Review the breast reconstruction FAQs below to help you better understand some of the issues important to our former patients as they went through their own reconstruction journey.
What is breast reconstruction?
Breast reconstruction is a type of surgery performed at the same time or some time after breast cancer surgery to restore a naturally shaped breast. Breast reconstruction surgery aims to rebuild the breast to the same size and shape that it was prior to mastectomy or lumpectomy. Most women who have undergone a mastectomy are eligible for breast reconstruction.
Why consider breast reconstruction?
The reasons why women undergo breast reconstruction surgery are many and varied, but can include the following:
- To regain self-esteem and restore a sense of femininity
- To make the breasts look balanced
- To eliminate the constant reminder of their breast cancer ordeal
- To avoid having to use an external prosthesis
- To gain closure from their breast cancer experience
What are the major benefits of the DIEP and SIEA procedures over other breast reconstruction procedures?
Unlike the traditional TRAM flap, the DIEP procedure spares the rectus abdominis muscle (or the “abs”), because it is based on small vessels that are microscopically separated from the muscle, leaving it intact. The rectus muscle acts as a counterbalance for the spinal muscles, and is important in straight posture as well as sitting activities. The SIEA procedure entails an even more superficial surgical dissection, where the deeper muscle layers are left undisturbed.
If a patient decides to move forward with breast reconstruction, what are her options?
There are essentially two different types of breast reconstruction:
Autologous Breast Reconstruction: Also referred to as Flap reconstruction, this type of procedure uses the patient’s own fat, skin and tissues taken from other areas of the body to reconstruct the breast. The abdomen, back and buttocks are all common donor sites for Flap breast reconstruction.
Implant Breast Reconstruction: This form of breast reconstruction involves placing a breast implant beneath the pectoralis muscle. Breast implant reconstruction is usually carried out in two separate stages. The first phase involves placing a tissue expander under the skin and chest muscle. This expander will then be gradually filled with a salt-water solution over time, in order to stretch the muscle enough to create a pocket for the implant. This typically takes anywhere from 3 – 4 months. Once this process is complete, a second surgery will be performed to replace the expander with the implant. The muscle does not have to be stretched significantly, because only the top portion of the implant is hidden beneath the muscle. Collagen strips provide a supportive framework for the lower portion of the implant. This connective structure acts somewhat like an internal bra that supports and provides cushioning for the bottom of the implant.
What determines which procedure is performed and when is this determination made?
During the initial patient consultation, all available procedures are discussed. Once the patient is found to be a good candidate for breast reconstruction with their own excess abdominal tissue, the SIEA or the DIEP flaps are preferred. Depending on the anatomy, the decision as to which flap is performed is made intraoperatively. The recovery and long-term results are similar for both flaps.
Who is a candidate for these procedures?
The DIEP or the SIEA procedures can be performed in all patients who have an adequate amount of abdominal tissue, provided that their medical status is not a contraindication. These procedures are best performed on patients who are active enough to appreciate the preservation of abdominal muscles. Older patients who are in poor health are not candidates, mainly due to the longer duration of the procedure, and are best served by a simpler form of reconstruction.
When does a patient undergo breast reconstruction surgery?
There are a number of factors that can affect when a woman has breast reconstruction, including the patient’s general health, stage of cancer, amount of available tissue as well as the physician’s recommendation. Breast reconstruction can either be performed at the same time as mastectomy (Immediate Breast Reconstruction) or sometime later on (Delayed Breast Reconstruction). Some women prefer to deal with treating breast cancer first before they focus on breast reconstruction, while others prefer the psychological and aesthetic benefit of waking up with a new breast rather than an empty space after breast cancer surgery. Your doctor will be able to help you determine which treatment course will best benefit you as an individual.
Can these procedures be done immediately following mastectomy? Can they be done following radiation?
Both the DIEP and the SIEA flaps can be performed immediately after mastectomy or at a later date after radiation treatment is completed.
Is breast reconstruction covered by insurance?
Yes, according to the Women’s Health and Cancer Rights Act of 1998 (WHCRA), group health plans, insurance companies and health maintenance organizations (HMOs) that offer mastectomy coverage, must also provide coverage for certain services related to the mastectomy in a manner agreed upon in consultation with the patient and attending physician. This mandated coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgical reconstruction of the other breast to create symmetrical appearance, prostheses and treatment of any physical complications that result from mastectomy. Click here for more information.
What is the recovery period after breast reconstruction surgery?
The recovery period after breast reconstruction will vary from patient to patient and also depends on what type of procedure you have. Because breast reconstruction is an invasive surgery, most patients will experience some degree of soreness, pain, tenderness, swelling and bruising. Pain medication will be administered to control pain or discomfort. During this time, your Houston breast reconstruction nursing staff will take extra care to optimize your comfort level and provide a great deal of personal attention to help accelerate your recovery process.
