Procedures

Breast Reconstruction

Should I have breast reconstruction after mastectomy?

It’s one of the biggest questions women have after having their breast tissue removed due to breast cancer.

For many women, the breast is a source of confidence and femininity, which is why it is difficult to accept the loss of their breast tissue. Luckily, there is a range of procedures that can help rectify some of the loss that comes with a cancer diagnosis or trauma: breast reconstruction.

If you would like to learn more about how a breast reconstruction can help you, give our office a call at 612-688-3177 or text us at 952-925-1765.

What Is a Breast Reconstruction?

Breast reconstruction is a surgery that aims to restore the natural appearance of one or both breasts following a mastectomy (complete removal of the breast tissue) or a lumpectomy (partial removal of breast tissue and tumor). Breast reconstruction can also be performed on patients whose breast appearances have been damaged through trauma or developed improperly from congenital deformities.

Breast reconstruction can be executed in tandem with the mastectomy or be delayed until another time. Either way, our goal is to create a natural, symmetrical breast appearance to help patients who feel like they have lost a part of their physical, gender or sexual identity to illness or trauma. The procedure can be performed with implants or through the use of natural tissue.

Am I a Candidate for a Breast Reconstruction?

A breast reconstruction is a great way to reverse some of the damage that has been done by illnesses like breast cancer. But there are a few things it is important to understand going into any reconstruction surgery.

The first is that no amount of surgery can restore the original sensations originally felt by the breast. The second is that there will always be visible surgical scars on the breast, whether they are from the mastectomy itself or the subsequent breast reconstruction. Lastly, certain techniques that use natural tissue to restore the appearance of a breast mound will leave behind additional scarring because it requires surgery on a separate area of the body.

It is very important for patients to go into the breast reconstruction process with the understanding that no matter what technique is used, this is most likely going to be a multi-procedure process that usually occurs over the course of one to two years. A “one and done” procedure for breast reconstruction is very rare.

If you are able to properly cope with these points, then you are on your way to becoming a good candidate for breast reconstruction. But it is also vital that you are free from other medical conditions that could cause adverse effects on your healing and that you have realistic expectations about what breast reconstruction can achieve. Active smokers are not good candidates for breast reconstruction because the procedures rely on blood supply from tiny blood vessels that are choked off by nicotine. Patients who smoke have an unacceptably high risk of complications and must stop smoking 6 weeks prior to undergoing reconstruction, and continue smoking cessation for another 6 weeks.

The best way to ensure you do not end up disappointed with your procedure is to look at scores of before and after photos of breast reconstruction. This will give you a great idea of what kind of results you can expect. Your reconstructed breasts will never look or feel like your natural breasts.

How Should I Prepare for a Breast Reconstruction?

Breast reconstruction is an invasive surgical procedure, so it is good to get a head start on what you will need to prepare for through your surgery and recovery. The first step in the breast reconstruction process is to schedule an initial consultation with one of the physicians at Edina Plastic Surgery. Our surgeons are board certified and extensively trained and experienced to best address the needs and desires of your procedure.

We recommend that you keep a thorough and running list of any questions, comments or concerns that you have regarding your surgery in the time leading up to your first consultation. It is best to jot them down in a notebook or keep a list on your phone so that you do not forget to ask anything during your appointment when nerves may be a little high. We will strive to answer any and all questions so that you are armed with as much information as possible as you decide on moving forward.

Conversations about breast reconstruction can be particularly overwhelming, so it is best to bring someone with you (or have them call in virtually during the current pandemic). It is helpful to have someone else to absorb information or to ask questions. It is not uncommon to need a second consultation to review options again or in greater detail.

During your consultation, your physician will conduct a thorough physical examination, review your medical history and listen to your goals for the surgery. They will then use this information and work with you to develop a treatment plan, discuss your breast reconstruction options, and provide you with a list of preoperative instructions.

It is crucial that you follow these instructions as closely as possible to ensure that your surgery and recovery are as complication free as possible. There may be changes that need to be made to your diet, medications and habits (e.g., smoking, drinking, sun exposure, etc.).

