Frequently Asked Questions from Patients Undergoing Breast Reconstruction

Who is a candidate for breast reconstruction?

 

Women who have a mastectomy for breast cancer are candidates for breast reconstruction. However, not every woman is a candidate for every type of reconstruction. For example, if a patient has radiation therapy, she might not be surgical candidates for an expander and implant. However, she could have natural tissue reconstruction through a procedure such as a TRAM Flap or DIEP Flap. Very few women are not candidates for breast reconstruction. Factors that could affect your decision for breast reconstruction are your medical condition, emotional and general health as well as activity level and breast size and shape.

 

When should I talk to my doctor about breast reconstruction?

 

Most women who have a mastectomy for breast cancer can have it rebuilt through reconstructive surgery. Breast reconstruction is a surgical procedure that attempts to restore the appearance of a woman's breast. It can be performed at the time that a breast is removed or after all of a patient's cancer treatments are complete. The best candidates for immediate breast reconstruction (surgery done at the same time as mastectomy) are women whose cancer will not require radiation therapy or women who are choosing to remove their breasts due to a genetic mutation or strong family history of breast cancer. Other women might be advised by their doctors to wait on breast reconstruction surgery, depending on their overall health, stage of the breast cancer and amount of skin tissue available for reconstruction.

 

What non-surgical options do I have if I decide not to have breast reconstruction surgery?

 

Women who choose not to have reconstruction following mastectomy have other options to create the appearance of a breast. The UW Health CareWear store specializes in fitting protheses, breast forms, mastectomy bras and swimwear. Call CareWear at (608) 262-2609 to schedule an appointment.

 

What does breast reconstruction involve?

 

Breast reconstruction surgeons typically use one of two common procedures: skin expansion or flap reconstruction. Skin expansion involves expanding breast skin and inserting an implant. After mastectomy, your surgeon inserts an expander beneath the skin and chest muscle and gradually fills it with saline (salt water) over several weeks. After the skin has stretched enough, the expander is removed and a permanent implant is inserted during a second surgery. For the flap reconstruction procedure, tissue is taken from the back, abdomen or buttocks and placed on the front of the chest wall. This tissue could be enough to reconstruct a breast, or a breast implant may be added.

 

What are the advantages and disadvantages or potential complications for each type of breast reconstruction?

 

Read about the different types of breast construction, including advantages and disadvantages to consider.

 

Do I have a choice between immediate and delayed breast reconstruction?

 

Yes. Your plastic surgeon will work with you and discuss your personal goals for reconstruction to help you make the right decision for you. Read more on this topic to help with your decision.

 

What happens before breast reconstruction surgery?

 

Before surgery and during your pre-operation exam, we will discuss medications or vitamins and you will have lab work, X-rays and other tests (such as an EKG). If you have had a difficult reaction to anesthesia, you will be seen in our Anesthesia Screening Clinic.

 

How real do reconstructed breasts look and feel?

 

A reconstructed breast can feel firmer and look rounder or flatter than the natural breast. It might not have the same shape as your breast before breast cancer surgery or exactly match your opposite breast. In some cases, the nipple and areola can be preserved. In women who don't have cancer, it is more frequently possible to save the nipple. You may lose feeling in the nipple and chest wall skin as well, but this depends on the procedure.

 

What should I expect immediately after breast reconstruction?

 

You could have soreness and be tired for several months after breast reconstruction. You should be up and walking within two days after surgery, but you may need four to eight weeks to return to full activity following a flap procedure. Recovery for implant reconstruction is usually shorter than for flap reconstruction, and you should return to full activity in two to four weeks.

 

Will I have visible scarring?

 

You will have visible scarring, but where depends on the procedure. Scarring will fade over time (between one and two years), but will never go away entirely.

 

Is there a need for additional surgery after breast reconstruction?

 

Your breast reconstruction process might require additional surgery, such as nipple reconstruction or surgery to the other breast to make them look the same. This depends on what type of procedure you and your doctor agree is best for you.

 

Will I be on pain medicines after breast reconstruction surgery?

 

Yes. We will work with you to ease any pain. Your pain medication can be taken every four to six hours. Taking it on a schedule will help make you more comfortable. Your doctor also may prescribe muscle relaxants to help with the pain and discomfort after breast reconstruction.

 

Will I have drainage after breast reconstruction surgery?

 

After surgery, there will be drains near your incisions to collect blood and other fluids. They will remain in place for up to six weeks depending on your procedure. While you are in the hospital, our nurses will help you and your family learn how to care for them.

 

May I bathe or shower after breast reconstruction surgery?

 

After you return home, you can shower daily. When showering, it is helpful to drape a hand towel around your neck and safety pin your drains to either end. This will keep them from pulling or falling. If you don’t want to shower every day, you will need to wash the incisions and drain sites once a day with soap and water. Please do not soak in a bathtub, hot tub or swimming pool until your incisions are healed or after your doctor’s approval.

 

When can I start wearing a bra?

 

Your plastic surgeon will let you know when you can start wearing a bra. A front-closing bra is most comfortable and you may be given one after surgery. Also, wearing loose fitting clothes or tops that button or zip will be easier when dressing and undressing because raising your hands above your head may be painful for the first week or so.

 

When can I return to work?

 

Returning to work will be different depending on which reconstructive surgery you had. A breast reconstruction that uses natural tissue, such as a TRAM or DIEP Flap procedure, will require about six to eight weeks before you can return to work. For those undergoing expander/implant reconstruction, the time to return to work may be four to six weeks. The amount of time needed away from work also varies depending on how physically demanding your job is.

 

When can I go back to normal activity and exercise?

 

A return to normal activity can be different for each person. During the first week, you should take things very slowly. You might find a gallon of milk hard to carry, depending on the type of reconstruction. By the second week, you should not be lifting anything heavier than 10 pounds or a medium size bag of groceries. This may be necessary for up to six weeks. Avoid exercise or work activity that might strain your chest and abdominal muscles during the first few weeks. You should not drive until your doctor gives you permission. This usually is not until after the first two weeks, or when you can lift your arms above your head comfortably and are not taking narcotic pain medicine. An occupational therapist will guide your exercise activity. Your occupational therapy will begin one week after surgery.

 

How often will I need to return for follow-up care?

 

Following breast reconstruction, your plastic surgeon would like to see you every week for the first two to three weeks. After that, your clinic visits will likely be less often: one month, six weeks and six months after surgery.