General Breast Reconstruction FAQS
What is breast reconstruction?
Breast reconstruction is a type of surgery with the purpose of restoring the natural shape of the breast after a procedure such as a mastectomy or lumpectomy. Breast reconstruction surgery can be immediate, at the same time as your breast cancer surgery, or delayed, at a time after your mastectomy or lumpectomy.
There are various options for breast reconstruction including using your own fatty tissue to reconstruct the breast or implant based breast reconstruction. The decision as to what reconstruction option is the best fit for the patient is tailored on a case by case bases and considers the cancer treatment plan, medical history, and the patient’s own personal goals for their reconstruction.
Why consider breast reconstruction?
Breast reconstruction is a personal decision and the reasons why a patient chooses to proceed with reconstruction vary, but may include:
- To achieve breast symmetry and balance
- To regain self-esteem and restore a sense of femininity
- To avoid having to use an external prosthesis
- To correct a deformity created by a previous procedure
- To eliminate the constant reminder of their breast cancer
- To gain closure from their breast cancer experience
How are the long-term results?
The short and long-term results are excellent. Any necessary revision or second stage procedures are generally performed 4-6 months after the initial procedure. Please visit our patient image gallery for specific examples of our results.
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.
How do I get started with breast reconstruction?
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.
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 the prepectoralis placement of a breast implant.
Prepectoralis implant placement (placing the implant above the chest muscle) has many benefits over the traditional subpectoral breast implant placement (placing the implant below the chest muscle), including preserving all pectoralis muscle function, eliminating pectoral animation (deformity caused by placing implant below the muscle), and the appearance and feel of a more natural breast.
When does a patient undergo breast reconstruction surgery?
There are several 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 (Delayed Breast Reconstruction). Some women prefer to deal with treating breast cancer first before they focus on breast reconstruction, or, due to required breast cancer treatment, it is recommended they undergo reconstruction at a later date. Other women prefer the psychological and aesthetic benefit of waking up with a new breast 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?
Depending upon the specific patient case, both autologous reconstruction and implant based reconstruction can be performed at the same time as the mastectomy (immediate breast reconstruction), or after the mastectomy (delayed breast reconstruction).
If radiation is required, autologous tissue reconstruction will be delayed until after radiation is completed, as to not radiate the flap tissue. In most cases, it is safe to radiate implants and tissue expanders, and these can be placed at the time of the mastectomy.
How long do I have to wait after radiation before having breast reconstruction?
In most cases, implants or tissue expanders can be placed immediately after the mastectomy and can safely be radiated. Autologous tissue breast reconstruction is performed after radiation is completed. If your surgical plan includes autologous reconstruction but you need radiation, a tissue expander or breast implant may be placed temporarily until after radiation is complete.
If a surgical procedure is required after radiation, it is best to wait at least 6 months after the completion of radiation therapy before operating.
What determines which procedure is performed and when is this determination made?
During the initial patient consultation, the patient’s specific medical, surgical, and family history are discussed. Various factors are considered in order to determine which type of breast reconstruction the patient is a candidate for, including the type of cancer treatment the patient will require and the patient’s lifestyle, hobbies, social support, etc.
If the patient is a good candidate for more than one type of procedure, we discuss risks and benefits of each procedure in detail and help guide the patient to decide which type of breast reconstruction will be their best fit.
What is the recovery period after breast reconstruction surgery?
The recovery period after breast reconstruction will vary from patient to patient and depends on what type of procedure you have. Most patients will experience some degree of soreness, pain, tenderness, swelling and/or bruising. Pain medication will be administered to control pain or discomfort. During this time, your Houston breast reconstruction team 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, to improve blood circulation and decrease the risk of complications, such as blood clot.
Your specific recovery period can be discussed in more detail at your appointment, but general recovery periods are outlined below:
AUTOLOGOUS TISSUE RECONSTRUCTION:
Hospital stay: 3-4 days
Drains: typically, two drains are placed to each operated breast, and a total of two drains are placed the abdomen (one on each side)
Mobility: usually by the second to third day in the hospital most patients are able to get up and walk, as well as use the bathroom, and shower
Activity Restrictions: initially activity and arm range of motion restrictions will be placed, that are gradually lifted throughout the first month after surgery. Most normal daily activities can be resumed around 3-4 weeks post op, and depending upon the type of work, patients can return to work at 4-6 weeks. It is important to note that patients are not to lift/push/pull anything greater than 5-7 lbs for approximately 6 weeks and should avoid more strenuous activity for 2-3 months.
Special precautions: DIEP/SIEA patients – Patients must walk flexed at the hips in order to take tension off of the abdominal incision. Patients must also sleep in a recliner chair and cannot lie flat in bed, again to protect their abdominal incision. Typically, these abdominal precautions are continued for approximately 4 weeks, or until the tension on the abdominal incision decreases
IMPLANT BASED RECONSTRUCTION:
Hospital stay: 1 night
Drains: typically, two drains are placed to each breast
Mobility: Patients can get up and walk around starting the first day after surgery. They may shower 48 hours after surgery
Activity Restrictions: initially activity and arm range of motion restrictions will be placed, that are gradually lifted throughout the first month after surgery. Most normal daily activities can be resumed around 3-4 weeks post op, and depending upon the type of work, patients can return to work at 4 weeks. It is important to note that patients are not to lift/push/pull anything greater than 5-7 lbs for approximately 6 weeks and should avoid more strenuous activity for 2-3 months.
Will the reconstructed breast have sensation?
The final goal of breast restoration is not only, to create a soft, symmetric breast, but also, to restore protective sensation. Autologous reconstruction allows the ability to reconnect the sensory nerve of the breast, that is severed during the mastectomy, to a sensory nerve that is taken from abdominal tissue. Over a period of three to six months, the nerve grows slowly and offers the possibility of regaining sensation. For more information regarding breast sensation please visit our Breast Sensation page.
