Cincinnati Plastic Surgery Specialists in Breast Reconstruction
Thank you for considering UC Health Plastic Surgery for your plastic surgery procedure. We offer a safe, comfortable atmosphere in our modern, state-of-the-art facility located in West Chester, Ohio, convenient to both Cincinnati and Dayton, Ohio. We offer a friendly staff of nurses and administrative support to help with your scheduling issues and questions.
Restorative Breast Surgery after Mastectomy
The goals of breast reconstruction are to provide a similar breast in shape, size, position, and texture to the opposite breast. Women are now referred to a plastic surgeon following their diagnosis of cancer to allow the choice of immediate or delayed reconstruction. Most women who have had a mastectomy can have reconstruction. Women who have had a lumpectomy usually do not need reconstruction. Breast reconstruction is a staged procedure. The first operation involves creation of the breast mound; subsequent operations involve revisions to achieve symmetry with the opposite breast as well as creation of the nipple areola complex. Several types of operations can be performed, using a newly shaped breast with the use of a breast implant, the patient’s own tissue flap, or a combination of the two. A tissue flap is a section of skin, fat, and muscle which is moved from the abdomen, back, or another area of the body to the chest area. Although there have been concerns that immediate breast reconstruction may delay adjuvant therapy, this is typically not the case. Studies have shown that immediate breast reconstruction does not increase the time to chemotherapy or worsen the prognosis. Immediate breast reconstruction typically will provide the most aesthetically pleasing result and is performed at the time of mastectomy.
Procedure Benefits
- Balance the appearance of breasts
- Create a nipple lost due to breast cancer surgery
- Change the size or shape of a previously reconstructed breast
- Replace breast(s) removed after surgery for breast cancer
Private Consultation
After you and your plastic surgeon discuss your needs and expectations, your surgeon will evaluate your overall health to ascertain that you are able to undergo this procedure. You can begin talking about reconstruction as soon as you are diagnosed with cancer. Ideally, you will want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction. Immediate breast reconstruction typically will provide the most aesthetically pleasing result and is performed at the time of mastectomy. After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. The reconstruction process may require one or more operations. You should discuss the benefits and risks of reconstruction to give yourself plenty of time to make the best decision for you. You should be prepared to discuss your complete medical history, including previous procedures and any medications you are taking, including vitamins. You will also discuss the cost of the procedure, keeping in mind that breast reconstruction is by law covered by insurance.
Preparation
Your oncologist and your plastic surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. You should arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Procedure Overview
Techniques of breast reconstruction can be either implant-based or autologous, meaning using the patient’s own tissue (such as the back, abdomen, or buttocks). Regardless, breast reconstruction is a staged procedure in which the first stage involves creation of the breast mound. Follow-up procedures include creation of the nipple and areola. The first stage of reconstruction is almost always done using general anaesthesia, so you will be asleep during the surgery. Follow-up procedures may require only a local anaesthesia with a sedative to make you drowsy. You will be awake but relaxed, and you may feel some discomfort. One-stage immediate breast reconstruction may be done at the same time as your mastectomy. After the oncologic surgeon removes the breast tissue, a plastic surgeon places an implant to form the breast contour. If your skin and chest wall tissues are tight and flat, a tissue expander is placed beneath the skin and chest muscle, and the surgeon injects saline to fill the expander. After the breast area has stretched, the expander is removed and a permanent saline implant is inserted, although some expanders are left in place as the final implant.
An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body. The most commonly used method of autologous breast reconstruction is the TRAM flap. This procedure involves using the skin and fat from the lower abdomen to make a breast. Although these options provide a reliable reconstruction, the most effective operation for breast reconstruction remains a free flap, particularly the free TRAM flap or one of its variations, although this requires a plastic surgeon expert in microsurgical techniques. A “free flap” is a flap which is harvested from other parts of the body and is transplanted using a microsurgical reattachment to its desired location. Therefore, the lower abdominal tissue used for the flap is completely disconnected from the body; the “flap” is “free” from the body and is then attached to a new blood supply in the chest using microsurgical techniques. This microsurgical technique helps to maintain the high aesthetic quality of autologous tissue breast reconstruction while minimizing the injury to the abdominal wall.
After the new breast mound is created and has settled, which typically takes 3 months, the plastic surgeon will proceed to the second stage of breast reconstruction which typically involves creation of the nipple and areola complex. This procedure involves the use of local flap of skin and a skin graft. It can be performed under local anesthesia and as an outpatient.
Recovery and Healing Time
Depending on the type and extent of surgery, you can expect to be released from the hospital in 2 to 5 days. A surgical drain may still be in place at the time of your discharge in order to remove excess fluids. You will probably be tired and sore for 1-2 weeks after surgery, but your discomfort can be controlled by prescribed medications. The surgical drain and sutures will be removed 1-2 weeks after surgery. It may take you up to 6-8 weeks to fully recover, although your recovery time may be faster if implants were placed without using flaps. You should avoid overhead lifting, strenuous sports, and sexual activity for 4-6 weeks following reconstruction. The tissues and scars will take much longer (up to 1 or 2 years) to completely heal, although the scars never go away entirely. Your surgeon will advise you on having periodic examinations to check on your implants, particularly if you have chosen silicone gel implants, which may rupture without causing immediate symptoms. You may also be advised to join a support group to cope with any emotional problems associated with your breast reconstruction.
Procedure Risks
- Adverse reaction to anesthesia
- Infection
- Scarring
- Fluid collection
- Tissue necrosis (death) of the flap
- Ruptured implant
- Scar tissue formation around the implant
- Skin donor site complications
