Fifty percent of women who have had a mastectomy decide to have reconstructive surgery, according to a study published in October 2017 in Plastic and Aesthetic Nursing. And with the advent of genetic testing, more and more women are choosing preventive mastectomy to reduce their risk.
Breast reconstruction surgery is a popular option, but it’s a lot more complicated than you might think, and many women who decide to have it don’t know all of their options or all of the risks involved with this type of surgery. in the American Society of Plastic Surgeons.
The 2017 study found that more than 40 percent of women who participated felt that the outcome of their surgery was worse than expected, with most having problems with the appearance of their breasts and experiencing breast pain after surgery .
Before deciding which reconstructive surgery is right for you, it’s important to have all the facts, especially since you may be making this decision at an overwhelming time when trying to decide on a lumpectomy versus a mastectomy, chemotherapy, or radiation therapy. all the while wondering how all these procedures will affect your life — and your overall health.
If you’re planning to pursue reconstruction, here’s what an expert wants you to know about this surgery — and what to expect after surgery:
What you need to know before surgery
There’s no need to rush – or do it at all
Many women feel rushed to make a decision about reconstruction before breast cancer surgery. The result is that many are unhappy with their choices. The truth is, there’s no need to rush, says Philip J. Torina, MD, a plastic and reconstructive surgeon and associate professor of surgery at the Icahn School of Medicine at Mount Sinai Hospital in New York.
“You don’t have to decide right away, which means you can choose reconstruction down the road after your mastectomy,” says Dr. Torina. “Also, you can forego the reconstruction altogether and wear a prosthesis. There are many bra companies that make patient-specific molds that fit well into a bra, if that’s what you prefer.”
Will You Need to Make Decisions: Implants vs. Tissue-Based Reconstruction? Saline vs Silicone?
There are two main types of reconstruction: implant reconstruction, which uses silicone or saline implants, and autologous tissue reconstruction, which uses your own tissue – either from your abdomen, thighs, buttocks or back muscles – to the reconstruction of your breasts.
If you choose implants, another decision you will make is what type of implant to get. Two of the most common options are saline implants (which are filled with sterile saline) and silicone implants (which are filled with silicone gel). Silicone implants tend to look more like natural breast tissue, according to the American Society of Plastic Surgeons.
Both options carry the risk of leakage, although saline implants will likely collapse, while silicone implants are designed to remain intact if leakage occurs. Whichever option you choose is largely based on personal preference and what your surgeon thinks is best for you.
Reconstruction of implants
For this type of surgery, your doctor will use either saline or a silicone implant. It can be done at the same time as your mastectomy or at a later date if you choose reconstruction in the future.
The first step will be for your surgeon to place expanders in your breasts. These expanders are essentially empty breast implants that stretch the skin until your skin is ready for implant placement.
If this is an option for you, you’ll see your surgeon every week or so for saline “injections” into the expanders, which gradually stretch the tissue to make room for the implant. After 2-3 months of saline injections, another surgery will follow in which the expanders are removed and the implants are placed in their place.
Your doctor may want to wait a month or two before placing the implants to make sure any cancer treatment you need is complete. If you’ve had radiation, the wait time may be a little longer, experts say.
It is possible that you will only be in the hospital for one night. If you have any complications or don’t like the result, they can be easily removed. One of the biggest advantages of this type of surgery is that your expanders can be placed during your mastectomy.
As with many surgeries, however, there are some risks. “With implants you can develop more scar tissue, the skin can thin, the implants feel cold and the nerves can’t come back as well,” says Torina.
There is also the possibility of developing a capsule, where scar tissue forms around an implant and causes pain. This leads to a stiff and tight feeling and can happen with both implants or just one.
Another potential complication is leakage. While this occurs in about 15 percent of patients after 10 years, it can also occur with saline and silicone implants. You may notice that your implant has deflated or you may not notice any change. Either way, if your implants are leaking, they should be removed immediately, Torina says.
In less than two percent of cases, a fungal or bacterial infection from other parts of your body could lead to an infection in or around the implant. If this happens, you will likely develop a fever or chest pain. If you notice these symptoms after surgery, contact your doctor.
Wing reconstruction
Flap reconstruction surgery uses your own tissue to create a new breast mound. This surgery allows your reconstructed breast to feel more natural. The majority of flaps are deep inferior epigastric perforation (DIEP) flaps that use abdominal tissue.
“People tend to have excess skin [in the abdomen]says Torina. “It looks like a tummy tuck. The scar can be hidden under clothing, and the surgery is sometimes easier because it’s within the surgical field, so we can start the procedure while doing the mastectomy.”
There are several types of flap procedures. In addition to DIEP flap surgery, some less common options for flap reconstruction include the TUG flap (which uses tissue from the inner thighs), the GAP flap (which uses tissue from the buttocks), and the LDF (latissimus dorsi flap, which uses tissue from the large back muscles).
These options are not as common because there is not as much fat in these areas, and if they are done, they may need to be combined with an implant, Torina says.
Flap reconstruction tends to take at least four hours, sometimes longer, and you’ll likely spend about three days in the hospital. In addition, you will be checked once an hour via Doppler, a device used to check blood flow immediately after surgery. If your operation has gone well, you will be checked every two to four hours with the Doppler and then every six hours.
You will be sent home with drains attached to your new breasts and the donor area – usually in the abdomen – which help prevent fluid build-up and blood clots.
Flap repair usually takes about six months to fully heal and tends to look better over time, Torina says. Recovery time for flap repair is longer than implant reconstruction because you’ll have two surgical sites that need to heal, according to American Cancer Society. “Plus, expect to feel tightness in your belly for six weeks to three months,” says Torina.
One of the biggest risks with this type of surgery is necrosis, or tissue breakdown, due to lack of blood flow. This can lead to partial or complete failure of the vane. If this happens, your surgeon may need to remove the flap and replace it with either tissue from another area or an implant, according to breastcancer.org.
An indication of this is the fin becoming darker or lighter in colour. “[And] if you see a large amount of swelling, it could be that you’re bleeding under the skin and you need to be seen as soon as possible,” says Torina.
If you have the DIEP flap, expect to feel numbness in your lower abdomen. “Whether this will improve depends on the person and how quickly the nerves recover,” says Torina. Another thing to prepare for after this surgery is the lack of sensation in the breasts themselves. “This could take forever,” he says.
How to take care of yourself after surgery
Watch your chest Be sure to tell your doctor if you notice any changes in your breasts after surgery. These may include color changes, bleeding, swelling, pain or fever.
Discuss your bras While you will leave the hospital wearing a surgical bra (these are made of breathable cotton, have soft seams, no wires, and adjustable shoulder straps), be sure to discuss with your doctor what bras you should wear moving forward.
“We tell patients not to wear underwire bras because you’re numb, and if the underwire doesn’t fit well, it can injure the skin without you even realizing it,” Torina says, adding that if your surgeon agrees, she can wear an underwire bra as soon as sensation returns to the skin.
Avoid strenuous activities In general, you can return to exercise about six weeks after surgery, regardless of your procedure. “After three months, you can go back to lifting heavy weights, but you should always listen to your body,” says Torina.
Prepare for changes It is likely that you will need a period of time to adjust to your new body. It may help to talk to your family, close friends, or other women who have gone through reconstruction. Consider visiting breastcancer.org to find virtual support groups and meetups in your area.
