Welcome to Ponte Vedra Plastic Surgery’s guide to breast reconstruction. This information cannot take the place of your consultation, and we can best answer any questions you have or address specific concerns in your private consultation.
Many women seek breast reconstruction after undergoing a mastectomy or surgery to remove a breast lump. A misconception of this procedure is that it will make your breast(s) look normal while nude. In some instances, this is possible if your reconstruction is completed at the same time as your mastectomy. In most all circumstances this procedure will make your breast(s) look normal while wearing a bra. No matter which type of breast reconstruction you choose, your affected breast will differ from your unaffected breast. That being said, most women are satisfied with their breast reconstruction finding that it restores their confidence and makes life easier.
How will your breast reconstruction be performed?
There are two basic options available for breast reconstruction, breast implants or muscle flaps. Nipple/areola reconstruction may be performed with both techniques and is usually delayed until after the breast mounds have had time to completely heal.
This option is usually completed in two phases. The first surgery may last up to an hour and consists of placing a tissue expander in the breast area underneath the skin and chest muscle. Our plastic surgeons will fill the tissue expander (similar to a balloon) with salt-water solution approximately once a week. Once your skin has stretched (usually over three to four months), the next surgery will replace the tissue expander with a permanent saline or silicon breast implant. The principle advantage of breast implant reconstruction is the less invasive nature of the procedures.
Muscle Flap Reconstruction
This procedure involves the use of your own tissue to rebuild the breast. The most popular option utilizes excess fat from the tummy. Another alternative uses a back muscle with an implant.
In the Tansverse Rectus Abdominis Muscle (or TRAM) flap procedure, the surgeon moves skin, fat, and muscle from your abdominal area to contour the reconstructed breast, leaving the tissue connected to its blood supply in the abdomen. If you do not have enough tissue to reconstruct your breast, a small implant may be inserted.
In a Latissimus Dorsi flap procedure, the surgeon uses muscle and skin from your back and transfers it to the breast area. This helps create a pocket so an implant may be inserted and placed. In some patients when neither of these options is suitable, other more complex procedures may be necessary. Your surgeon will discuss which option would be most suitable given your circumstance. For example, many women choose the less invasive route of implant reconstruction but prior radiation may make that option less desirable.
Here are some suggestions to help you prepare for breast reconstruction surgery.
During your consultation you should be very open with the plastic surgeons. Provide us with all of your medical history and list all of the medications, vitamins, and herbs you are taking (even if you don’t think they’re important). It is important to discuss your desires so that we can help you set realistic expectations.
Here are some tips that may help you decrease your chances of complications from your breast reconstruction surgery:
• Discontinue using Aspirin or Ibuprofen (these medications act as blood thinners and could cause problems with blood clotting).
• Stop smoking for at least two weeks before your breast reconstruction as nicotine can impair circulation and healing.
• Do not drink alcohol in excess before or after surgery.
• Drink several glasses of water in the days leading up to your breast reconstruction.
To make your breast reconstruction recovery easier and more comfortable be sure to:
• Arrange for someone to take you home and take care of you for at least the first day.
• Fill your prescriptions and have them within easy reach of where you will be resting.
• Place plenty of pillows and a bed wedge nearby so that you can keep your back elevated.
You will also want to avoid raising your arms above shoulder level during the first few days after surgery.
What to expect post breast reconstruction surgery.
Swelling will be significant in the first four weeks following your breast reconstruction surgery but will become mild soon after. Scars fade between six to twenty-four months and bruising may last up to four weeks. Pain after surgery will be controlled with appropriate medications. During the first 48 to 72 hours, your pain medication will be needed regularly. After this time, the medication is needed less frequently. Although pain cannot be fully avoided, it can be minimized by the medication prescribed by your surgeon, however, if you begin to have severe pain, contact your surgeon immediately.
You may be released from the hospital on the same day and as long as or be admitted for 2 – 4 days. Drains remove excess fluids from the surgical sites following the procedure. These may be removed after the first week or two following surgery. The removal of your stitches will follow in approximately 7 - 10 days. Your doctor will discuss what time is best for you to begin showering after your procedure. Strenuous as well as sexual activity must not be engaged in for several weeks. It may take up to six weeks to recover from combined surgery. If implants were used without flaps and if surgeries were done separately, your recovery time can be less. The amount of time it will take for you to return to work may differ if you are having breast reconstruction done right after a mastectomy or in the weeks following, but expect to be out of work for approximately 2 to 4 weeks.
Results vary from woman to woman but can usually be seen after two years. This allows a maximum amount of time for scars to heal.
Be sure to take a look at our before and after breast reconstruction photo galleries by our plastic surgeons to get a better idea of the results you may achieve. If you have any remaining questions or are ready to schedule your consultation, give us a call, we’ll be waiting to help.
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