نظرة عامة

Breast reconstruction is surgery that restores shape to the breast. It's most often done after a mastectomy to treat or prevent breast cancer.

Common types of breast reconstruction include:

  • Breast reconstruction with flap surgery. During this surgery, a surgeon takes tissue from another area of the body to shape the new breast. That tissue is called a flap. It most often comes from the belly. Another name for this surgery is autologous breast reconstruction.
  • Breast reconstruction with an implant. During this surgery, a surgeon uses a breast implant to reshape the breast. Another name for this surgery is prosthetic breast reconstruction.

A plastic surgeon does these complex procedures. Reconstruction often starts at the time of the mastectomy. It's a process that may need one or more additional operations to complete. Sometimes reconstruction starts later.

Breast reconstruction can happen after surgery to remove one or both breasts. If only one breast is reconstructed, surgery on the other breast may help the breasts look more alike. Options may include a breast lift, a breast reduction, or a breast enlargement, also called a breast augmentation.

The goal of breast reconstruction is to give you the most natural look and feel possible after breast cancer surgery. Some people say having breast reconstruction improves their confidence and helps them feel more comfortable with their bodies. But breast reconstruction can't replace your breast exactly. The new breast may not look or feel the same or have the same sensations as a natural breast.

Not everyone chooses to have breast reconstruction after a mastectomy. Some people choose aesthetic flat closure. This procedure creates a smooth, flat chest instead of rebuilding the breast.

Types

There are many types of breast reconstruction. You don't have to sort through the options on your own. Your plastic surgeon can explain the choices and work with you to find an approach that fits your breast cancer treatment, your body and your preferences.

Reconstruction with an implant

Implant reconstruction uses a breast implant to shape the breast. The implant may be placed during one operation, or reconstruction may be done in stages.

  • Direct-to-implant reconstruction. The surgeon places the breast implant at the time of the mastectomy. This may be an option when there is enough healthy skin after mastectomy to cover the implant.
  • Tissue expander followed by an implant. A tissue expander is a temporary device that helps stretch the skin on the chest. The surgeon places it at the time of the mastectomy. Over weeks or months, the expander is slowly filled with saline to make room for the breast implant. Later, the surgeon removes the expander and places the implant.

Breast implant options also may vary by whether the implant is placed above or below the chest muscle.

  • Prepectoral breast implant. The implant is placed above the large chest muscle, called the pectoralis major muscle. It may be placed there at the time of the mastectomy or an expander may be placed first.
  • Subpectoral breast implant. The implant is placed below the large chest muscle. It may be placed there at the time of the mastectomy or an expander may be placed first.

Breast implants can be made of different materials and come in different shapes and sizes. For breast reconstruction, the implants are made of silicone and typically are filled with silicone gel, rather than saline. Your plastic surgeon can explain the types and which type is recommended for you.

Reconstruction with a flap

Flap surgery uses tissue from your own body to shape the breast. The tissue, called a flap, may come from the belly, back, thighs or buttocks.

Types of flaps include:

  • Pedicle flap. Pedicle flap surgery involves moving tissue and keeping some of the blood vessels attached. The plastic surgeon moves the tissue under the skin to the chest area. The surgeon then creates the new breast mound with the tissue. The tissue remains attached to the original blood vessels.
  • Free flap. Free flap surgery involves disconnecting the blood vessels completely before moving the tissue. The surgeon uses the tissue to create a new breast mound and attaches the tissue to blood vessels in the chest. Because of the need to reattach blood vessels, free flap surgery often takes longer than surgery using a pedicle flap.

Common types of flap breast reconstruction include:

