After a mastectomy, some women choose to have cosmetic surgery to remake their breast. This type of surgery is called breast reconstruction.
During breast reconstruction that uses natural tissue, the breast is reshaped using muscle, skin, or fat from another part of your body.
This surgery can be performed at the same time as mastectomy or later.
If you are having breast reconstruction at the same time as mastectomy, the surgeon may do a skin- or nipple-sparing mastectomy. With skin-sparing mastectomy, only the area around your nipple and areola is removed. With nipple-sparing mastectomy, all of the skin, nipple, and areola are kept. In either case, skin is left to make reconstruction easier.
If you will have breast reconstruction later, the surgeon will remove just enough skin over your breast to be able to close the skin flaps.
Types of breast reconstruction include the following:
For any of these procedures, you will have general anesthesia (asleep and pain-free).
For TRAM surgery:
For latissimus muscle flap with a breast implant:
For a DIEP or DIEAP flap:
For a gluteal flap:
For a TUG flap:
When breast reconstruction is done at the same time as a mastectomy, the entire surgery may last 8 to 10 hours. When it is done as a second surgery, it may take up to 12 hours.
You and your surgeon will decide together about whether to have breast reconstruction and when. The decision depends on many different factors.
Having breast reconstruction does not make it harder to find a tumor if your breast cancer comes back.
The advantage of breast reconstruction with natural tissue is that the remade breast is softer and more natural than breast implants. The size, fullness, and shape of the new breast can be closely matched to your other breast.
But muscle flap procedures are more complicated than placing breast implants. You may need blood transfusions during the procedure. You will usually spend 2 or 3 more days in the hospital after this surgery compared to other reconstruction procedures. Also, your recovery time at home will be much longer.
Many women choose not to have breast reconstruction or implants. They may use a prosthesis (an artificial breast) in their bra that gives a natural shape. Or they may choose to use nothing at all.
Risks of any surgery are:
Risks of breast reconstruction with natural tissue are:
Tell the health care provider if you are taking any drugs, supplements, or herbs you bought without a prescription.
During the week before your surgery:
On the day of your surgery:
You will stay in the hospital for 2 to 5 days.
You may still have drains in your chest when you go home. Your surgeon will remove them later during an office visit. You may have pain around your cut after surgery.
Fluid may collect under the incision. This is called a seroma. It is fairly common. Seromas may go away on their own, but sometimes they need to be drained by the surgeon during an office visit.
Results of reconstruction surgery using natural tissue are usually very good. But reconstruction will not restore normal sensation of your new breast or nipple.
Recovery is usually faster when reconstruction is done after the mastectomy wound has healed.
Having breast reconstruction surgery after breast cancer can improve your sense of well-being and quality of life.
Transverse rectus abdominous muscle flap; TRAM; Latissimus muscle flap with a breast implant; DIEP flap; DIEAP flap; Gluteal free flap; Transverse upper gracilis flap; TUG
McGrath, MH, Pomerantz J. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.
Roehl KR, Wilhelmi BJ, Phillips LG. Breast reconstruction. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 375.
Updated by: Debra G. Wechter, MD, FACS, General Surgery practice specializing in breast cancer, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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