POST MASTECTOMY RECONSTRUCTION

PROCEDURE OVERVIEW

Procedure – Breast cancer is one of the most common reasons causing women to undergo tumor resection by lumpectomy (removal of tumor) or mastectomy (removal of breast). If you are considering a mastectomy or have previously undergone a mastectomy, it is helpful to talk to a plastic surgeon to determine your reconstructive options. Often times the first stage of reconstruction can be performed at the same time as the mastectomy procedure, or may need to be delayed depending on whether radiation is needed right away or not. Dr. Brown will work closely with the team of doctors made up by your surgical oncologist, medical oncologist, and radiation oncologist to help plan the type of reconstruction that is best for you.

Reconstruction typically restores a sense of wholeness and helps patients continue with their lives. However, breast reconstruction is not for everyone. It requires more than one operation that may take up to a year to complete. Some women choose not to undergo reconstruction and are very comfortable with their decision. For those women who prefer restoration of the breasts, several good techniques are currently available. There are a variety of operations that may be performed that can be divided into two main categories: procedures that borrow your own tissue from one part of the body, or strictly implant based reconstruction with saline or silicone implants.

How do I know what procedure is right for me? – At your initial consultation, Dr. Brown will discuss all the options with you. This will be a lengthy discussion lasting 30-60 minutes. It is our goal that no one leaves after a breast reconstruction consultation with doubts or unanswered questions. The procedure that you choose will be based on your desires and goals, lifestyle, overall health, body type, and what the oncologic team feels is the safest course of action to take.

What about symmetry procedures on the other breast? – If you are having cancer surgery on one breast, you may be a candidate for a procedure on the other breast in order to make it more closely match the reconstructed breast. These symmetry procedures include augmentation, reduction, or lifting of the breast. All breast reconstruction as well as symmetry procedures are covered by insurance as mandated by the Federal law.

Surgery and incisions – If you have an implant based reconstruction we will use the same incisions made by your surgical oncologist whether it is at the same time as your mastectomy or weeks, months, to years later. If we use your own tissues for reconstruction you will have additional scars.

What does an implant/expander reconstruction involve? – An implant/expander reconstruction can be performed after a mastectomy. This technique is usually a two-step process. The first stage involves placing a tissue expander underneath the pectoralis (chest) muscle. The expander is gradually inflated like a balloon by filling it with saline. This is done weekly in the office starting several weeks after all wounds have had time to heal. Once the skin has been adequately expanded, a second surgery is planned. The second stage involves removal of the expander and replacement with an implant (either saline or silicone).

What does using my own tissue involve? – If you choose to use your own tissue there are two main regions of the body that offer excellent reconstructive options. The latissimus flap procedure borrows skin and muscle from the back, and leaves a scar where the skin was removed. Every attempt is made to hide the scar within the bra line. Sometimes the latissimus flap can be combined with an implant if necessary.

TRAM (Trans-rectus abdominus muscle) flaps are created from lower abdominal tissue and muscle. It is usually obtained from the skin and fat which would normally be discarded in a conventional “tummy tuck”. TRAM flaps can be delivered to the chest wall while still attached to one of the abdominal wall muscles. These muscles allow blood flow into the tissue so it remains healthy and alive.

How long does the surgery take? – The length of surgery is highly variable. In addition to the time it takes the breast surgeon to perform his or her part, the reconstruction can take anywhere from an hour (for an implant/expander reconstruction) to 6 hours for a more complicated reconstruction. Dr. Brown will have a better estimate of the length of the procedure after your initial consultation.

BEFORE SURGERY

Initial consultation – If the surgery is to be performed immediately following a mastectomy, coordination between Dr. Brown and your surgical oncologist is very important. Our office staff will be intimately involved with the coordination of the entire reconstructive process, so that you can focus on other important issues.

Tell Dr. Brown about any medical problems you have, and any problems you may have had with surgery in the past. Most importantly, tell him if you have had any hernias or any abdominal surgery in the past. Inform him what medications you take. You will be told which medications to stop and which to take before surgery. If you smoke, you will be asked to quit for a minimum of 4 weeks prior to surgery as well as 4 weeks after surgery. If you get sick or have any health issues in the days before surgery, please notify the office at once in case we have to postpone your operation.

AFTER SURGERY CARE

What about swelling and bruising? – Swelling and bruising are normal signs of the healing process. They occur after any surgery to varying degrees. Swelling peaks at about 48 hours, and then rapidly decreases. By the end of the first few weeks, 50% of the swelling is gone. During this early period, your breasts will appear larger than their final size due to the swelling. By 6-8 weeks, a majority of the swelling has diminished. By six months, almost all the swelling is gone. Any remaining swelling is almost not perceptible. Bruising is worst the day after surgery and then rapidly gets better. It is usually gone by two weeks.

What restrictions are there? – Implant/expander reconstruction patients usually stay in the hospital for 1-2 days. After that you will be discharged home with family or friends who will help take care of you. Women who receive autogenous (your tissue) reconstruction with a TRAM flap stay for 4-7 days. Those who undergo a latissimus flap stay somewhere in the middle (2-4 days). Most likely you will have taken a shower at the hospital and will be able to continue showering at home. You should not submerge incisions in a bathtub, hot tub, or swimming pool. Dr. Brown will give you more specific instructions prior to leaving the hospital. Most likely you will have surgical drains in place that will be removed 1-2 weeks after surgery. Once at home patients are walking under their own power and require minimal oral pain medications. Vigorous activities should not be performed until 6 weeks after surgery. Also, you should not do any heavy lifting (over 10 pounds) during these 6 weeks.

These are only general guidelines, and Dr. Brown will give you more specific instructions at your consultation.

When can I travel? – Traveling after surgery (air travel, long distance car trips, train rides, etc) should not be done before you have had your first postoperative visit. Typically, this occurs 5-7 days after surgery for suture removal. Patients who are at high risk for developing a blood clot should not travel until instructed by their surgeon. Short car trips under 60 minutes can be done before the first visit. A good rule of thumb is when you are off the stronger pain medication and can get up without assistance you are ready to go for a short drive. You should not drive the car yourself, until your surgeon gives you clearance for this.

What if I have a problem? – When should I call the office? We always welcome calls from patients. If you have any concerns at any time, please feel free to contact our office. If it is an emergency, the answering service is available 24 hours a day, including weekends and holidays.