Breast Reconstruction at Finesse Plastic Surgery
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At Finesse Plastic Surgery, we understand that breast cancer is a challenging journey, and breast reconstruction is an important part of the healing process for many women. Our goal is to empower you to make informed decisions about your reconstruction options, ensuring that you feel whole, feminine, and confident after your cancer treatment.
Personalized Breast Reconstruction
Breast reconstruction is a deeply personal choice, and we are here to support you every step of the way. Whether you choose to undergo reconstruction immediately following your cancer treatment or opt to delay the procedure, our team will work closely with you to develop a personalized treatment plan tailored to your unique goals and needs. We offer a variety of modern reconstruction techniques, including options that use implants or your own tissue (flaps) to rebuild and reshape your breasts. Your preferences and comfort are our top priority, and we are committed to delivering the best possible results.
Collaborative Care for Optimal Results
To ensure the highest level of care, Finesse Plastic Surgery collaborates with a team of experts throughout your breast cancer treatment. We partner with Breastlink and other specialists, including breast surgeons, oncologists, and restorative tattoo artists, to coordinate your care and integrate aesthetics into your treatment plan. This multidisciplinary approach ensures that your reconstruction journey is seamless and focused on achieving the best possible outcomes.
Reconstruction Options
Lumpectomy
Lumpectomy, or partial mastectomy, involves removing the cancerous tissue while preserving the natural shape of your breast. While many women are satisfied with the aesthetic results, some may experience asymmetry or contour irregularities. For those seeking to restore their appearance, several reconstructive options are available.
Oncoplastic Breast Reduction
Ideal for patients who are candidates for breast reduction surgery or those who prefer a smaller breast size, oncoplastic breast reduction combines cancer removal with breast reduction. This two-stage procedure not only enhances the aesthetic outcome but also relieves symptoms like neck and back pain while potentially increasing the effectiveness of cancer treatment.
Oncoplastic Breast Lift
For women satisfied with their breast size but unhappy with sagging or low nipple position, an oncoplastic breast lift (mastopexy) can restore a more youthful contour. This two-stage procedure removes the cancer first, followed by reshaping the breast to achieve a lifted, rejuvenated appearance.
Fat Grafting
For patients with small tumors and minimal deformities, fat grafting offers a less invasive option. This procedure uses liposuction to harvest fat from areas like the abdomen or thighs, which is then injected into the breast to improve shape and contour. Multiple sessions may be needed to achieve the desired results.
Mastectomy
In cases of widespread or recurrent breast cancer, mastectomy may be recommended, involving the removal of one or both breasts. While some women opt not to pursue reconstruction, the majority choose to rebuild their breasts. Reconstruction can be immediate or delayed, depending on individual circumstances and health considerations.
Two-Stage Implant Reconstruction
The most common method worldwide, implant-based reconstruction typically involves two surgeries. First, a tissue expander is placed to gradually create space for the permanent implant. Once the desired size is achieved, the expander is replaced with the final implant in a second surgery.
Direct-to-Implant Reconstruction
In select cases, implants can be placed in a single surgery without the need for a tissue expander. This option is suitable for healthy women with small breasts who wish to maintain or reduce their breast size. However, not all patients are candidates, and your surgeon will assess the viability of this approach during your consultation.
Autologous Breast Reconstruction (Flap Surgery)
For women seeking a more natural reconstruction using their own tissue, autologous (flap) reconstruction is an option. Tissue is taken from areas such as the abdomen, back, or buttocks and used to reconstruct the breast.
Latissimus Flap
Tissue from the back is tunneled to the chest to create a new breast mound. This technique is often combined with an implant for additional volume.
TRAM Flap
Tissue from the lower abdomen is used, similar to a tummy tuck, to reconstruct the breast. This method may compromise core strength due to the removal of abdominal muscles.
DIEP Flap
Similar to the TRAM flap but preserves the abdominal muscles, maintaining core strength. This procedure requires microvascular surgery expertise.
SGAP/IGAP Flaps
Tissue from the buttocks is used for reconstruction, ideal for patients without sufficient abdominal tissue or those who have already undergone abdominal flap surgery.
Fat Grafting
Fat grafting can also be used in conjunction with implant or flap reconstruction to refine the shape and improve contour irregularities. While not a substitute for cosmetic liposuction, this technique can provide subtle enhancements and is often used during revision procedures.
Nipple and Areola Reconstruction
For patients who have undergone a mastectomy, nipple and areola reconstruction can be performed 3-4 months after the placement of permanent implants. This procedure uses skin from the reconstructed breast to create a new nipple, which is then tattooed to match the natural color of the areola. Patients can also opt for 3-D tattooing alone, which provides a realistic appearance without the need for additional surgery.
Revision of Reconstruction
Our goal is to ensure long-lasting and satisfactory results for our patients. Up to half of all women who undergo breast reconstruction may require revision surgery within 7-10 years to maintain or improve their results. These outpatient procedures typically have shorter recovery times and are usually covered by health insurance under the Women’s Health and Cancer Rights Act (WHCRA).