  • TRAM flap. A transverse rectus abdominis muscle (TRAM) flap uses skin, fat and abdominal muscle from the lower belly. TRAM may use a pedicle flap or a free flap.
  • DIEP flap. A deep inferior epigastric perforator (DIEP) flap uses skin and fat from the lower belly. It doesn't use the abdominal muscle. DIEP uses a free flap.
  • SIEA flap. Superficial inferior epigastric artery (SIEA) flap surgery uses skin and fat from the lower belly. The blood vessels it uses aren't as deep within the belly. SIEA uses a free flap.
  • TUG flap. Transverse upper gracilis (TUG) flap surgery uses muscle and fatty tissue from the upper part of the inner thigh. TUG uses a free flap.
  • PAP flap. Profunda artery perforator (PAP) flap surgery uses skin and fat from the back of the upper thigh. It doesn't use muscle. PAP uses a free flap.
  • Latissimus dorsi flap. Latissimus dorsi flap surgery takes skin, fat and muscle from the back. This surgery uses a pedicle flap. This option typically takes less skin and fat than other kinds of flaps, so this approach also may use a breast implant.
  • Gluteal flap. A gluteal flap takes tissue from the buttocks. This surgery uses a free flap. Gluteal flap surgery may be an option when there isn't enough tissue in other parts of the body.

Reconstruction with a flap and an implant

Some breast reconstruction operations use a flap and a breast implant. This is sometimes called hybrid breast reconstruction. The implant can add volume when the flap alone does not provide enough tissue to create the breast size or shape you want.

Latissimus dorsi flap reconstruction typically takes less skin and fat than other kinds of flaps, so this approach often also uses a breast implant.

Fat grafting

Fat grafting also is called fat transfer or fat injection. The surgeon uses liposuction to collect fatty tissue from another part of your body. The surgeon injects the fat into the chest skin and tissue.

Fat grafting alone often isn't enough to reconstruct a full breast. It's usually used along with an implant or flap to add volume or improve the breast's shape.

Reconstruction with excess breast skin

Using your own breast skin may be an option if you have larger breasts. This is done at the time of your mastectomy. The plastic surgeon uses some of your extra breast skin to make a small breast mound. You may hear this referred to as the Goldilocks procedure. It is a middle option between a full breast reconstruction and an aesthetic flat closure.

Some people have only this procedure. Some also have fat grafting over several months until their new breast is the desired size. Sometimes this procedure is combined with flap or implant surgery.

Choosing a type of breast reconstruction

There isn't one type of breast reconstruction that is best for everyone. Each approach has advantages and disadvantages.

Using an implant for breast reconstruction is generally a less invasive operation than reconstruction with a tissue flap. Reconstruction with an implant may offer a faster recovery. But breast implants aren't designed to last forever. If your breast reconstruction uses implants, you may need more surgery in the future to replace or remove the implant.

A breast reconstructed using a tissue flap is a more complex operation. It often has a longer recovery than reconstruction using a breast implant. It might require a hospital stay.

Once the reconstruction is completed with a tissue flap, you typically don't need surgery in the future to replace the flap. Some people later have fat grafting or another procedure to improve the look of the breast or to make the breasts look more alike. Over time, a breast reconstructed with a flap often changes as your skin ages or your weight changes, much like the rest of your body.

Your plastic surgeon can help you compare the choices. The options your surgeon recommends may depend on your overall health, body shape and your breast cancer treatment plan.

لماذا يتم ذلك؟

Breast reconstruction is done to restore shape to a breast after mastectomy. Some people choose reconstruction because it can help them feel better about their appearance and body image. Whether to have reconstruction is a personal choice.

Who may consider breast reconstruction

Breast reconstruction can be done after different types of mastectomy operations.

  • After mastectomy. A mastectomy is surgery to remove all breast tissue from a breast. It's often used to treat breast cancer. Breast reconstruction restores shape to the breast that was removed. You also may choose to have surgery on the other breast so that your breasts look more alike.
  • After double mastectomy. A double mastectomy is surgery to remove all breast tissue from both breasts. It may be done to treat cancer in one breast or both breasts. Breast reconstruction restores shape to both breasts.
  • After prophylactic mastectomy. A prophylactic mastectomy removes all breast tissue from one or both breasts to lower the risk of breast cancer. Breast reconstruction can restore shape to the breasts after this surgery.
  • After nipple-sparing mastectomy. A nipple-sparing mastectomy removes the breast tissue, but keeps the nipple, areola and breast skin. Breast reconstruction restores shape to the breast. Keeping the skin may give the reconstructed breast a more natural shape.

In general, the kind of mastectomy you're having doesn't determine which type of reconstruction you can have. But the reconstruction you choose may affect how the mastectomy is planned, including how much skin is preserved and where the incisions are made. That's why it's helpful for the breast surgeon and plastic surgeon to plan the operation together.

