Breast reconstruction is type of cosmetic surgery used to restore the appearance of a breast for women who have had a breast removed (mastectomy) to treat breast cancer.

Most women who have had a mastectomy are good candidates for breast reconstruction. Women who have had a lumpectomy usually do not need reconstruction.

Before getting a breast reconstruction, you will need to have a preoperative consultation with your surgeon. The surgeon will perform a thorough examination and evaluation of your breasts and explain which reconstructive options are best for your age, health, body type, lifestyle, and goals. The types of available breast implants will also be reviewed (see below for a description of the types of implants). The surgeon will give you preoperative instructions as to what you can or cannot eat or drink before surgery, which medications you should take or avoid, and a list of things you will need to have on hand for your recovery. During your consultation, the surgeon will answer any questions you might have, so come to your appointment prepared.

Types of Implants

Saline implants are filled with sterile salt water. How much salt water an implant contains can affect the shape, firmness, and feel of the breast. If a saline implant leaks, it will collapse and the saline will be absorbed by the body.

Silicone implants are filled with an elastic gel. The gel feels and moves much like a natural breast. If a silicon implant leaks, the gel may remain inside the implant, or may leak into the implant pocket.

A leaking silicone implant may not collapse. If you choose this type of implant, you will likely need to visit your plastic surgeon regularly to make sure the implants are functioning properly.

In the past ten years, a number of independent studies have examined whether silicone gel-filled breast implants are associated with connective tissue disease or cancer. The studies, including a report by the Institute of Medicine, have concluded there is no convincing evidence that breast implants are associated with either of these diseases.

In November of 2006, the U.S. Food and Drug Administration (FDA) approved the use of silicone gel-filled breast implants for breast reconstruction in women of all ages.

Breast reconstruction is usually performed under general anesthesia, which means that you will be given drugs through an IV to put you to sleep.

A mastectomy or radiation therapy will usually not leave enough tissue on the chest wall to cover and support a breast implant. Therefore, flap techniques or tissue expansion, as described below, will be used to reposition your own muscle, fat, and skin to create or cover the breast mound.

Flap Techniques

A TRAM (transverse rectus abdominis myocutaneous) flap uses muscle, fat and skin from your abdomen to reconstruct the breast. Alternatively, your surgeon may choose the DIEP or SGAP flap techniques which do not use muscle but transport tissue to the chest from the abdomen or buttock.

A latissimus dorsi flap uses muscle, fat, and skin from the back.

Tissue Expansion
Tissue expansion stretches healthy skin to provide coverage for a breast implant. The recovery for this type of reconstruction is easier than with flap procedures, but the reconstruction itself will take longer. Reconstruction with tissue expansion requires several follow-up office visits over 4-6 months to slowly fill the implanted expander through an internal valve to expand the skin. A second surgery will be needed to replace the expander with an implant if it is not designed to serve as a permanent implant.

After the surgeon performs a flap technique or tissue expansion, a breast implant is used to create a breast mound.

Grafting and other specialized techniques are used to create a nipple and areola.

Tissue expansion and implants are often done on an outpatient basis, which will allow you to return home after surgery, although you will need someone to drive you. If you are having a flap reconstruction, you will remain in the hospital for two to five days. You may have drainage tubes to drain excess fluid from the surgical site. These will be removed in the first few weeks and stitches will be removed in 7 to 10 days. During breast reconstruction recovery, you will be tired and sore for one to two weeks. Your surgeon can prescribe medications for pain.

You should expect some swelling and bruising, which could last for several weeks.

The location of your breast reconstruction scars will depend on the technique used during surgery. Your scars will most likely remain firm and pink for approximately six weeks. Over the next several months, the scars will fade significantly, but they will never disappear completely. To reduce the chances of more noticeable scars, follow your surgeon’s recovery instructions carefully.

Most people are able to return to work within one to two weeks after surgery. You may be required to wear a surgical bra or other support garment (see below for post-surgical support garment options), and limit your activities for a few weeks following surgery.

Breast Reconstruction Surgical Bras and Other Support (Compression) Garments
Immediately following a breast reconstruction procedure your doctor may instruct you to purchase and continuously wear a compression garment. These are designed to help improve and increase blood circulation, rid your body of potentially harmful fluids, decrease your post surgery recovery time, and reduce swelling. They also help the new skin fit the body’s contours allowing you to recover faster.

To purchase a breast reconstruction surgical bra or other support garment, click on the links below. Among your garment options are compression vests and a variety of compression and post-surgical bras. Ask your doctor which type(s) of garment is best for you.

These garments are typically worn immediately after your surgery. They are generally worn continuously for several weeks, so you may want to purchase more than one.

Contour® is America's 1^st choice in premium quality post-surgical compression garments for women and men. Contour® has 25 years of experience with design, fabric and craftsmanship so Contour® garments fit every subtle contour of the body, offering unprecedented comfort during the recovery process. ContourMD website also offers helpful information on recovery tips and sizing charts.

Although breast reconstruction is a relatively safe procedure, all surgery comes with some risk. Potential breast reconstruction risks may include:

• Bleeding
• Blood clots
• Poor wound healing
• Infection
• Reactions to anesthesia
• Scarring
• Changes in sensation
• Severe bruising
• Rippling (wrinkling or folding of the implant shell)
• Rupture (tearing of the implant shell)
• Capsular contracture (when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant)

any of these complications can be avoided if you closely follow your surgeon’s instructions.

Breast reconstruction costs vary based on a number of factors including:

• Type of surgery
• Geographic location
• Facility fees
• Surgeon expertise and demand

Costs can range from around $5,000 to around $9,000. Before you schedule your breast reconstruction surgery, check with your insurance company to see if your costs will be covered.

American Society of Plastic Surgeons www.plasticsurgery.org

American Cancer Society www.cancer.org

Breastcancer.org www.breastcancer.org

U.S. Food and Drug Administration