Frequently Asked Questions
Lumpectomy with Oncoplastic Reconstruction: Patients go home the day of surgery and come back for a follow up in the office 1-3 days after surgery. The follow up appointment will be made for you when your surgery is scheduled.
Mastectomy with Tissue Expander/Implant Reconstruction: Once the post-operative pain is manageable you will be able to go home. This may be the same day as surgery or the following day. Your first follow up appointment in the office will be 3-5 days after surgery.
Mastectomy with Flap Reconstruction: Patients stay in the hospital for 1-2 days following a latissimus flap. After abdominal flaps (TRAMs and DIEPs), patients usually stay for 3-5 days.
If you are experiencing shortness of breath or chest pain, this may be a sign of a medical emergency and you should call our office or 911 immediately. Any of the following symptoms should also be reported to our office right away:
- Fever over 101.0F
- Chills
- Redness or bruising on the skin that spreads to a progressively larger area
- Swelling or change in size of one of the breasts
- A sudden increase in drainage
- Uncontrolled nausea or vomiting
You should also call us if your pain getting worse or is not relieved by the pain medication. If in doubt, call us. There is always a doctor on call, 24 hours a day, including weekends.
Pain levels vary from patient to patient, but most patients report tightness and numbness in the chest, as well as pain and stiffness at the bottom of the breasts and under the arms. You may experience shooting pains or tingling sensations on the insides of the arms, and it may be difficult to raise your arms over your head or extend your arms fully.
Take the pain medication as prescribed. Many of our patients take it regularly for the first few days and then gradually decrease the frequency and amount of pain medication they use. We often prescribe Percocet and Valium. Percocet relieves pain, while Valium helps with muscle spasms and tightness. These medications can be taken together, but not at the same time. Both of these medications can cause sedation, so space them out by at least 30 minutes if you are taking them together, and do not take either of them if you feel drowsy or sedated. Please note that Percocet is a controlled substance and must be filled with the original written prescription. If you need another prescription, you must pick it up in person at our office.
What about constipation caused by the pain medications?This is a common symptom of continued use of narcotic pain medication. We advise you to use a stool softener daily until you stop the narcotics. We recommend starting with over the counter Colace, twice daily. If constipation occurs, take over the counter Dulcolax – 2 tablets at night. If this is not effective, the dose may need to be increased; refer to the package instructions. Drinking plenty of fluids and eating a high fiber diet will also help ease constipation. Some patients find prune juice helpful as well. If you go more than 6 days without a bowel movement, you may require the use of an enema.
When should I start the antibiotics and how long do I keep taking them?You should start your antibiotics the evening you get home from surgery and continue them until you are told to stop. Patients who have drains in place will remain on antibiotics until they are all removed. If you run out of antibiotics while your drains are still in, you will need to contact our office for a refill. You will stop taking antibiotics 48 hours after the last drain is removed.
No reconstruction: If we do nothing to reconstruct the breast, you can expect to take a week off work to recover.
Tissue expander reconstruction: Most of our patients take 4-6 weeks off work to recover. Many of our patients are able to work on a computer from home within a few days of surgery. It is usually 2-3 weeks before patients start feeling back to normal.
Flap surgery: Patients who have flap reconstruction typically stay in the hospital for 2-3 days.
Patients who have a mastectomy will be given a prescription for two postoperative camisoles. You can pick these up at the shop in the lobby of the Breastlink Center in Orange, Ginny’s at St. Joseph’s Cancer Center, or Nordstrom’s. Bring one with you to the hospital to wear home. You will also want to bring a loose-fitting layer of clothing to wear over the camisole. Please make sure that during the first 2 weeks after surgery all garments you wear are loose fitting. Tight clothing may interfere with the blood supply to the healing tissues and result in skin loss.
Patients who have a lumpectomy with an oncoplastic procedure will be placed in a bra at the end of the procedure. This garment is provided by the hospital and can be worn for the first several weeks after surgery before you transition back into your own bras.
This will depend on the amount of fluid that comes out of each drain. You will empty the drains 2 or 3 times a day, recording the fluid output in milliliters (CCs). You will keep a record of the output that you should bring to each of your appointments. Typically, the drains are removed after 1-3 weeks, when the drainage is less than 30 milliliters in a 24-hour period for two consecutive days.
Use this machine for approximately 2 weeks after surgery, at night when you are sleeping and during the day when you are resting. This machine helps prevent the formation of blood clots. You do not need to bring this machine to the hospital; they will provide a similar machine for you.
Initially, you will need to come in to the office at least once a week, until the drains are removed and your skin and incisions are healed. During each visit, your care team will tell you when to need to return again and will schedule your next appointment. Once your skin and incisions are fully healed, your visits will become less frequent.
Your surgeon will tell you when you can start showering. Depending on the incision dressings and closure, most patients can start showing again two days after surgery. If you have drains, we ask that you only shower for five minutes or less. The surgical site may get wet briefly and should be dried thoroughly afterwards with a clean towel. Do NOT use a hairdryer on the surgical site, as your sensation changes after surgery and there is a risk of burning or overheating the skin. Drains should be supported while you shower. You can clip them to a necklace (our office can provide you with a lanyard) or pass the loops through an old belt that you don’t mind getting wet.
