Immediate Breast Reconstruction

What is Immediate Breast Reconstruction?

Breast reconstruction is a surgery performed to restore the normal shape, size, symmetry, and appearance of one or both breasts after a mastectomy (surgical removal of one or both breasts to treat or prevent the spread of breast cancer). Breast reconstruction can be performed at different junctures, depending upon what works best for your case. Immediate breast reconstruction is a surgery that is performed at the same time as your mastectomy. The decision to perform a reconstruction surgery immediately or at a later time may depend upon several factors, such as:

• Your medical condition
• Your breast cancer stage
• Your lifestyle and preference
• Additional treatment measures, such as chemotherapy or radiation therapy required to treat breast cancer

An immediate breast reconstruction requires the coordination of both a breast cancer surgeon and a plastic surgeon. During immediate reconstruction, a plastic surgeon reconstructs the breast either using an implant or using the patient’s own tissue soon after the breast is removed by a breast cancer surgeon. Almost all of this procedure is done simultaneously during one operation to provide the patient with a completely reconstructed breast. However, immediate reconstruction may not be feasible if your surgeon deems you require additional therapies such as chemotherapy and radiation therapy prior to reconstruction. Immediate reconstruction is not advisable as these therapies can cause the reconstructed breast to change in appearance, texture, color, and to lose volume.

Merits and Demerits of Immediate Breast Reconstruction

Some of the merits and demerits of immediate breast reconstruction include:

Merits

• Better cosmetic results
• Preserve breast skin
• Preserve breast nipple
• Minimal scarring
• Low surgery cost and potentially few surgeries
• No notable delays in having other cancer treatments
• Oncologically much safer

Demerits

• Difficult to detect mastectomy skin issues
• Prolonged recovery and hospitalization time
• Additional scarring other than mastectomy alone

Methods of Immediate Breast Reconstruction

Immediate breast reconstruction can be performed either with prosthetic implants or autologous tissues. The 2 main techniques of immediate breast reconstruction include:

• Implant-Based Reconstruction: Inserting a permanent implant that is filled with silicone gel or saline (salt water) under the skin and muscle of the chest to create a new breast mound is the most commonly performed technique.
• Flap or Autologous Reconstruction: The patient’s own skin tissue is taken from another section of the body, such as the stomach, thigh, or buttocks and used to create a new breast mound.

Preparation for Immediate Breast Reconstruction

In general, preparation for immediate breast reconstruction may involve the following:

• A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to the procedure.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and a mammogram to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• Inform your doctor of any medications, vitamins, or supplements that you are taking.
• Refrain from taking any anti-inflammatory drugs, aspirin, or supplements, as they may increase the chance of bleeding.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You may be instructed to shower with an antibacterial soap the night prior to surgery.
• Refrain from smoking pre- and post-procedure for a specific period of time, as this may hamper proper healing and increase your chances of areolar or nipple damage, tissue necrosis, and other complications.
• You will be given an opportunity to analyze before and after surgery pictures of patients with similar desired breast shape and size.
• A written consent will be obtained from you after the procedure has been explained in detail.

Procedure Involved in Immediate Breast Reconstruction

Mastectomy and immediate breast reconstruction are usually performed under general anesthesia in a hospital setting. The surgery may take a couple of hours or more based on the size and composition of the breasts.

In general, your surgeon will undertake the following steps:

• Use a marker to draw guidelines on the breast to mark the breast boundaries
• Make a surgical cut accordingly and more commonly on the inframammary fold
• Carry out mastectomy and lymph node related procedure
• Develop a pocket under the chest wall muscle to insert an implant (prosthesis)
• An implant is carefully inserted in the pocket to form a new breast mound
• The implant is then supported with a mesh, which acts as an internal bra to hold the device in place
• A drainage tube may be placed under each arm to drain excess fluid or blood
• Close the incisions with sutures and wrap the breasts with a waterproof dressing

Post-Procedure Care and Recovery

Most people can go home within a couple of days after surgery if no complications are noted. The drains are usually removed in about a week or two from the surgery.
In general, postoperative care instructions and recovery involve the following:

• You may notice sensitivity, tenderness, swelling, and bruises over the reconstructed breast. Pain and anti-inflammatory medications are provided as needed.
• Your physician will also provide you with antibiotics to prevent the risk of infection.
• Refrain from any physical activity using your upper body for at least 2 to 4 weeks to promote healing.
• You will be able to have a shower from the first day after surgery. A waterproof dressing will protect your surgical site.
• Avoid heavy lifting or any strenuous activities as you recover.
• Your doctor will provide you with instructions on diet and wound care.
• You are recommended to wear a supportive bra for at least 2 days post procedure.
• Refrain from using anything too cold or too hot on your reconstructed breast skin as your breasts will lack normal sensation.
• You may need to take off from work for at least a week to facilitate recovery.
• You will be able to resume normal activities within a couple of weeks, but may have certain activity restrictions.
• A periodic follow-up will be scheduled to monitor your overall progress.

Benefits of Breast Reconstruction

Some of the benefits of breast reconstruction include:

• Improvement in self-image, self-esteem, and confidence
• Helps you appear more youthful with a firm and well-positioned breast
• Form-fitting clothes, sports bras, and swimsuits will feel and look better

Risks and Complications of Immediate Breast Reconstruction

Immediate breast reconstruction is a relatively safe procedure; however, as with any breast reconstruction surgery, some risks and complications may occur, such as:

• Bleeding
• Poor healing of surgical cuts
• Infection at the surgery site
• Anesthetic risks
• Blood clots
• Necrosis or tissue death
• Uneven breasts
• Accumulation of fluids in breast tissue
• Loss of sensation in the breasts or nipples
• Need for revision surgery