You should also prepare to have someone accompany you on the day of your surgery who can take you home and help you get set up for recovery. Some breast reconstruction procedures are outpatient procedures, while others you will be inpatient for a couple of days. We recommend creating a recovery station in a comfortable place with all the necessities close by so you can focus solely on your recovery as much as possible.

What Should I Expect from a Breast Reconstruction Procedure?

On the day of your procedure, after checking in, you will be asked to come back into the intake room where you will meet with your physician. They will likely make some marking on your chest area to notate how landmarks appear while you are in a sitting position.

Don’t worry, not all of these marks are incisions! When the procedure begins, you will be administered either intravenous or general anesthesia (which one you have will be predetermined during an earlier meeting with your surgeon).

There are many different approaches to breast reconstruction surgery that are all available to you. While most of them include immediate breast reconstructions performed after a mastectomy for cancer (via implants or natural tissues), there are also delayed breast reconstruction options that can be done any time after the removal of the breast tissue.

Dr. Christine Stewart provides insights into the process of Breast Reconstruction in the video below:

Breast Reconstruction with Implants

Because they do not require additional incisions or tissue removal, many women feel most comfortable opting for a reconstruction that uses breast implants. This is the most common reconstructive method in the United States.

While it is less invasive than other methods, the results tend to not feel as natural as other methods that use fat or tissue grafting. Breast implant reconstruction is performed alongside the mastectomy, and there are two locations that the breast implant can be implanted: above or below the pectoral muscle.

Above the Pectoral Muscle

This is the preferred method of Edina Plastic Surgery for a few different reasons. The first is that the recovery period for this technique is shorter since no muscle tissue is being displaced. The second is that it prevents the implant from being affected by muscle contraction and possibly becoming misshapen.

This is called “animation deformity.” During this technique, an internal “bra” is constructed out of a material called an acellular dermal matrix to help the implant stay within the natural boundaries of the breast. These boundaries are often disrupted by the mastectomy in an effort to remove the breast tissue completely and must be reconstructed.

While this is the preferred method, there are reasons why patients are not candidates for this method including location of the breast tumor near the pectoralis muscle and poor blood supply to the mastectomy flaps seen after mastectomy. Sometimes this is known before surgery, but sometimes the plan has to change intraoperatively based on what is found.

Below the Pectoral Muscle

Placing the implant below the muscle was a popular approach because it put some tissue between the implant and skin, providing more soft tissue coverage that would reduce the risk of visible implant rippling. However, with fat grafting and construction of an internal bra, similar results can be achieved.

Autologous Breast Reconstruction

Autologous breast reconstruction (also known as flap or autogenous reconstruction) focuses on using tissue, fat and sometimes muscle from donor locations on your body to replace the breast tissue that was lost.

Total breast reconstruction with just fat grafting is not possible. Fat grafting is used most commonly in secondary procedures after autologous reconstruction or after implant reconstruction to help camouflage implants or provide a small size increase. This involves removing fat with liposuction and then injecting it into the breast.

In order to build a breast from fat, fat must be taken in the form of a flap and oftentimes this requires removing small pieces of muscle that carry blood vessels to the area. Common donor areas are the abdomen, back and inner thighs.

This approach has the unique advantage of looking and feeling very natural since only natural elements are used. For this reason, women who have the excess tissue and fat to donate are often more prone to this method. The only downside is that flaps require additional excision, which leads to more scarring. Fortunately, the scarring can usually be hidden in the bikini line to minimize its appearance.

Delayed Breast Reconstruction with Tissue Expander

While implant and autologous breast reconstruction can be performed at the same time as the mastectomy, delayed breast reconstruction, as the name implies, puts off the reconstruction of the breast tissue.

Any time after a mastectomy, a tissue expander is inserted into the chest wall and incrementally enlarged to promote the stretching of skin in patients who may not have otherwise had enough excess skin to perform a breast reconstruction.

Breast expansion is usually performed weekly, but the pace can be changed depending on the patient’s pain and tolerance levels. Patients who have tissue expansion then will go on at a second stage to have either implant-based reconstruction or autologous reconstruction.

