after your surgery, depending on the extent of the surgery and whether or not it was performed at the same time as your mastectomy. It is important to have someone drive you home from the hospital and to stay with you for a few days after you return home.

You most likely will feel sore and tired for up to a week after surgery. Pain medication will be prescribed to alleviate as much post-surgery pain as possible. You will also have some bruising, swelling, and numbness in the area of your surgery.

For nipple reconstruction, your surgery will be performed on an outpatient basis and you most likely will return home shortly after surgery. Again, it is wise to have someone drive you home and stay with you for a day or two after surgery. Discomfort should be mild and can be controlled with prescribed pain medication.

The First 24 to 48 Hours After Your Surgery
During the first 24 to 48 hours after your procedure, you will feel tired from the anesthesia and sore from the surgery. The doctor will prescribe pain medication to alleviate much of the discomfort. Your discomfort level will improve rapidly after the first two days.

A gauze dressing is placed over your reconstructed breast after surgery. This dressing will be removed in seven to ten days. In addition, a special elastic bra may be placed over your reconstructed breast to hold it in the correct position for healing. This bra must be worn at all times (even while sleeping) for the first two weeks after your surgery.

You may experience some minor bleeding or oozing in the areas of your incisions. This bleeding or oozing usually results in a slight staining of the gauze dressing placed over your breast. If more than a slight staining of the gauze occurs, call the staff at The Metropolitan Institute for Plastic Surgery.

The First Two Weeks After Surgery
You will notice a marked improvement in your discomfort level during the first few weeks after your surgery.
� You should be able to return to work within one to two weeks after your surgery.
� The surgical drains used to remove excess fluid from the surgery site will be removed within the first few weeks of surgery.
� The gauze dressing placed over your breast will be removed in seven to ten days from the surgery.
� Your stitches will be removed within a week to ten days of surgery.
� Any bruising you experience will usually disappear in about two weeks.

During the first two weeks after surgery, you should also:
� Wear the specialized elastic bra provided by The Metropolitan Institute for Plastic Surgery at all times, even while sleeping, to help hold your reconstructed breast in the correct position. You may take the elastic bra off to shower or bathe, but must put it back on immediately after drying off.
� Avoid heavy lifting and straining for at least three to six weeks as instructed.

Resuming Your Normal Routine
Everyone heals at different rates and you are the best judge of when you are ready for certain activities, but the following are general guidelines:

� You can most likely return to work within one to two weeks from the date of your surgery, unless your work is strenuous.

� You can resume driving as soon as you experience no pain when you turn the steering wheel, usually within two weeks for cars with power steering and a little longer for manual steering.

� Two weeks after surgery, you can begin to sleep without the special elastic bra you've been wearing. However, you should continue to wear this bra during the day for four to six weeks after your surgery.

� You should not go braless, except while sleeping, for four to six weeks following your surgery. At your follow-up appointment, the doctor will let you know when you can begin to go without a bra.

� Strenuous exercise can begin about three to six weeks after surgery; the doctor will give you specific instructions on when to return to your exercise program.

� The scars on your breast should be protected from sunlight for at least a year after surgery.

Things To Be Aware Of After Your Surgery
� It may take up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps or if reconstruction is done apart from mastectomy, your recovery time may be less.

� Reconstruction cannot restore normal sensation to your breast, but over time some feeling may return.

� The skin of your reconstructed breast may appear shiny due to swelling. Within a few weeks, the swelling will disappear and the skin will return to a normal appearance.

� Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy nor will it match your natural breast exactly.

� Most scars will fade substantially over time; though it may take one or two years for them to become much less visible.

What Are The Possible Side Effects or Risks?
Like all surgical procedures, there are risks associated with breast reconstruction. During your pre-surgery consultation with your doctor, your individual risks will be assessed and discussed in detail. As with any surgery, you can help reduce the risks associated with your breast reconstruction by closely following the instructions provided to you by the staff of The Metropolitan Institute for Plastic Surgery. And, the doctors and staff at the Institute will be with you every step of the way to ensure a safe and pleasing outcome.

Possible side effects include:
� Capsular contracture (if an implant is used)
� Infection
� Fluid collection
� Wrinkling of the skin
� Scarring
� Hematoma

It should also be noted that women who have had breast reconstruction should request a mammogram technician experienced in the special techniques needed to get a reliable x-ray of a reconstructed breast when undergoing their annual mammograms.

How Long Will the Results of Your Breast Reconstruction Last?
While breast reconstruction cannot exactly duplicate your natural breast, it can provide women who have lost a breast to cancer or other disease with a natural looking appearance and an improved quality of life. Breast reconstruction is permanent; however, some sagging may occur as the natural result of aging.

Questions You May Have
� Does breast reconstruction surgery have any effect on the recurrence of cancer or other breast disease?
Reconstruction has no known effect on the recurrence of cancer or breast disease, nor does it generally interfere with chemotherapy or radiation treatments should the cancer recur.

� Will my insurance coverage pay for my breast reconstruction?
Generally, breast reconstruction (and nipple reconstruction) is covered by insurance. The staff at The Metropolitan Institute for Plastic Surgery will work with you to obtain pre-approval from your insurance company.

� Are there alternatives to breast reconstruction surgery?
Many women choose not to have breast reconstruction immediately following breast removal, electing to wait until they are ready for another surgery or to wear some form of a prosthetic breast. This is a personal decision and differs from woman to woman.

� Are there ways to correct the look of my remaining breast if it is not symmetrical to my newly created breast?
A symmetry operation is often planned to provide a matching breast in size and shape to the reconstructed breast. This procedure may include a reduction, lift, implant, or a combination of techniques. The goal is to finish the reconstructive process with an aesthetically acceptable and matching pair of breasts.