The loss of a breast due to cancer surgery can be a devastating emotional experience. In most cases, reconstruction can help minimize the physical trauma of cancer surgery either at the time of mastectomy or once all other treatments have been completed. Breast reconstruction can be done with a variety of procedures. The two most popular techniques are expander/implant reconstruction and tissue reconstruction using abdominal skin, fat and muscle, also known as a TRAM flap.

Reasons for Considering a Breast Reduction:

• Breast loss due to unilateral or bilateral mastectomy procedures.
• Breast deformity due to lumpectomy or radiation therapy changes 
• Breast deformity due to trauma or birth defects.

Breast Reconstruction Procedures

Techniques for breast reconstruction vary. Expander/implant reconstruction involves the least ammount of surgical time but requires multiple procedures to obtain the best results over time. The reconstruction starts with the placement of a tissue expander (balloon device) under the chest muscles. Over the next one to two months fluid is gradually added to the expander to create an appropriate size pocket for an implant. The expander is then left in place for about three months. Final reconstruction is completed with the exchange/replacement of the tissue expander with a saline or silicone gel filled breast implant. Revision surgery is not uncommon years after the initial reconstruction is completed.  This usually only involves minor touch up procedures such as loosening or removing scar tissue around the implants.

Tissue reconstruction requires longer and more intense initial operative procedures but seldom requires additional procedures once the initial reconstruction is completed. The most common type of tissue reconstruction is the TRAM flap which uses abdominal skin, fat and muscle to reconstruct the breast mound. The abdominal donor site is the tissue normally removed during a tummy tuck (abdominoplasty) procedure leaving the patient with an improved abdominal contour as well as a newly reconstructed breast.  Prior surgical scars may be a contraindication to this procedure due to limited blood supply to the desired tissues. Other areas such as the back, buttock or lateral thigh may also be used as donor sites for breast reconstruction but with less favorable donor site defects.  

Reconstruction can be performed at the time of mastectomy or later after chemotherapy and radiation therapy have been completed. It can even be performed years after the inital mastectomy. Patients with implant reconstructions can switch to tissue reconsruction at a later time and some tissue reconstructions can be improved by implants at a later date.  It is usally recommended that patients undergoing radiation treatment to their chest or lymph nodes wait at least six months after the completion of their radiation treatments prior to embarking on breast reconstruction. Chemotherapy patients are advised to wait at least three months after completion of their treatments in order to let their blood counts and immune systems return to normal prior to reconstruction. Each patient has specific cicumstances that can make some procedures more appropriate for them.  The best procedure can usually be determined during the initial consultation visit.

Recovery Process

The actual recovery after breast reconstruction depends on the type of procedure performed. Expander/implant reconstruction patients can usually be back to work within two to three weeks. Tissue reconstruction patients may take three to six weeks before returning to normal activity. Some tissue reconstruction patients may also be admitted to the hospital for several days while implant patients may have outpatient procedures or only spend one night. Patients report varying levels of pain after surgery but in most cases,  pain can be treated with oral medication.  While complications are rare, patients can minimize potential problems by carefully following the instructions given after surgery.