BREAST RECONSTRUCTION

General Information

DEFINITION--Reconstruction of the female breast during mastectomy (see in Surgery section) or at a later date. You and your surgeon should have a clear understanding of what is to be done during surgery, but the surgeon will need some leeway in case unexpected problems occur.

BODY PARTS INVOLVED--Breasts; chest wall muscles.

REASONS FOR SURGERY--Reconstruction of the breast following a mastectomy for breast cancer is usually done for psychological and cosmetic reasons. It is becoming the standard procedure and is normally covered by medical insurance.

SURGICAL RISK INCREASES WITH

• Obesity; smoking.
• Excess alcohol consumption.
• Recent or chronic illness.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--Plastic surgeon; general surgeon or oncology surgeon (sometimes).

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: As required for the mastectomy procedure.
• After surgery: As required for follow up of cancer therapy or monitoring.

ANESTHESIA--General anesthesia by injection and inhalation, with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

Several options are available and additional methods are undergoing development:

• During mastectomy: If there is sufficient muscle and skin to cover the implant, a simple silicone gel bag implant may be all that is required. If additional muscle and skin is needed, it is brought in (usually from a nearby location on the body) to cover the implant.
• Temporary expander: During the mastectomy or later, a silicone bag with a separate valve is implanted under the skin and muscle. It is inflated at intervals over a 6-week period to expand the skin and muscle. The expander is then replaced by a permanent implant.
• Tissue to form a "new breast" is obtained from the abdominal wall or back. An implant is not necessary. This procedure produces the most normal and natural breast in appearance and feel.
• In some patients, the other (noncancerous) breast may be altered to better match the reconstructed breast.
• The nipple-areola area can also be reconstructed. This is generally done after breast reconstruction healing so that the positioning is correct. Skin may be grafted from the inner thigh near the groin. Color may be added by tattooing. For some patients, the nipple area may be preserved during mastectomy and used in reconstruction.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Accumulation of blood or fluid under the surgical area.
• Limited shoulder motion.
• Capsular contracture (hardening of the implant).
• Failure of the implant due to slippage, rupture, infection or scarring.

AVERAGE HOSPITAL STAY--6 to 8 days if done with mastectomy. Follow up procedures may require shorter times or be done on an outpatient basis.

PROBABLE OUTCOME--Expect complete healing without complications. Allow about 6 weeks for recovery from surgery.

Postoperative Care

GENERAL MEASURES

• Bathe and shower as usual. You may wash the incision gently with mild unscented soap.
• Use warm compress to relieve incisional pain.

† You may use non--prescription drugs, such as acetaminophen, for minor pain. Avoid aspirin.

ACTIVITY

• Return to work and normal activity as soon as possible.
• Perform implant exercises to help reduce the risk of capsular contracture. Ask your doctor.
• Your doctor may recommend special exercises to aid in recovery of arm mobility.

DIET---No special diet.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.