Will the reconstructed breast be made symmetrical to the existing breast?
Yes, a symmetry procedure is performed approximately four to six months after the initial breast reconstruction procedure. The symmetry procedure that is performed is based upon your specific situation, including the breast surgery and breast reconstruction procedure performed, as well as if the reconstruction was bilateral (performed on both breasts) or unilateral (performed on just the affected breast). For bilateral reconstruction, the symmetry procedure, if needed, allows for refinement of the shape and size of the reconstructed breast. For unilateral breast reconstruction, the symmetry procedure, if needed, allows for the reconstructed breast to be refined, and at the same time a procedure is also performed on the other breast (breast lift, breast reduction, etc) to achieve optimal balance between the breasts.
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/symmetry procedure. Initially the nipple is reconstructed using the flap or mastectomy tissue. After the reconstructed nipple heals, approximately 6 months, medical tattooing can be performed to restore the color of the areola. For more information regarding this please visit the nipple reconstruction page.
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 3-4 days and can return to normal daily activities in about two to four weeks. Most patients can resume all activities without restrictions, including lifting at three months.
The major benefits of implant based reconstruction is a natural appearing breast with a simpler procedure with less recovery time. The average hospital stay for a direct to implant case, where the implant is placed at the time of the mastectomy, is one night. Typically, most patients can resume their normal activities at four weeks and all activity restrictions are lifted at three months.
All breast reconstruction and breast symmetry procedures, following a mastectomy, are covered by insurance, as legislated in 1998.
The risks of microsurgical 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 healthy patients.
The risks of implant based reconstruction include seroma (a collection of fluid within the breast), infection, and capsular contracture. These risks factors are reduced by surgical technique, including the use of an acellular dermal matrix to support the implant, the placement of breast drains, intraoperative antibiotics, patient activity restrictions, and post surgery oral antibiotics that are taken until all drains are removed. On average, two drains are placed per breast and typically all drains are removed by 2-3 weeks post op but may stay longer depending on the specific patient situation.
What bra should I wear post op?
A special surgical bra will be placed post operatively in the operating room that is soft and breathable, allowing for optimal healing after your breast surgery. In the initial post operative period it is important that your breasts are supported, and the surgical bra is to be worn both during the day and at night.
How long do I wear the post op bra?
This is very individual and is based on the size of the breasts and your specific post operative recovery. Typically, at your one month post op appointment, pending no recovery complications, you will receive information regarding approved bras that you may purchase. After having a mastectomy, most patients have some degree of sensation change to the breasts. This decrease in breast sensation increases the risk of bras rubbing and causing skin irritation. It is important that you wear a bra that is soft, without underwire, and that does not have thick seams, to reduce the risk of skin irritation and breakdown. Our office has spent a lot of time finding bras that are safe and comfortable and you will be given this information when it safe for you to transition from the initial surgical 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 or have decreased 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. If you are going to wear an underwire bra (for example for an event), you should wait at least 3 months after your initial surgery or 2 months after your symmetry procedure.
When can I shower?
You may shower 48 hours after surgery (postop day 2), with the water to your back. Showering with the water to your back prevents direct contact of water on the incisions. It is ok if water trickles over your shoulders to the incisions. Just pat the incisions/dressings dry after you shower. Please do not wash/scrub your incision sites. A sterile dressing was placed over your incisions in the operating room and this will stay in place and will be changed during your post op appointment. Please do not remove or change your dressings, unless otherwise specified by our office.
Can I shower with drains?
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 sentinel 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.
How do I care for my drains?
Please strip your drains 5-6 times per day and record the output per drain, per day on your drain log. For specific instruction on how to care for and strip your drains please refer to the drain care page.
What wound care do I need to do?
In most cases after surgery you are not required to do any wound care, unless otherwise specified by our office. A sterile dressing will be placed over your incisions that should remain intact and will be changed in the office during your post operative visit.
When do I start range of motion exercises?
You will begin simple range of motion exercises after all drains have been removed, typically at the 2-3 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.
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, and it is important to listen to your body and not push yourself while your body is trying to heal. At 4-6 weeks, we allow you to gradually increase your activity. Most patients can resume light exercise including the stationary bicycle at 4-6 weeks post operatively. More strenuous exercise can typically be resumed at approximately 2-3 months post op. Please discuss with our office before resuming any exercise to ensure it is safe for you to do so in your specific situation.
When can I sleep on my stomach or side?
Please discuss with our office before transitioning to sleeping in a new position, including transitioning from your recliner to bed (if you had a DIEP/SIEA flap procedure), to determine if it is safe for you to do so. All patients are required to sleep on their back for a minimum of 4-6 weeks post operatively. Typically, at 3 months post op, as long as there are no delays in your recovery, you can sleep on your stomach.
When can I resume sexual activity?
Intimacy can be resumed 6 weeks post operatively, as long as there are no recovery complications or delays in healing. Please avoid direct pressure to the breasts until at least 3 months post operatively.
Can I massage my breasts?
Breasts can be lightly massaged at 2-3 months post operatively. Please avoid applying direct heat or cold to the breasts, this can result in burns or damage to the breast due to decreased breast sensation after mastectomy.
How soon can I drive after surgery?
Once you no longer have drains, you no longer are taking pain medication, and you feel confident in your ability, you can return to driving.
In the immediate post operative period you are at an increased risk for blood clots and precautions should be taken to avoid this. 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 place 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/pushing/pulling 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 is procedure dependent.
When do I stop iron, selenium, 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 zinc and selenium 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.