Nipple-Areolar Complex Reconstruction

In some cases, it may be possible to reconstruct the nipple-areolar complex after it has been damaged or lost during surgery or trauma. It can be done with donor tissue, which requires additional recovery and downtime, but one of the new breast reconstruction techniques is 3D tattooing to create hyper-realistic nipple-areolar complexes.

This provides women with the appearance of a real nipple when reconstruction is not possible or feasible. There are tattoo artists that specialize in 3D nipple tattooing.

What Should I Expect During Breast Reconstruction Recovery?

Your recovery will differ depending on which technique you are having performed. Breast reconstruction can be an outpatient or inpatient procedure depending on the procedure performed. You may also have a small tube placed in the surgical site — this helps prevent excess fluid build-up and swelling. This tube or “drain” is usually in for one to two weeks after surgery.

Similar to your initial consultation, one of our physicians will provide you with a list of postoperative instructions to follow in the days and weeks following your breast reconstruction. You will likely be placed on an antibiotic to prevent infection and over-the-counter or prescription pain medication, when necessary, to cope with any pain or discomfort you are having.

The bulk of the pain and discomfort should subside within a few weeks, if not a few days. You will need to get as much sleep and quality rest as possible and avoid any kind of strenuous activities until your surgeon clears you. 

Most patients will have lifting restrictions for four weeks. Most patients can usually return to work within six weeks, but this can change depending on your unique anatomy and reaction to the procedure.

Final results of a breast reconstruction can take months to achieve as tissue swelling settles. Most second or third stage procedures will be spaced three to six months after your first procedure.

Can I Combine My Breast Reconstruction with Other Procedures?

Achieving symmetry is one of the primary objectives in the reconstruction of the breast. In cases where both breasts were removed, the focus is on creating two new breasts that look similar. When it comes to women who have only lost one breast, creating symmetry can get a little trickier.

There are limitations to the shape and size that can be created with reconstruction techniques, so it is normal for surgeons to recommend various breast alterations like a breast reduction, breast lift, fat grafting or breast augmentation. These procedures will help the surgeon match the natural breast to the one be reconstructed.

If you are interested in getting the most from your cosmetic procedures, you might also consider other surgeries that can help accentuate the shape of your new breasts, such as a tummy tuck, liposuction, or a full body lift.

How Much Does Breast Reconstruction Cost?

In order to provide an accurate determination of your breast reconstruction cost, you must have an initial consultation with one of our physicians so we can get an idea of what kind of procedure you will need and what techniques are most appropriate.

Breast reconstruction due to cancer or a high genetic risk of cancer, such as after a prophylactic mastectomy, is usually covered by insurance. Patients who have had a mastectomy in the past or a lumpectomy in the past and require a revision of their reconstruction, usually have these procedures covered by insurance.

In determining whether something will be covered by insurance there are three important things to check: if the procedure/diagnosis is something your insurance will cover, if your chosen physician is in-network and if your chosen facility (where the procedure will be performed) is in-network.

The only way to know for sure is to have your surgeon submit a prior authorization for the procedure(s) the surgeon plans to do to your insurance company. Prior authorizations for these procedures can take between four to eight weeks for insurance companies to process, and facilities often will not schedule procedures without a prior authorization in hand. 

Prior authorizations can be submitted after an in-person consult with your physician. It is also important to remember that just because something is “covered” by insurance does not mean that it is free. The “cost” of the procedure ultimately depends on your insurance plan and deductibles that must be met before your insurance plan kicks in.

Patients that have breast deformities due to trauma or congenital abnormalities should check with their insurance company on specifically what procedures and diagnoses are covered; these patients less commonly will have their surgeries covered by insurance. 

In some cases, even if their procedure was covered by insurance in the past, it may be considered cosmetic by today’s terms. In this case, an accurate price estimate can be given at the time of your appointment, as the procedure will be billed independently from your health insurance.

Reclaim Your Breasts with Breast Reconstruction in Edina, MN

If you are ready to learn more about how breast reconstruction can help you restore the appearance you have lost, then give our office a call at 612-688-3177 or text us at 952-925-1765. If you would like to set up an appointment, you can fill out our online contact form, and we will get back to you as soon as possible.

We are looking forward to helping you through the reconstruction process and are standing by to help answer any questions or address any issues you may have about the process.

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