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BREAST RECONSTRUCTION PROCEDURE

Generally performed under general anesthesia, breast reconstruction can vary greatly in surgery time depending on the option that's best for you.

There are many options available for breast reconstruction. Historically, breast implants, or muscle flap reconstructions, sometimes performed in combination with implants, have been used. Recently, microsurgical flap reconstruction options such as the DIEP, SIEA, and SGAP have been developed.

Breast Implants

This option is usually completed in two phases. The first surgery may last up to an hour and consists of placing a tissue expander in the breast area underneath the skin and chest muscle. The tissue expander (similar to a baloon) will be gradually filled, adding salt-water solution approximately once a week. Once you skin has stretched (usually three to four months), the next surgery will replace the tissue expander with a permanent saline or silicon implant. Through some patients who choose this option need replacement or modifications of their implants after five to ten years, its principal advantage remains its less invasive nature.

Muscle Flap Reconstruction

A muscle flap reconstruction involves the use of your tissue to rebuild the breast. Various donor sites may be used such as the back, stomach, or buttock area. With this procedure there will be some scarring, both at the donor site and on the reconstructioned breast.

In the Transverse Rectus Abdominis Muscle (or TRAM) flap procedure, a flap of skin, fat and muscle from your abdominal area is moved up to your breast, providing contour to the reconstructed breast, and leaving the tissue connected to its blood supply in the abdomen. If you do not have enough tissue to reconstruct your breast, a small implant may be inserted.

In a Latissimus Dorsi flap procedure, a flap of muscle, fat, and skin from your back is transferred to the breast area. This helps create a pocket so an implant may be inserted and placed.

Microsurgical Techniques

The Deep Inferior Epigastric Perforator (or DIEP) flap procedure is similar to the TRAM flap procedure, but less invasive. In this procedure skin and fat and the blood vessels that feed them are removed from the muscle of the abdomen and connected to the blood supply located in the breast area using microsurgical techniques. This allows the abdominal muscles to remain in place while providing sufficient blood supply to allow your newly reconstructed breast tissue to heal.

The Superficial Inferior Epigastric (or SIEA) flap procedure is possible only when the blook vessels close to the surface of the abdomen are large enough to support the new breast. This occurs in approximately fifty percent of all women. This procedure is very similar to the DIEP flap, except that superficial blood vessels in the abdomen are used to feed the reconstructed breast. This reduces deep incisions in the muscles of the abdomen and allows a shorter recovery time.

For women who do not have sufficient abdominal tissue, the Superior Gluteal Artery Perforator (or SGAP) flap may be a good option. This surgery uses tissue from the upper buttock and a similar microsurgical technique to the DIEP flap procedure to reattach the blood vessels to their new supply in the breast area.

With all these techniques nipple and areola reconstruction usually takes place about three to four months after surgery. Once the new breast has had time to heal, the nipple and areola can be reconstructed using tissue taken from your own body, along with tattooing to help add color.

BREAST RECONSTRUCTION PREPARATION

During your consultation, you should be very open: provide all your medical history and list all of the medications, vitamins, and herbs you are taking (even if you don't think they're important). It is important to discuss your desires and listen closely so that you can set realistic expectations.

Here are some tips that may help you reduce scarring, shorten your recovery time, and decrease your changes of complications:

• Discontinue using Aspirin or Ibuprofen (these medications act as blood thinners and could cause problems with blood clotting).
• Stop smoking for at least two weeks before your breast reconstruction as nicotine can impair circulation and healing.
• Don't drink alcohol in excess for at least two weeks before your breast reconstruction, and one week after surgery.
• Drink lots of water in the days leading up to your breast reconstruction.

To make your recovery easier and more comfortable, be sure to:

• Arrange for someone to take you home and take care of you for at least the first day.
• Fill your prescriptions and have them within easy reach of where you will be resting.
• Place plenty of pillows and a bed wedge nearby so that you can keep your back elevated.
• Have several loose fitting, button-down blouses ready to wear in your new breast size.
• You will also want to avoid raising your arms above above shoulder level during the first few days after surgery.

BREAST RECONSTRUCTION POST-SURGERY

Pain after surgery will be controlled with appropriate medication. During the first two to four days, your pain medication will be needed regularly. After this time, the medication is needed less than frequently. Severe pain is not normal, and we wold want to know about it immediately. Swelling and bruising can range from moderate to significant in the first four weeks following surgery but will become mild soon after. Scars take some time to fade, usually between six to twenty-four months.

After surgery, you may release from the hospital as few as two days or as many as six days. A surgical drain may be used to remove excess fluids fromthe surgical sites following the procedure. These may be removed after the first week or two following surgery. The removal of your stitches will follow in approximately ten days. The best time for you to begin showering will be discussed with you after your procedure. Strenuous activity (as well as sexual activity) must not be engaged in for several weeks. It may take up to six weeks to reciver from combined surgery. If implants were used without flaps and if surgeries were performed separately, your recovery time can be less. The amount of time it takes for you to return to work may differ if you are having breast reconstruction performed right after a mastectomy or in the weeks following, but expect to be out of work for approximately three to six weeks. Results vary from woman to woman but can usually be seen after two years.