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Breast Reconstruction

Breast reduction is a procedure designed to relieve the discomforts caused by large, heavy breasts including:

  • Understand clearly that although your figure will be significantly improved, your reconstructed breast will not look or feel exactly the same as the natural breast that was removed
  • Your oncologist has advised you that reconstruction is appropriate for you with regard to your stage of cancer or treatment
  • You feel that you are able to handle the period of emotional adjustment that may accompany breast reconstruction. Just as it takes time to get used to the loss of a breast, it may take some time before you begin to view the reconstructed breast as your own
  • You have no additional health concerns that may make the procedure more complicated, such as obesity or heart disease

Surgical Options

There are many options available today in breast reconstruction. A woman’s anatomy, the surgeon’s recommendations and your desired results will together determine which method is best for you.

Skin Expansion with a Breast Implant

This is a very common method of reconstructing a breast. Following mastectomy, a balloon-type device (tissue expander) is inserted beneath the skin and chest wall muscle. Once the incision has adequately healed, over several weeks, the expander is gradually filled with a salt-water solution in the physician’s office, allowing the overlying skin to stretch. After the skin has stretched sufficiently, the expander is left in place several more weeks to allow the skin to over-stretch and provide a more natural contour for the final implant. Once this process is complete, a surgery to replace the tissue expander for a more permanent implant takes place. The nipple and skin surrounding it, called the areola, are reconstructed in a later procedure – once the breast has settled. A few weeks following the nipple reconstruction, pigmentation is added to the nipple and areola in a short office procedure. In limited cases, when a sufficient amount of skin is available, an implant may be placed without the preliminary skin expansion step.

Flap Reconstruction

Although flap reconstruction is more involved at the initial procedure than reconstruction with an implant, many women still prefer it because it may allow the breast to be rebuilt with natural tissue. Also, unlike the tissue expander method, the breast mound is completed at the initial operation without the need for expansion over an extended time period. In one method, the breast is reconstructed using a tissue flap – consisting of a portion of skin, fat and muscle –that is taken from the back or more commonly from the abdomen. The flap, still attached to its original blood supply, is tunneled beneath the skin to the front of the chest wall. The transported tissue may be full enough to create a new breast mound itself.

With an alternative flap technique, tissue that is removed from the abdomen, is surgically transplanted to the chest by reconnecting the flap’s blood vessels to vessels in the chest region. Although technically more complicated, this microsurgical reconstruction may provide a more natural and less traumatic reconstruction in many women. This is the approach that Dr. Yousif prefers when performing the TRAM flap.

Although recovery from flap reconstruction may take longer than with implant reconstruction at the initial procedure, it does not require a secondary procedure for placing a permanent implant, nor does it require the weekly office visits needed for tissue expansion. Additionally, a flap procedure may improve the contour of the site from which the borrowed tissue was taken. For example, a protruding abdomen may appear trimmer after tissue is taken from the area and used to rebuild the breast.

Advances in skin sparing approaches to the mastectomy have allowed reconstructive surgeons to minimize the scarring and the amount of chest skin removed. This results in a more natural-looking breast reconstruction. Skin sparing approaches are routinely used by Dr. Yousif when performing breast reconstruction at the time of mastectomy.

All of these procedures have advantages and disadvantages, and many times the choice of procedures is limited by other health factors, such as weight, other medical conditions and previous cancer therapy. Your reconstructive surgeon will help guide you in determining which procedure is best for you.

Follow-up Procedures

Once the breast mound is restored in the initial procedure, one or more follow-up procedures will be performed to replace a tissue expander with a permanent implant, improve on the shape of the TRAM flap reconstruction or to reconstruct the nipple and areola. An additional operation to lift or reduce the opposite breast to match the appearance of the reconstructed breast may also be recommended.

Patient Testimonial

"Dr. Yousif does miracles. A few years back, I had a mastectomy and a lumpectomy on different breasts, leaving me uneven. Dr. Yousif fixed mistakes that were done by another surgeon. I'm very happy with my results. He has a passion for perfection!"

Anesthesia and Surgery Facility

General anesthesia in all circumstances. For the TRAM flap technique, the inpatient hospital stay ranges from 4-7 days. For the tissue expander technique, the inpatient hospital stay ranges from 1-3 days. Operative time is variable, depending upon the technique and whether reconstruction is performed at the same time as the mastectomy. The number of hours will be determined for each patient by the physician.

Side Effects / Recovery

Recovering from breast reconstruction will vary significantly depending upon the method chosen, whether immediate reconstruction is performed, and individual factors.

In general, it may take up to 6 weeks to recover from a combined mastectomy and reconstruction, or from a flap reconstruction alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be less.

Follow your surgeon’s advice on when to begin stretching exercises and normal activities. As a general rule, you will want to avoid overhead lifting, strenuous sports, and sexual activity for 6 weeks following reconstruction.

Risks

Each year, thousands of women undergo breast reconstruction at the time of or following mastectomy, and experience no major complications. Certain complications are possible in any type of surgery. These include blood loss, infection and anesthetic-related complications. Potential complications are also very specific to the type of breast reconstruction you and your surgeon choose. For example, with flap reconstruction, there is a small risk or partial or, very rarely, complete flap loss. Reconstruction with an implant has the potential for implant rupture/deflation of for breast firmness (capsular contracture). Your specific risk should be discussed with your surgeon. Stopping smoking for a period of time designated by your surgeon before and after surgery can significantly reduce the risk of healing problems and infection. Keep in mind that by carefully following your surgeon’s advice and instructions, you can do your part to help minimize some of these risks.

Duration of Results

It is very normal to go through a period of adjustment to your new look. Concerns about the reconstructed breast are likely to pass within a few months as a woman begins to incorporate her reconstructed breast as her own.

Most women who undergo breast reconstruction find that the procedure provides both physical and emotional rewards. For many women, breast reconstruction represents a new beginning, the chance to put breast cancer behind them and get on with their lives.