What is Reconstructive Breast Surgery?
These techniques restore breasts following cancer treatment, burns or other types of trauma. Reconstructive surgery is sometimes appropriate for certain congenital deformities affecting the breasts.
Losing one or both breasts to cancer is obviously a unique, deeply personal experience for each person who undergoes mastectomy. For most of us that are breast-possessing individuals, this body part can be a profound aspect of femininity, motherhood, identity, sexuality and self-image. Equally unique is each person’s choice of what to do following a mastectomy or lumpectomy. It’s completely up to you whether you want to explore reconstruction options. We support that decision-making process by providing lots of information and answers to your questions.
Deciding when to have breast reconstruction
Whether you’ve already had a mastectomy, double mastectomy or lumpectomy, or have a procedure scheduled, breast reconstruction is likely an option. The timing of the procedure is usually one of the following –
- Immediate reconstruction: performed at the same time as mastectomy.
- Delayed reconstruction: performed days, months or years after mastectomy.
There are pros and cons to both immediate and delayed techniques. Both Dr. Franco and your doctor can help you make the decision with consideration of factors including the stage of breast cancer, additional treatments required, your preferences for timing, your certainty vs. uncertainty about reconstruction, and other factors.
A delayed procedure means you don’t have to decide if you want reconstruction at the time of mastectomy. Some people aren’t sure whether restoring the form of breasts is something they want, so opting for an immediate technique may be unappealing. Delayed reconstruction does have the disadvantage of adding more surgery – you’ll need to have another procedure in addition to the mastectomy.
Immediate reconstruction can eliminate having to spend any time without the presence of breasts, which is important to some people. It also means the mastectomy and reconstruction is combined into a single surgical appointment.
Creating Breast Symmetry
If your mastectomy involves only one of your breasts, Dr. Franco will likely suggest breast surgery for both breasts, so that the final look is symmetrical and even. If your health insurance covers breast reconstruction, it should also cover surgery on the other breast for symmetry.
Types of Breast Reconstruction
Dr. Franco is an experienced provider of all of the basic forms of breast reconstruction, which we outline below.
Implant-based reconstruction: A breast implant may be what you associate with reconstruction. The first step in the process is to create room in the skin for the placement of a breast implant. This space is created with a device called a tissue expander, which looks like a breast implant and is inflated to be larger gradually, until the desired breast pocket size is created.
The implant-based reconstruction may incorporate the Alloderm tissue matrix. This is a sterilized tissue sheet placed along with the tissue expander. It will remain in the breast pocket even after the expander is removed, providing additional support, breast structure and coverage of the breast implant for the long-term.
Autologous tissue flaps: Tissue flap reconstruction uses a section of your own tissue to rebuild the breast. It involves using microsurgery to graft skin, fat and sometimes muscle to the chest. This technique can be a great option if you want to avoid the placement of anything artificial like breast implants.
The different types of flaps are based on where they are grafted from –
- TRAM (Transverse Rectus Abdominal Muscle Flap). The TRAM flap uses abdominal tissue. The procedure is similar to an abdominoplasty, except that the tissue that is normally discarded can be used for the breast reconstruction. The benefit of this reconstruction is the patient often has the benefit of removing unwanted abdominal skin and fat.
- DIEP (Deep Inferior Epigastric Perforator Flap). DIEP flaps are similar to the above TRAM reconstruction, except that only skin and fat are taken from the abdomen. No muscle is taken from the abdomen.
- SIEP (Superficial Inferior Epigastric Perforator Flap). SIEP is similar to TRAM reconstruction, except that only skin and fat are taken from the abdomen. No muscle is taken from the abdomen. The blood vessels grafted for this flap differ from the DIEP flap.
- Latissimus Muscle Flap. This reconstruction uses natural tissue from the back area to reconstruct the breast. It most often requires the use of an implant in addition.
There are other types of tissue flaps. Dr. Franco can help you decide if this type of reconstruction may be right for you.
Fat grafting: What if you could use your own excess fat to restore breast shape? With fat grafting, you can! It is unusual to use fat grafting alone to restore an entire breast mound. Fat is more often used to even out the shape and provide extra coverage of a breast implant, or to refine the breast shape achieved with a tissue flap. Fat can also be used to fill in a divot left behind by lumpectomy.
The fat is removed from an area of excess (often the abdomen, back or thighs) with liposuction, processed and then re-injected strategically into the breast mound. In this way, it has the additional benefit of removing a stubborn pocket of fat.
Am I a Good Candidate for Breast Reconstruction?
Working along with your doctor, Dr. Franco will first establish that you are a good candidate for breast reconstruction. Most women who want to restore breast shape after cancer surgery are good candidates. Your doctor may want to evaluate the status of the disease, the location, need for future treatment and other health-related factors before clearing you for reconstruction.
You’ll also want to consider the non-physical aspects of your candidacy, such as:
- Is restoring the shape and form of breasts important to you?
- Can you envision yourself using removable breast forms instead of having breast reconstruction? How do these two options compare?
- Are you prepared for the additional surgery?
- What are the pros and cons of going without reconstruction?
Reconstructive breast surgery does not restore nipple sensation or breast sensation, but it does rebuild the shape and presence of breasts. For many people who have undergone mastectomy or lumpectomy, that’s important.
How Long Does it Take to Recover from Breast Reconstruction Surgery?
The recovery depends on the type of procedure you undergo, and whether it is immediate or delayed. Dr. Franco discusses the different timelines as part of your consultation. In general, the road to recovery can be a challenging one, emotionally and physically. Dr. Franco and our team are here to provide support every step of the way.
In the first days after surgery, you will likely take pain medication to address any discomfort. You may remain in the hospital to recover for a few days, depending on the specifics of your procedure. Plan to take it easy for at least 1-2 weeks. Over the next 6 weeks, you will work with Dr. Franco to decide when to:
- Return to daily routines
- Return to work
- Return to exercise and strenuous activity
We provide complete and easy-to-follow surgical aftercare instructions related to diet, showering, wound care, follow-up appointments and more.
Most people are fully healed at 6 weeks. After a few months, you can explore the option of nipple reconstruction. This technique does not restore nipple function or sensation, but many people prefer the finishing touch it puts on their reconstructed breasts. Options include a tattooed nipple or a rebuilt three-dimensional nipple.
One year after reconstruction your scars will look lighter and flatter. You may regain mild sensation in the breast skin. At this point your follow-up appointments will most likely conclude.
Dr. Franco Wants You to Know all of Your Options
If you live in Austin, Texas, or any of the surrounding areas, Dr. Franco is conveniently located near Loop 1 and Highway 183. Dr. Franco has been an advocate for many women on their journey to breast reconstruction. He wants to provide complete information about the procedure so that you can decide whether it is right for you. To arrange a consultation at our practice, please call our team at 512-827-0638.