Breast reconstruction restores a natural, symmetrical appearance to the bosom; maintains body proportion; allows clothes to fit better and, most important of all, boosts self-confidence for women who have lost one or both breasts to mastectomy or who lack breasts due to a congenital or developmental abnormality. Reconstructive surgeons strive to create a new breast and nipple that resemble the woman’s natural breast as closely as possible in shape, size and position. The unaffected breast is also reshaped to give it a more youthful look with improved symmetry.
A commonly used technique combines skin expansion with implant insertion. First, the surgeon inserts a balloon expander beneath the skin and chest muscle. In the office, a saline (salt water) solution is injected into the expander, stretching the skin until the breast mound reaches the desired size. The expander is then replaced with a permanent implant. A final procedure reconstructs the nipple and areola (the dark area of skin around the nipple). In very rare situations, a patient may not require tissue expansion but will begin with the implant.
Another, type of implant reconstruction involves the creation of a breast using tissue from other parts of the body. If the flap is not large enough to serve as the new breast by itself, an implant can be inserted beneath it. The tissue that is transferred consists of skin, fat and occasionally muscle from the back, abdomen or thigh. This muscle may either be surgically removed and reattached (free flap, requiring a microvascular surgeon) or remain connected to its original blood supply and “tunneled” through the body to the chest (pedicled flap). These procedures are known as DIEP flaps, muscle-sparing TRAM flaps, and TUG flaps, respectively. Some advantages of these procedures over implant insertion are a more natural look and feel for the breast and abdomen and elimination of any risks associated with silicone implants; disadvantages are scars at the breast and donor-tissue site and longer recovery.
Our surgeons perform all of the above-mentioned procedures frequently and with good results. We are one of the few practices in South Texas that offers some of the more complicated procedures, such as DIEP flaps and muscle-sparing TRAM flaps. We work with all of the general and breast surgeons in the area so that we can perform the reconstructive procedures immediately after the mastectomy, if desired and appropriate.
Both implant insertion and tissue flap surgery are followed by nipple and areola reconstruction and revision surgery on the reconstructed breast to optimize the appearance. The reconstructed breast will probably look and feel different from the natural breast. Further surgery may be desired to adjust the natural breast to better match the reconstructed one. Good symmetry is usually obtained, although perfect symmetry, which is usually not present before surgery, is not always reached.
Mastectomy patients are usually candidates for breast reconstruction. The reconstruction can be performed immediately after the mastectomy in many cases to get the best results. In certain cases, delaying the reconstruction may be the best option. A consultation with one of our plastic surgeons, who will review your medical history after a detailed examination, will allow us to advise you best on the recommended treatment.
Patients who have had a more limited procedure to treat breast cancer (through a lumpectomy and radiation) may also be candidates for reconstruction. This can be done to restore symmetry, and a consultation with one of our plastic surgeons will help determine if you are a good candidate for this procedure.
The reconstruction itself consists of multiple operations, the first of which involves the creation of the breast mound, and is performed during or after the mastectomy in a hospital and under general anesthesia. Later surgeries, if necessary, may be done in the hospital or an outpatient facility, with either general or local anesthesia.
There are several ways to reconstruct the breast, both with and without implants; your breast surgeon and plastic surgeon should work together with you in deciding which is the best for you.
Most patients will be in the hospital for two to four days and will then go home. We give them medications for pain and, if required, nausea and antibiotics. Most patients will have surgical drains, which need to be cared for. The drains should be emptied every eight hours, and the output should be carefully measured in milliliters and recorded separately. This is because we remove the drains when the output is a certain amount. All drains are usually removed within three to four weeks after surgery.
Patients may shower two days after the surgery. Although the area can get wet, there can be no immersion of the wounds, which means no swimming or wading in pools, bath-tubs and other such activities. It is also important to not perform any strenuous activities. All normal activities can be performed, but nothing that requires strenuous use of the arms, and in the case of TRAM flaps or DIEP flaps, no strenuous use of the abdomen. This limited activity level should be strictly followed for four to six weeks after the surgery is performed.
The reconstructed breast will be numb following surgery; some sensation will return as time passes. Scars will fade over time. Periodic mammograms with a radiologist trained to examine breasts with implants are recommended.
Breast Reconstruction Surgery Postoperative Instructions
It is important to follow all of your doctor’s postoperative instructions for breast reconstruction surgery to achieve the best possible results. Corpus Christi Institute of Cosmetic & Plastic Surgery patients are provided with detailed instructions to ensure the best outcome to the procedure.
- Have someone drive you home after surgery and help you at home for 1-2 days.
- Get plenty of rest and increase your fluid intake.
- Decreased activity may promote constipation, so you may want to add more raw fruit to your diet.
