After a mastectomy, some women choose to have cosmetic surgery to remake their breast. This type of surgery is called breast reconstruction.
During breast reconstruction therapy using natural tissue, the breast is reshaped using muscle, skin, and fat from another part of your body.
This surgery can be performed at the same time as mastectomy or later.
Transverse rectus abdominous muscle flap; TRAM; Latissimus muscle flap with a breast implant; DIEP flap; Gluteal free flap
If you are having breast reconstruction at the same time as your mastectomy, your surgeon may do a skin sparing mastectomy. This means only the area around your nipple and areola is removed, and more skin is left to make reconstruction easier.
If you will have breast reconstruction later, your surgeon will remove enough skin over your breast to be able to close the skin flaps.
The two most common methods of breast reconstruction are transverse rectus abdominous muscle flap (TRAM) and latissimus muscle flap with a breast implant. For both of these procedures, you will have general anesthesia (asleep and pain-free).
For TRAM surgery:
For latissimus muscle flap with a breast implant:
When breast reconstruction is done at the same time as a mastectomy, it adds about 2 - 4 hours to the surgery. When it is done as a second surgery, it may take more than 2 - 6 hours.
You and your doctor will decide together about whether to have breast reconstruction, and when. The decision depends on many different factors.
Having breast reconstruction does not make it harder to find a tumor if your breast cancer comes back.
The advantage of breast reconstruction with natural tissue is that the remade breast is softer and more natural than breast implants. The size, fullness, and shape of the new breast can be closely matched to your other breast.
But muscle flap procedures are more complicated than placing breast implants. You may need blood transfusions during the procedure. You will usually spend 2 or 3 more days in the hospital after this surgery compared to other reconstruction procedures. Also, your recovery time at home will probably be longer.
Many women choose not to have breast reconstruction or implants. They may use a prosthesis (an artificial breast) in their bra that gives a natural shape, or they may choose to use nothing at all.
Risks for any surgery are:
The risks for breast reconstruction with natural tissue are:
There is also a risk of bleeding into the area where the breast used to be. Sometimes a second operation is needed to control this bleeding.
Always tell your doctor or nurse if you are taking any drugs, supplements, or herbs you bought without a prescription.
During the week before your surgery:
On the day of your surgery:
Your doctor or nurse will tell you when to arrive at the hospital.
You will stay in the hospital for 2 - 5 days.
You may still have drains in your chest when you go home. Your surgeon will remove them later during an office visit. You may have pain around your cut after surgery.
Fluid may collect under the skin of your armpit. This is called a seroma. It is fairly common. Seromas usually go away on their own, but sometimes they need to be drained.
Results of reconstruction surgery using natural tissue are usually very good. But reconstruction will not restore normal sensation on your new breast or nipple.
Recovery is usually faster when reconstruction is done after the mastectomy wound has healed.
Having breast reconstruction surgery after breast cancer can improve your sense of well-being and quality of life.
Wilhelmi BJ, Phillips LG. Breast reconstruction. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 35.