Cosmetic Procedures: Breast Reconstruction | Cosmetics & Makeup | Breast, Reconstruction, Surgery, After, May

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Cosmetic Procedures: Breast Reconstruction

Reconstructive plastic surgery for breast cancer is performed to replace skin, breast tissue and the nipple-areolar complex removed during a mastectomy. The amount of missing tissue varies with each mastectomy. Factors contributing to the amount of tissue removed include the width, size and location of the original tumor and its proximity to the axilla, where the lymph glands are removed.

The ultimate goal of reconstruction is to restore symmetry between the two breasts

Reconstruction: A Personal Decision

The choices that are right for one woman won't necessarily be right for another. That's because the long-term prospects of living without a breast or part of a breast affect every woman differently.

After your mastectomy, you may choose to wear external breast forms or pads or make no attempt to alter your appearance. Or you may choose breast reconstruction, using either breast implants or your own tissue.

Continual improvements in plastic surgery techniques offer better results today than ever before and make breast reconstruction an option for most women facing a mastectomy.

The decision, however, is a personal one and often not easy to make.

Why Should I Consider Breast Reconstruction?

Restoring the breast is not considered cosmetic surgery. Operations performed to restore anatomy and symmetry, like breast reconstruction after a mastectomy, are considered reconstructive surgery. Since breast reconstruction after mastectomy is part of the treatment of a disease and not cosmetic surgery, health insurance companies usually pay the major portion of the cost of the procedure.

Breast reconstruction not only changes your physical appearance, but has psychological benefits as well. It can help promote a sense of wellness for you and your family.

When Should Breast Reconstruction Be Performed?

Timing of reconstructive surgery is based on the patient's desires, medical conditions and cancer treatment. Whenever possible, plastic surgeons encourage women to begin breast reconstruction at the same time they are having their mastectomy. For many women, immediate reconstruction reduces the trauma of having a breast removed as well as the expense and discomfort of two major operations.

It is also possible to do the reconstruction months or years after a mastectomy. If any chemotherapy or radiation treatments have already been started, reconstruction is usually postponed until those treatments are completed. Your surgical team can help you decide the appropriate timing for reconstruction.

What Are the Different Breast Reconstruction Options?

A variety of reconstructive techniques are available that offer cosmetically-appealing results. Multiple factors, such as the patient's goals, medical condition and previous surgery, are considered when choosing between reconstruction using breast implants or flaps of tissue moved from other parts of the body.

One procedure to consider after breast reconstruction is nipple reconstruction. Usually, the nipple and areola (dark area around the nipple is removed during mastectomy operation because it is breast tissue and is at risk for cancer recurrence.

Nipple/areola reconstruction is usually done at a later date after reconstruction of the breast is complete. This allows new breast tissue to heal and settle into place so minor adjustments in size and position can be carried out when the nipple and areola are reconstructed.

The nipple/areola reconstruction is typically an outpatient procedure performed under local anesthesia. Tissue for the nipple/areola is often taken from the newly constructed breast. To match the color of the nipple of the other breast and to create the areola, medical tattooing may be done.

The prosthetic nipple is another option that may be temporary or permanent. The plastic surgeon makes a copy of your natural nipple and colors the areola. It can be adhered to the breast using prosthetic glue and re-glued every week or so.

How Long Does Breast Reconstruction Surgery Take?

Preparation for surgery, including administering anesthesia and any work done to treat the breast cancer may take two hours. Once the plastic surgery team takes over, the reconstructive portion of the procedure is completed within an additional one to six hours.

Following surgery, the patient spends approximately two to three hours in the recovery room before being transferred to a hospital room.

Recovery From Breast Reconstruction Surgery?

For the first few days after surgery, you may experience some discomfort, but you will be given pain medication as needed. Throughout your hospital stay, your recovery will be closely monitored.

Soon after surgery you will be encouraged to move your arms, but not for any forceful activity such as pulling yourself up, getting out of bed or lifting heavy objects. Nurses will help you in and out of bed. The day after surgery, you will normally be able to sit in a chair beside the bed. On the second day, most patients are walking without assistance.

Intravenous fluids will probably continue for a day or two, but you will gradually progress to a regular diet. You may have a urinary catheter in overnight or until you can walk to the bathroom. You will also have drains at the incision sites. If you go home with these drains in place, you will be given instructions on how to care for them.

The length of your hospital stay depends on the type of operation and how your recovery progresses. If you've gotten implants, the average length of hospitalization is one to two days. Flap procedures require a stay of five to six days.

Follow-up Care

Most women return to normal activities within six weeks after surgery. It may be several weeks before you can do strenuous exercise.

After you go home, you can expect some soreness, swelling and bruising for two to three weeks. You may be asked to apply medications to the suture area or change bandages at home. Your plastic surgeon will advise you about showering, bathing and wound care.

The mastectomy and breast reconstruction will leave areas of numbness where the surgery was performed. Instead of feeling pain where the tissue was taken, a patient may feel numbness and tightness. In time, some feeling may return in your breasts. Most scars will fade over time.

The shape of your reconstructed breast will gradually improve over the months following the reconstruction.

You'll be asked to return for regular checkups at first. If you have a temporary expander implanted, it will be expanded with saline once a week, on average, until the desired size is obtained (usually within 6 to 10 office visits).

After breast reconstruction, you should continue to examine your breasts every month. You should continue to have regular screening examinations, such as an annual mammogram.

Breast reconstruction has no bearing on cancer recurrence or surveillance, and generally does not interfere with chemotherapy or radiation treatment. A recurrence can still be treated by any of the standard treatment methods, which include surgery, radiation and chemotherapy. In addition, reconstruction rarely, if at all, hides or obscures a local recurrence.

Does Insurance Cover Breast Reconstruction?

Insurance coverage may vary on your personal situation and your insurance carrier. Make sure to speak with someone at your insurance company who knows the policy. In most cases, insurance companies will cover the first breast reconstruction operation, but there are many gray areas in insurance coverage.

For instance, insurance coverage for re-operation procedures or follow-up visits to your doctor may not be covered, but this depends on your carrier's policy. Additionally, if you are seeking breast reconstruction after a mastectomy, there is an Federal law established in 1998 that requires health insurance plans to cover reconstruction associated with a mastectomy.

Reviewed by the doctors at The Cleveland Clinic, Department of Plastic Surgery.

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