Patients are frequently encouraged to become mobile as quickly as possible, so as to improve blood circulation and decrease the risk of complications such as blood clot. Usually, by the second day of recovery, most patients are able to walk and have usually returned home by the third or fourth day. Although abdominal swelling may persist for a few weeks, the majority of patients are up and walking normally within a 10 to 14 day period after DIEP Flap surgery. Typically, patients can return to work within 3–4 weeks, depending on the type of work. Many patients choose to avoid most strenuous activity until 2 months after their procedure. Patients having Tissue Expander surgery will typically only require an overnight stay and can generally resume light normal activities within one week and return to work after two weeks. Full active status activities can be resumed six weeks after your surgery.
How long do I have to wear the support binder?
Most patients feel that the binder helps relieve low back discomfort. We recommend 4-8 weeks depending on your abdominal swelling.
Do I wear the support binder during the day or at night?
You do not have to sleep in the binder. We recommend placing the binder on once you wake up in the morning and should be worn throughout the day.
Do I wear the postop bra during the day or at night?
Typically the postop bra will be worn during the day. On occasion, a patient may have special needs that require wearing the bra at night, but this will be on an individual basis.
How long do I wear the post op bra?
This is very individual and is based on the size of the breast. Some individuals will not be required to wear a bra.
When do I transition to a regular bra?
Typically at the one month appointment, you will receive a prescription for a soft supportive bra. 4-6 weeks after surgery, pending no wound healing complications, you can go back to a regular bra.
When can I wear an underwire bra?
We do not recommend wearing an underwire bra. The wire tends to rub in areas that no longer have sensation, causing chafing or blistering. If you choose to wear an underwire for a short period of time, check your skin frequently for any breaks in the skin. This is typically not until 3 months after your initial surgery or 2 months after your symmetry procedure.
When can I shower?
48 hours after surgery (postop day 2).
When can I wear deodorant?
Do not wear deodorant on the day of surgery. You may start wearing deodorant after you have been discharged home, unless you had a sentinal node biopsy, in which case you will need to wait until 1 week after surgery. There are no restrictions on the type of deodorant you may use.
Can I shower with drains?
How do I monitor the flap?
While in the hospital, the skin “island” for monitoring will be identified for you, as well as how to check a capillary refill. You, or your caregiver, will be shown the color of the flap because you will need to do daily checks of the flap looking for any color change.
Why is the Doppler wire needed?
The blue wire is used with an internal Doppler that is attached around the internal mammary vein, allowing us to monitor blood flow through your flap. You will go home with the blue wire which will be removed at your first post-operative visit.
How long do I have to walk bent forward?
This varies depending on the individual elasticity of the abdominal tissue and if there are wound healing complications. The general time frame is 2-6 weeks.
Will a walker help me walk better after a DIEP reconstruction?
NO. You will be restricted to “no lifting, pushing, or pulling” with your operative arm. Using a walker causes you to place your weight on your arms for walking which tenses the chest area and can damage the reconstruction.
Where do I purchase/rent a recliner?
For more information regarding the correct type of Recliner
Does insurance cover the cost of the recliner?
You will need to contact your insurance for the possibility of coverage, they may at least pay the tax for the recliner. We can provide a prescription for the recliner and if you have an FSA (flexible spending account), you may be able to offset the cost of the recliner with that. You can also use the cost of the recliner as a tax write off. Our office will not handle the insurance for the recliner.
Is it mandatory to sleep in the recliner?
After the DIEP reconstruction, you are essentially recovering from a “tummy tuck.” We highly recommend that you sleep in the recliner to avoid abdominal wound healing complications. In addition to your tummy, sleeping in the recliner keeps you from sleeping on your reconstructed breast flap.
How long do I have to sleep in the recliner?
Time in the recliner varies with each patient, ranging from a minimum of 2 weeks to as many as 8 weeks depending on the elasticity or “stretchiness” of your tummy tissue.
When can I exercise?
You can begin walking as soon as you return home, but you may not feel like walking long distances at first. At 6 weeks, we allow you to gradually increase your activity. It is important that you do not do core strengthening activities such as sit ups or crunches before the 3 month mark. Using your abdominal muscles too soon can cause the wound to open.
When do I start range of motion exercises?
You will begin simple range of motion exercises after the 2 week appointment. If at 4 weeks you have not been able to restore full range of motion, you will receive a prescription for physical therapy.
How soon can I drive after surgery?
Once you no longer have drains, no longer taking pain medication, and are feeling confident of your ability, you can return to driving. If you are driving longer than 2 hours, wear TED stockings and take breaks from sitting. You should only wear a lap belt, however if you must wear one that crosses your chest, be sure to put some sort of padding between you and the belt.
