The benefits of a breast reconstruction can be classified into two: physical and emotional. Though there are risks associated with the procedure, these are often outweighed by the benefits.

One of the physical benefits is that it effectively restores the shape of the breast, giving women natural and attractive curves. It also allows them to wear form-fitting outfits and bathing suits, and even their old clothes.

They can also get more symmetrical breasts with this surgery. Though it is often challenging to make the breasts look symmetrical when only a unilateral mastectomy was previously performed, this can be easily remedied by performing a breast lift, augmentation, or reduction to the unaffected breast to match the new breast.

But more importantly, a breast reconstruction offers several emotional and psychological benefits. Many women associate their femininity and sexuality with their breasts, so getting a post-mastectomy can greatly impact their emotional well-being. It can increase a woman’s confidence and make her feel whole again. It can also alleviate feelings of anxiety, depression, fear, and low self-esteem.

Even though post-mastectomy will never be able to recreate a woman’s original breast shape and size, it is nevertheless still a truly rewarding surgery.

Candidates

A good candidate for a breast reconstruction are individuals who have had either one or both breasts removing following breast cancer. You should consider getting this procedure if you think that it will give you a sense of psychological well-being or a feeling of wholeness. Many women who want to restore their feelings of femininity and confidence in their appearance opt to get this surgery.

But aside from psychological readiness, a good breast reconstruction candidate should be physically ready as well. If you are thinking of getting this procedure, you should have a body mass index under 30, which means you are not overweight. You should also not have any serious health problems like heart disease, high blood pressure, diabetes, and certain autoimmune diseases, as these can increase your risk of developing complications. You should also quit smoking at least six weeks prior to the surgery, as this can interfere with proper blood circulation and delay healing after surgery.

Radiation therapy and chemotherapy may also affect your chances of getting a post-mastectomy surgery. While these two are not absolute contraindications, it is recommended to delay your surgery while you are still undergoing these treatments, as they may cause issues in wound healing.

Your previous surgical and medical history, family history, and coexisting illnesses are also factors in determining whether a breast reconstruction is right for you.

Procedure

There are several ways that this procedure can be performed, as each case differs from patient to patient. In general, the procedure takes place over several stages.

First off, your doctor puts you under general anesthesia, which is the anesthesia of choice for complex procedures like this one. Once the anesthesia has been administered, your surgeon will make the incisions based on the type of breast reconstruction you are going to undergo.

For an implant reconstruction, the incisions are typically made across the center of the breast area. Expect to have more incisions in a flap reconstruction because they involve the relocation of tissue from one area of the body to the breast.

The actual process of creating a new breast also depends on the reconstruction technique. In an implant reconstruction, a balloon expander is placed beneath the skin and chest muscle to stretch the area. This type of reconstruction usually takes place in stages, so expect the next steps to happen within the weeks and months. Small amounts of liquid will be added to the expander little by little to stretch the skin enough to fit the desired implant size. Once the skin has stretched enough, silicone or saline implants are placed on the breast area.

If the preferred method is a flap reconstruction, tissue is taken from one area of the body and relocated to the chest to serve as the new breast mound. Blood vessels in the transplanted tissue are re-attached to new ones in the chest area. Implants may also be placed in some instances.

After the creation of the breast mound, your surgeon will close the affected areas with sutures and bandage. Nipple reconstruction is done much later when the breasts have settled into their final position. This is done by lifting a flap of skin from the reconstructed breast and folding it in such a way as to create a small piece of tissue with projection. The areola is then created by tattooing the area or grafting skin from the groin area, which has a similar skin tone to the areola.

Types

While most women think that implants are the only option for breast reconstruction, the reality is that there are plenty of options available. These can be divided into two broad categories: implant reconstruction and flap reconstruction.

Implant Reconstruction

There are two sub-types that require the use of implants: immediate implant breast reconstruction and tissue expander with implant.