After your incisions are healed, you will need to wait eight more weeks before submerging or soaking the surgical area. This means you will usually need to wait 10-12 weeks after surgery before bathing or swimming. Your care team will give you specific instructions.
You should avoid lifting anything heavier than five pounds and avoid any upper body exercise during the first 3-4 weeks after surgery. Also avoid any strenuous pushing or pulling movements during this period, such pushing open a heavy door. The range of motion of your arms will probably be limited to some extent. Listen to your body and stop any activity or movement that causes pain.
Start stretching exercises after all the drains are removed. These are outlined on a handout that you will be given in the office. Be patient with your body while it’s healing and expect slow progress regaining full range of motion in your arms. If you are having trouble making progress with range of motion or strength, let us know, and we will refer you to a physical therapist.
Walking is encouraged. You will need to take it easy initially and increase your activity gradually, but walking several times a day will help you regain your strength and energy, as well as being an important prevention strategy for avoiding surgical complications, such as blood clots. A good rule of thumb is that if you are sweating, you are doing too much.
Patients can start taking these medications and supplements after all the drains have been removed.
We will start adding fluid to the tissue expanders after the incisions and skin are fully healed. This can be as early as two weeks after surgery, but may be later. We usually do the expansions at 1-3 week intervals, based on patient comfort.
How does expansion work?We will identify the port in your expander by using a specialized magnet and then place a fine needle through your skin into the tissue expander port. Once the needle is in place, a small volume of saline will be injected in to the expander.
Are the expansions painful?Most patients have numbness in the chest after surgery and do not feel pain at the time of the procedure. A few hours after the procedure, some patients report tightness and discomfort in the chest muscles. This may last a few days, but will gradually improve as your body adjusts to the expansion. Patients are typically expanded about 50-150 cc per visit. Amounts will be determined based on the patient’s comfort level
For pain after expansions, take Valium as prescribed. It is a muscle relaxant, and will help releive tightness and discomfort in the chest muscle after the expansion.
How many expansions will I need? How will I know when I’m done?With each expansion, we will tell you to pay attention to how the new volume feels, and how you fit into your clothing and bras. You will play a large role in determining when the expansions are done.
Breast reconstruction should not delay chemotherapy. If patients experience a complication such as delayed wound healing or infection, chemotherapy may be postponed for a short period of time. We work closely with the medical oncologists and will typically "clear you" to start chemotherapy in the time frame they recommend for your cancer treatment.
Patients typically start radiation therapy two months after their cancer surgery. Patients who have a mastectomy with expander reconstruction will first need to complete the expansion phase. This is normally completed within two months of surgery. In some cases, the expansion may go on for an additional 2-4 weeks, but this will not influence your cancer treatment. We will communicate with your radiation oncologist to ensure that any brief delay will not affect the success of your radiation therapy.
For most patients, the second surgery happens 3-5 months after the initial mastectomy. Patients who require postoperative radiation therapy or chemotherapy will have the second surgery delayed until their treatment is complete. The second stage of reconstruction, where the tissue expanders are removed and the implants are placed, is generally an outpatient procedure with a much shorter recovery time than with the initial mastectomy and reconstruction. You may or may not have drains after the second surgery. Should you have drains, they are usually removed within 5-7 days. Most patients report that there is less pain and “down-time” associated with the second surgery.
How long do breast implants last?It varies from patient to patient. In our practice, we have had patients who have their first implant problem within one year of surgery. We have also cared for patients who have had the same implants for over twenty years. Studies have demonstrated that there is a 93 percent chance your implants will still be intact 10 years after surgery.
What are the different implant choices?Implants come in various shapes and sizes. We will discuss your goals and work with you to choose the proper fill material, shape, size, and texture for you. Fill options include silicone or saline (salt water). We prefer to use silicone when possible because it tends to give a more natural feel and appearance.
The term “gummy bear” implants refers to modern, form-stable implants that look like a gummy bear when cut (the silicone is firmer and doesn't spill out of the shell). Despite the name, gummy bear implants are not as firm as their namesake candy. We use teardrop-shaped (“anatomic”) and round implants. In reconstructive breast surgery, anatomic implants may look more natural in some women. Implants come in smooth and textured forms. Most round implants we use are smooth and most anatomic implants are textured. The anatomic implants are textured so they do not spin out of position.
Is silicone safe?In 1992, the FDA placed a moratorium on the use of silicone implants because they were concerned about possible safety issues. Meanwhile, the rest of the world continued to use them. In 2006, the FDA reconsidered the use of silicone implants for cosmetic and reconstructive surgery. They concluded that the data gathered from 1992-2006 convincingly demonstrated that silicone was safe. Eight other studies performed worldwide supported this conclusion.
Today’s silicone implants are far superior to the implants used in the 80’s and 90’s. The silicone used is similar to the texture of Jell-O. Because of this, it is much more likely to stay inside the shell. Even if the implants were to rupture, the silicone is very unlikely to spread beyond your breasts.
For more information about implant rupture, please read our article: What if Silicone Breast Implants Rupture.