- Take pain medications as prescribed. Do not take aspirin or any products containing aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs).
- Do not drink alcohol when taking pain medications.
- Refrain from drinking alcohol for three weeks following surgery, even when no longer taking pain medications, as alcohol causes fluid retention.
- If you regularly take vitamins with iron, resume these as tolerated.
- Do not smoke or consume nicotine, as smoking delays healing and increases the risk of complications.
- Start walking as soon as possible with assistance the day of surgery, this helps to reduce swelling and lowers the chance of blood clots. Starting the day after surgery, walk 300 feet three times per day with assistance daily.
- Do not drive until you are no longer taking any pain medications (narcotics).
- Unless stated on this form, discuss your time off work with your surgeon.
- Do not drive until you have full range of motion with your arms.
- No overhead lifting, strenuous sports or sexual activity for 3-6 weeks unless otherwise specified by Dr. Bindingnavele.
- You may remove gauze and shower 48 hours after surgery.
- Keep steri-strips on, and replace if they come off. Keep incisions clean and inspect daily for sign of infection. No tub soaking while sutures or drains are in place.
- Place daily soft dressing over incisions and around drain sites to wick away moisture.
- You are likely to feel tired and sore for 1-2 weeks.
- You CAN NOT have an MRI imaging scan while having an expander in place. Please consult Dr. Bindingnavele prior to any radiology testing.
- Normal sensation to the breast cannot be restored; in time, some feeling may return.
- Reconstructed breast may feel firmer and look rounder or flatter than natural breast.
- Reconstructed breast may not match natural breast.
- Scars will be reddened looking for six months. In time, these usually soften and fade.
- One drain per side usually removed in 1-2 weeks after surgery.
- Second drain per side usually removed in 3-4 weeks after surgery.
- Empty drain bulb 3 times a day and record outputs in mL (milliliters) noting time of day and drain amount. Make sure to record each drain’s output separately.
- It is normal for drain outputs to vary and for clots to be in tube and bulb.
- Do not disconnect bulb from tube.
- Do not push in or pull on the drain tube at its entrance on the skin.
- See additional attachment for more instructions and additional drain log.
FOLLOW UP CARE
- Your post-operative appointment will be scheduled before surgery for your convenience.
WHAT TO EXPECT AFTER TISSUE EXPANSION
- You may experience minor discomfort for the following 12 to 24 hours after each tissue expansion. This discomfort usually subsides 2 to 3 days after each tissue expansion.
- The tissue expander may shift after the first or second expansion.
- You may experience more discomfort on one side than the other if you have bilateral tissue expanders placed.
- Your posture may change causing you to have some upper and/or mid back pain as you’re expanded.
- Your shoulder range of motion may become stiff requiring continuing to perform the shoulder exercises during the tissue expansion process to prevent shoulder stiffness and a frozen shoulder.
- You may find it difficult to sleep because you feel tight across the chest and shoulders.
- You may find it difficult to fit into certain types of tight fitting clothing. You may need to wear oversized shirts until the final exchange of the tissue expander (s).
- You may feel chest persist tightness or heaviness secondary to being expanded. This usually subsides with time.
- The tissue expanders will remain in place for a minimum of 8 weeks after completing the last tissue expansion. This will allow for the soft tissues (i.e. skin and muscle) to heal and recover from being stretched before the second surgery takes place for the exchange of the tissue expander for a permanent breast implant.
- You’ll see your surgeon when we think you have achieve your desired breast size to determine if you need additional expansions and for surgical planning.
TREATMENT FOR DISCOMFORT
- Ibuprofen (or other NSAIDs) 600 mg by mouth every 6 to 8 hours with food starting the morning of each tissue expansion and continue to take around the clock for 3 to 5 days as needed for discomfort. You may start this two weeks after surgery.
APPEARANCE DURING EXPANSION
- While the tissue is being expanded, a bulge will be created. Depending upon the location of the tissue expander, the bulge may be considered desirable or unsightly.
- Following the exchange of the tissue expander, a more normal and desirable look should be restored.
- After the exchange for permanent implant, the breasts will feel softer with less fullness in your axilla.
WHEN TO CALL
- If you have increased swelling or bruising.
- If swelling and redness persist after a few days.
- If you have increased redness along the incision.
- If you have severe or increased pain not relieved by medication.
- If you have any side effects such as rash, nausea, headache, or vomiting.
- If you have an oral temperature over 100.4 degrees.
- If you have yellowish or greenish drainage from the incisions or notice a foul odor.
- If you have bleeding from the incisions that is difficult to control with light pressure.
- If you have loss of feeling or motion.
Why Choose Dr. Vijay
Dr. Vijay is very unique in the sense of his great customer care, service and experience. He approaches each client as an individual and takes the time to thoroughly understand their needs and desired results.