The implant only reconstruction is best suited for women with small to medium-sized breasts and with enough skin left over after mastectomy. It is done immediately at the time of the mastectomy, ensuring no extra scars, fast placement, and immediate results.

However, implants are the most unnatural-looking of all the breast reconstruction techniques. It also carries the risks commonly associated with breast implants, such as wrinkling, dislodgement, leaking, capsular contraction, and pain. It also should be replaced within 10 to 20 years to avoid complications. Radiation may also compromise the cosmetic outcome of this technique.

For women who do not have enough excess fat and skin to support flap reconstruction, the administration of a tissue expander followed by an implant may be the technique of choice. In fact, it is common for women to use a combined technique for breast reconstruction.

In this procedure, your surgeon places a balloon-like tissue expander under your chest muscles to gradually stretch your skin and make room for an implant. Saline solutions are injected at weekly intervals into the tissue expander until it stretches sufficiently and the implant can finally be inserted. Because of this, the final results can only be seen months after your surgery.

The biggest advantage of an implant reconstruction over a flap reconstruction is that it requires less surgery. It results in fewer scars and a lower risk of infection. However, its results are not as natural-looking as a flap reconstruction.

Flap Reconstruction

Also known as autologous reconstruction, flap reconstruction uses tissues from another place in your body to form a breast shape. The tissue – called a flap – is composed of skin, fat, and muscles, and usually comes from the abdomen, back, buttocks, and thighs. Flaps can either be free – completely separated from its original blood vessels – or pedicled – still attached to its original blood vessels and moved under your skin to your chest.

One of the oldest methods is the TRAM flap surgery, which involves the use of the transverse rectus abdominis muscle (TRAM) in the lower abdomen to reconstruct the breast. However, some TRAM flap reconstruction problems include decreased abdominal muscle strength and increased risk for hernias.

Another flap reconstruction technique is the DIEP flap, which stands for deep inferior epigastric perforator flap. It involves the transfer of skin and fat from the abdomen to the chest without disturbing the muscles. Your surgeon then carefully reattaches the blood vessels of the flap to blood vessels in your chest during microsurgery. The DIEP flap is less taxing than the TRAM flap reconstruction surgery recovery time, plus it also preserves abdominal strength. But since it is a highly specialized procedure, not all surgeons can perform it well.

There are two types of gluteal flaps: superior gluteal artery perforator (SGAP) and inferior gluteal artery perforator (IGAP) flaps. Their main difference is where the tissue is taken from. In SGAP, skin and fat are taken from the top area of the buttocks, while in IGAP, these are taken from the lower area of the buttocks. These flaps have a high success rate, though they are deemed to be one of the most complicated microsurgical breast reconstruction techniques.

There is also the latissimus dorsi flap, the surgeon uses the latissimus dorsi – the skin and long muscle that runs beneath the armpit and diagonally across the back – to build a new breast. It is a good choice for patients who still want to get pregnant or have had abdominal surgery already. However, it can limit back and shoulder activity, plus it can only be done once.

Other minor options include the superficial inferior epigastric artery or SIEA flap, profunda artery perforator or PAP flap, and transverse upper gracilis or TUG flap.

For a more detailed look at these techniques, take a look at The Different Types of Breast Reconstruction Surgery.

Breast Reconstruction Results

Though the outcomes vary based on a number of factors, you can expect a post-mastectomy surgery to result in breast symmetry, an improved body contour, and higher self-esteem.

Immediate Results

For flap reconstruction, you can expect to have a new breast mound that feels natural because it is made of your own tissues. For implant reconstruction, silicone implants also appear more natural than saline implants, though the latter is considered to be safer. It is also expected that patients who undergo implant reconstruction should have their implants replaced within 10 years to minimize complications.

However, scarring is also inevitable, even though your doctor will use techniques to minimize visible scarring as much as possible. Scarring is also more extensive in a flap reconstruction than an implant reconstruction.

