Breast reconstruction

The breast reconstruction procedure involves the formation of a new breast. You will need this surgery after a mastectomy (breast removal surgery to treat breast cancer).

This surgery may be performed directly after mastectomy (immediate reconstruction) or after a few months or years (delayed reconstruction). The time gap may vary based on your treatment for breast cancer. For example, if you have radiation therapy scheduled after mastectomy, it can interfere with the wound healing process and increase your risk of complications after the reconstruction surgery. Hence, in such conditions, a delayed reconstruction procedure is performed.

Breast reconstruction procedures are of three types. Based on your preference, breast shape and size, general health, treatment for breast cancer, etc., the surgeon may advise on the type best suited for you. The choice is made between the following:

• Reconstruction using an implant: This procedure involves the insertion of an artificial implant made of silicone and filled with silicone gel or sterile saline solution.
• Reconstruction using your tissue: In this procedure, the surgeon will remove tissues from your body parts like the abdomen, buttocks, back, or inner thigh and use them to reconstruct your breast.
• Reconstruction using an implant and your tissue: This method involves the use of both implants and tissues from another body part to form a new breast.

This surgery is also done in men for the reconstruction of the breast after mastectomy for male breast cancer.

A surgeon may recommend this surgery to you after a mastectomy operation. You can opt for breast reconstruction to:

• Balance the look of both breasts
• Look more attractive and feminine after the surgery
• Reform your breast shape permanently

A surgeon may not perform this surgery if you have the following conditions:

• Obesity 
• Unstable emotional history 
• Previous radiation therapy 
• Collagen vascular disorder (inflammation in collagen and adjacent joints)
• Severe cardiac disease or lung diseases 
• Are more than 65 years 
• Have had previous chest or abdominal surgery 
• Have advanced-stage breast cancer

Before the surgery, you will need the following preparation:

• Your healthcare practitioner will conduct a physical examination and ask you to undergo the following diagnostic tests:
  • Mammogram 
  • Blood tests
  • Electrocardiogram (ECG)
• Tell your doctor about all the medications that you take, including prescribed or non-prescribed medicines, herbs, and supplements, with your doctor. He/she may ask you discontinue blood-thinning medicines like aspirin, vitamin E, ibuprofen, or warfarin before the surgery.
• Have a light dinner a night before the surgery. However, avoid eating or drinking anything after that.
• Ask someone, a friend or family member, to help you travel to and from the hospital on the day of the surgery. 
• Stop smoking to accelerate your recovery after the surgery.
• You will need to sign an informed consent form to grant your approval for the surgery. 

The procedure for this surgery may vary depending on the type of reconstruction. 

Reconstruction using your tissue:

Depending on the type of tissue, this surgery can be done by using the following:

• Transverse rectus abdominis myocutaneous flap and deep inferior epigastric artery perforator flap: In these surgeries, the surgeon removes tissues from the lower abdomen. 
• Latissimus muscle flap: Here, tissues from the upper back are removed, especially on the side from where the breast was removed.
• Gluteal flap: In this type of surgery, tissues from the buttocks are removed. 
• Transverse upper gracilis flap: For this operation, surgeons cut the thigh tissue to reconstruct a new breast. 
• In men, flaps from the transverse rectus abdominis, deltopectoral or latissimus dorsi muscles are used.

Generally, the following steps are conducted for breast reconstruction using healthy tissue:

• In the operating room, an anaesthetist (a medical professional who gives anaesthesia) will give you general anaesthesia to keep you asleep during the operation. 
• Your surgeon will make an incision (cut) on your body from where the tissues are to be taken for reconstruction. 
• He/she will loosen your skin, muscle, and fat in this area and then use this tissue to construct a new breast as per the size and shape of your other breast. 
• In some conditions, an implant is also placed along with the patient’s own tissues. 
• The surgical cut is then closed with the help of stitches and covered with dressings.

Reconstruction using an implant: 

This type of surgery can be performed in one or two stages. You will be under general anaesthesia throughout the procedure.

One-stage procedure

Your surgeon may opt for this surgery if you still have skin left around your chest wall. During the surgery, an implant made from silicone is inserted inside the skin in the chest area to reconstruct the new breast.

Two-stage procedure 

This surgery will be done if the skin and tissues around your chest wall are flat and tight. It is done in the following manner:

• Your surgeon will insert a tissue expander (temporary implant) under your breast skin.
• Then, he/she will inject a saline solution inside this expander.
• Your chest muscles will expand gradually as the expander increases in size.  
• Once your skin is expanded enough, the surgeon will put in a permanent implant and close the incision with stitches.

This procedure may take about two to six hours to complete. If performed immediately after mastectomy, a reconstruction may take up to eight to 10 hours. When carried out as a second operation, it may take about 12 hours. You will need a hospital stay for two to five days.

After the operation, the surgeon may insert a drainage tube in the operated site to remove any accumulated fluid.

You will be moved to the recovery room after the surgery where a nurse will monitor your pulse, breathing, and blood pressure. You may also have a spirometer to help you breathe deeply. The doctor may prescribe a few medicines to control your nausea.

Once you are home, you will need the following care:

• Pain management: Your surgeon may prescribe medications to help reduce post-surgical pain. You must avoid drinking alcohol when you are taking pain medicines and even after stopping them for the next three weeks.
• Wound care: 
  • Keep the operated area clean and dry. 
  • Avoid taking a shower for at least two to three days.
  • Avoid bathing, swimming, or soaking in a bathtub till your drains and stitches are removed. 
  • After the dressing is removed, women will be asked to wear a soft and wireless bra for two to three weeks to support their breast.
• Constipation management: You may feel constipated for a while after the surgery. To prevent this:
  • Drink plenty of liquids and eat fibre-rich food. Read more: How much water to drink in a day
  • Take laxatives (substances that increase bowel movements) as prescribed by the doctor.
• Activities: 
  • You should start with walking after the operation to avoid blood clots in your legs and reduce swelling.
  • Avoid doing strenuous exercises for at least four weeks.
  • Contact sports like football or boxing should be avoided for a few weeks.
  • You must avoid lifting heavy objects for six to eight weeks after the surgery. 
  • You can resume driving four weeks after the surgery. 
  • You will have to take leave from your office for about four weeks.

When to see the doctor?

Call or visit your doctor immediately if you have the following symptoms:

• Fever
• Chills
• Continuous nausea or vomiting 
• Pain even after taking medicines
• Pain or swelling in legs, feet, or calves 
• Chest pain 
• Sudden shortness of breath 
• Redness, bleeding, discharge, or swelling around the surgical area 
• Increase in intensity of pain at the operated area 
• Joint pain, tiredness, rashes, and stiffness

The possible risks associated with the surgery include:

• Pain 
• Bleeding 
• Abnormal scarring 
• Allergy to anaesthesia
• Uneven appearance of the breast due to size or position
• Absence of nerve sensation in the newly reconstructed breast 
• Rigidity, leakage, or rupturing of the implant 
• Implants can create difficulties in the detection of cancer through physical examination or mammogram 
• Accumulation of fluid or blood-filled cysts in the breast tissues during healing
• Necrosis (death) of the newly transferred tissue
• Weakness and pain at the donor site
• Pain or restriction in arm and shoulder movement

Your doctor will schedule a follow-up appointment seven to 10 days after the surgery. During the visit, he/she may remove your stitches and drainage tube.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.