When can I travel?
DIEP patients can travel after their first post-operative visit. Symmetry and implant reconstruction patients may travel the day after surgery. There are no restrictions with flying and you can fly with drains. Remember no lifting until you have been cleared. If you are flying or driving longer than 2 hours, wear TED stockings and take breaks from sitting. You should only wear a lap belt, however if you must wear one that crosses your chest, be sure to put some sort of padding between you and the belt. You may only drive yourself when you are no longer taking pain medication and your drains have been removed, generally this is one to two weeks post-operatively and procedure dependent.
How many milligrams of aspirin do I take after surgery?
You will take 81mg (baby aspirin), unless otherwise directed, prior to your discharge home.
When do I stop iron, multivitamins, and zinc after surgery?
You may stop iron 2-4 weeks after surgery if your energy levels have returned to normal (or you may stop if you are experiencing gastrointestinal issues with the iron). You may stop the multivitamin 2 weeks after surgery if you do not have wound healing complications. You may stop the zinc 2 weeks after surgery if you do not have wound healing complications.
When can I start Tamoxifen after surgery?
You can restart Tamoxifen 1 week after surgery.
Will the reconstructed breast be made symmetrical to the existing breast?
Yes, the symmetry procedure is performed approximately four to six months after the initial flap. The second stage provides refinement of the shape of the reconstructed breast as well as lifting or reduction of the other breast to achieve optimal balance.
Why do I have to wait 4 months after the DIEP surgery to have symmetry surgery?
4 months is the minimum wait. This allows the flap to establish its own blood flow. In addition, this wait period allows the tissues to return to a state without swelling and to become softer. This is also the time for patients to lose and stabilize their weight prior to symmetry surgery. We recommend that patients attain their goal weight and maintain that weight for 2 months prior to symmetry surgery.
What is done for restoring the nipple and areola?
The final stage of breast restoration takes place about two to three months after the second stage procedure. Initially the nipple is reconstructed using the flap tissue, and then medical tattooing is performed to restore the color of the areola. Both of these are performed as minor office procedures.
Will the reconstructed breast have sensation?
The final goal of beast restoration is not only to create a soft, symmetric breast but also to restore protective sensation. This can be achieved by microsurgically connecting the sensory nerve of the breast that is severed during the mastectomy to the sensate nerve of the abdominal tissue. Over a period of three to six months, the nerve grows slowly and offers the possibility of regaining normal sensation.
How are the long-term results?
The short and long-term results are excellent. Any necessary revisions are generally performed 4-6 months after the initial procedure.
Why do you want the pectoralis muscle to weaken after implant reconstruction?
When having reconstruction with implants, there is little or no native breast tissue to cover and soften the appearance. To help, as well as protect, the implant is placed under the pectoralis muscle so the top one-third to one-half is covered. The thinner layer of mastectomy skin can become attached to the muscle since there is no tissue to separate it; this is not abnormal. If the muscle is fully developed, it can cause outwardly noticeable movement of the implant when the muscle is in use. This “animation defect” may sometimes be seen as an undesirable outcome. If the muscle is allowed to weaken, any movement will be much less noticeable.
How do I get started with breast reconstruction in houston?
It is important to begin discussing breast reconstruction early on in your treatment process. Talk to your breast surgeon about breast reconstruction options and how your treatment plan can accommodate for your reconstruction. This way, you can ensure proper measures are taken with your cancer treatment therapy to prepare for breast reconstruction. Once you have decided on a breast reconstruction surgeon, you will be able to discuss your medical history, lifestyle, hobbies, etc.. during consultation so that you and your plastic surgeon can decide on the treatment plan that makes most sense for you.
If you are interested in learning more about our breast reconstruction options, please fill out our online form at top of the page or give our office a call at (713) 441-6102.
Risks & Benefits of Breast Reconstruction
The major benefits of breast reconstruction microsurgical procedures are the restoration of a natural appearing breast without losing any muscle from the abdominal or buttock donor site. The short and long term results of the procedure are excellent. Patients have a relatively short hospital stay of 4-5 days and can return to normal daily activities in about two weeks. Most patients are able to resume exercise and lifting in four to six weeks.
The risks of breast reconstruction procedures are mainly related to the possibility of flap loss, because these microsurgical techniques require connection of tiny blood vessels. If there is a problem with the flap, a re-exploration procedure is performed. Other risks are related to the length of the surgery, but are not a significant factor in patients who are in good medical status. All breast reconstruction and breast symmetry procedures, including the SIEA, DIEP, and SGAP are covered by insurance, as legislated in 1998.