Long-Term Results

One of the main concerns of patients after getting a breast reconstruction is how their breasts would look like. Breasts resulting from a tissue flap reconstruction often have more desirable shapes than implants, as they can be customized and fine-tuned based on your individual needs. Those who had implants also need to have them replaced within 10 years to avoid complications like capsular contracture and implant rupture.

The scars are permanent, though they become less noticeable over time. The appearance of your scars when fully healed depends on age, genetics, lifestyle, how your sutures and underlying tissues were sewn together.

Loss of sensation in the breast area should also be expected, but it might still be regained depending on the type of reconstruction technique used. In general, nerve regeneration is more likely to occur in flap reconstruction than implant reconstruction.

Learn more about what to expect after breast reconstruction in this article.

Preparation

Before your surgery, your surgeon will provide you with pre-operative instructions on which tests to take during your pre-operative appointment. These will likely include some blood workups, ECG, and x-ray. You will also be thoroughly interviewed about your medical and family history. A complete physical exam will be performed to determine your fitness for a breast reconstruction surgery.

To increase your chances of better healing, your surgeon will also instruct you to stop smoking at least six weeks before undergoing surgery. You also need to avoid taking drugs that might cause excess bleeding during your surgery, such as aspirin and certain anti-inflammatory drugs and herbal medications.

You also need to prepare your home for recovery to ensure a smooth transition from the hospital to your home. Have someone to take care of your during the first few days after your surgery since your movements will be severely limited. You should also have someone to drive you home after surgery as you will likely still be groggy because of anesthesia.

Prepare your clothes in advance as well. Opt for loose-fitting clothing, button-down shirts, and slip-on sandals to avoid straining your incisions. Also, make sure that you have a lot of pillows on your bed for maximum comfort.

Recovery

Since a breast reconstruction is a complex procedure, you should expect to stay in the hospital for around two to six days. During this period, you will likely have drains in your breast area to remove excess fluid from the surgery site. You are also likely to experience bruising, swelling, soreness, numbness, and scarring at the surgical sites immediately after surgery.

For those who opted for an implant reconstruction, you will be able to do most routine activities within two to three weeks. On the other hand, those who underwent flap reconstruction would need more time to recuperate, depending on the exact flap procedure performed. Lifting and straining are not allowed for six weeks. It is best to consult your doctor regarding the best time that you can return to work, as this varies from case to case.

Another thing that you need to focus during the recovery period is your emotional recovery. It may take some time to adjust to the reconstructed breast, as this will never look or feel exactly the same as a natural breast. Feelings of self-consciousness and depression are not uncommon, so many patients might find it beneficial to talk to a mental health professional regarding their feelings about breast reconstruction.

Risks and Side Effects

Some of the short-term risks involved in a breast reconstruction include poor reaction to anesthesia, nausea and vomiting, dizziness and blurred vision, headache, itching, bleeding, and infection. It is important to consult your doctor immediately especially if you experience the last two symptoms.

As for long-term risks, implant reconstruction can lead to capsular contracture, implant rupture or deflation, and delayed wound healing. Flap reconstruction also has several possible long-term complications, including blood clots, constricted blood flow, tissue death, scarring, reduced abdominal strength, and weakened arm, shoulder, or back. It all depends on the incision sites.

Breast Reconstruction Cost

Breast reconstruction in Miami can cost anywhere from $2,500 to $3,000 in surgeon fees. These often do not include other fees like facilities, anesthesia, medical tests, prescription, and garments.

Because of a federal law passed in 1998, all insurance providers are required to cover breast reconstruction for patients who were diagnosed with breast cancer. Still, it is recommended to contact your insurance provider to know if there are any other costs not included in your policy.

If a breast reconstruction post-mastectomy is what you need to boost your self-esteem and make you feel more feminine again, Schedule a Free Consultation with one of our board-certified and highly experienced cosmetic surgeons here on Face + Body Cosmetic Surgery. We will try our best to answer all your concerns.

References:

http://www.smartbeautyguide.com/procedures/breast/breast-reconstruction

http://www.docshop.com/education/cosmetic/breast/reconstruction