After a mastectomy, some women choose to have cosmetic surgery to re-create their breast. This surgery can be performed during the mastectomy itself or later. Depending on the case, a breast reconstruction is performed using either breast implants or natural tissue (where the breast is reshaped using muscle, skin, and fat from another part of the body).

When natural tissue is used, the reconstruction process may take longer than when breast implants are used, but the size, fullness and shape of the new breast, may look and feel more natural. Using breast implants to reconstruct the breast usually results in less scarring. In cases where the reconstruction is performed at the same time as the mastectomy, the surgeon may be able to do a skin sparing mastectomy, where more skin is left behind to make the reconstruction easier.

Breast reconstruction with implants is usually done in 2 or 3 stages. The first stage involves using a tissue expander and then, in the second stage, a breast implant is placed. 3rd stage involves nipple and areola reconstruction.

In the first stage:

  • A tissue expander is placed under your chest muscle and skin. The expander is a pouch made out of silicone, similar to a balloon.
  • Your chest will still look flat right after this surgery.
  • Starting about 2 to 3 weeks after surgery, a small amount of saline (salt water) is injected through the skin into the pouch through a valve. This is done approximately every 1 to 2 weeks.
  • The pouch or tissue expander slowly enlarges the pouch in your chest to the right size for the implant to be placed.
  • When it reaches the right size, you will wait 3 to 6 months before the permanent breast implant is placed (the second stage).

In the second stage:

  • The tissue expander is removed and replaced with a permanent breast implant. This surgery takes 1 to 2 hours.

In the third stage:

  • You may have another minor procedure later that reconstructs the nipple and areola area.

 The 2 most common methods of breast reconstruction using natural tissue are transverse rectus abdominous muscle flap (TRAM) and latissimus muscle flap with or without a breast implant.

For TRAM surgery:

  • An incision (cut) is made across your lower belly, from one hip to the other. Your scar will be hidden later by most clothing and bathing suits.
  • Skin, fat, and muscle in this area is loosened. This tissue, which is used to create the new breast, is then tunneled under the skin of your abdomen up to the breast area. Blood vessels remain connected to the area where the tissue is taken from.
  • In another method, the skin, fat, and muscle tissue are removed from your lower belly. It is then placed in your breast area to create your new breast. In this method, the arteries and veins are cut and reattached to blood vessels under your arm.
  • This tissue is then shaped into a new breast. The size and shape of the new breast is matched to that of your remaining natural breast as closely as possible.
  • The belly incision is then closed with stitches.
  • If you would like a new nipple and areola created, you will need a second, much smaller surgery later.

For latissimus muscle flap with a breast implant:

  • An incision is made in your upper back, on the side of your breast that was removed.
  • The skin, fat, and muscle from this area is loosened and then tunneled under your skin to the breast area. This tissue will be used to create your new breast. Blood vessels will remain connected to the area the tissue was taken from.
  • This tissue is then shaped into a new breast. The size and shape will be matched to that of your remaining natural breast as closely as possible.
  • An implant may be placed underneath the chest wall muscles to help match the look of your other breast.
  • If you would like a new nipple and areola created, you will need a second, much smaller surgery later.

Results of reconstruction surgery are usually very good. It is nearly impossible to make a rebuilt breast look exactly the same as the remaining natural breast. Additional surgery may be required for the results you desire. Reconstruction will not restore normal sensation to the breast or the new nipple. Having cosmetic surgery after breast cancer can improve your sense of well-being and your quality of life.

Additional Information

  • Duration of operation: 2 - 3 hours (depending on the type of surgery performed)
  • Anaesthetic: General anaesthetic
  • Hospital stay: 2 -3 nights

Recovery

  • Driving: 1 - 2 weeks
  • Back to work: 2 weeks
  • Exercise: 6 weeks

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