When breast reconstruction can be done

When breast reconstruction happens may depend on the type of reconstruction you choose, whether you need other breast cancer treatments and what you prefer.

  • Immediate reconstruction. Immediate reconstruction starts during the same operation as your mastectomy. This doesn't always mean it is completed that day. Another surgery may be needed to complete the reconstruction.
  • Delayed reconstruction. With delayed reconstruction, reconstruction does not begin during the mastectomy. It starts at a later operation. It's sometimes recommended if you have inflammatory breast cancer. You may choose this option if you want more time to decide or want to complete your cancer treatment. Doing the reconstruction later may make it harder to get the most natural breast shape.
  • Reconstruction and radiation therapy. If radiation therapy is part of your treatment plan and you want reconstruction, it's important to start the reconstruction at the time of your mastectomy. This may give you more options. Your surgeon may place an implant or tissue expander at the time of the mastectomy. This helps maintain the breast skin and space for the reconstruction while you have radiation. The expander may later be replaced with an implant or a flap. Radiation changes the skin on the chest. If an expander or implant can't be placed before radiation, implant reconstruction may not be possible later because the radiated skin may be too tight. Flap surgery may be the only reconstruction option.
  • Reconstruction and chemotherapy. Chemotherapy before or after surgery usually does not prevent you from having breast reconstruction. Having breast reconstruction also usually doesn't delay starting chemotherapy after surgery.

Talk with your healthcare team and plastic surgeon about when reconstruction could fit into your treatment plan and which options may work for you.

المخاطر

Breast reconstruction surgery carries a risk of side effects and complications. Some risks are related to having surgery. Other risks may depend on the type of reconstruction you have.

Your care team monitors your healing after surgery so that complications can be found and treated early. If complications happen, treatments may help manage them.

Risks of breast reconstruction surgery

The risks of breast reconstruction surgery include:

  • Bleeding.
  • Breast pain.
  • Breasts that don't match each other in size or how they look, called asymmetry.
  • Changes in feeling in the breast.
  • Infection.
  • Side effects of the medicine that puts you in a sleeplike state during surgery. The medicine is called a general anesthetic. Side effects include nausea, vomiting and confusion.
  • Slow healing of cuts in the skin, called incisions.

Risks of implant surgery

The risks of having breast implants include:

  • Scar tissue that tightens around the implant, called capsular contracture. This can cause firmness, pain or changes in how the breast looks over time.
  • Implant leaks or tears, called ruptures.
  • Future breast surgery to replace or remove the breast implant.
  • A slight risk of a very rare immune system cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). It's linked with breast implants that have a textured surface.

Some people associate certain symptoms, such as fatigue and joint pain, with breast implants. This is referred to as breast implant illness. Studies have not shown that breast implants are the cause. But for some people, symptoms get better when the implants are removed. Researchers continue to study whether breast implants cause these symptoms.

Treating complications of implant surgery may mean more surgery to remove or replace the implants.

Risks of flap surgery

The risks of having breast reconstruction with tissue flaps include:

  • Loss of feeling at the place where the tissue flap is taken from, called the donor site.
  • Slow healing at the donor site.
  • Flap loss or tissue death, called necrosis, from too little blood supply to the new breast.
  • A weakness in the belly wall that may let tissue come through, making a bulge. This is called an abdominal hernia. It can happen with tissue flaps that come from the belly.

Treating the complications of flap surgery may mean more surgery to remove or replace the tissue flap.

When to call your care team

Knowing the warning signs can help you get treatment quickly if a complication develops. Call your care team if you have:

  • A fever.
  • An opening in an incision.
  • Increased bleeding from an incision.
  • Oozing from an incision.
  • Sudden swelling or change in the shape and size of the breast.
  • Warmth and color changes to the skin on the chest.

كيف تستعد؟

To prepare for breast reconstruction surgery, you meet with a plastic surgeon. You and your surgeon talk about the options and choose one that fits your treatment and goals. As you think about your options, you also might consider talking with others who have had breast reconstruction. Preparation also may include getting ready for surgery and preparing for your recovery.

Meet with a plastic surgeon

If you're thinking about breast reconstruction, talk with a plastic surgeon about your options. Choose a plastic surgeon who is board certified and experienced in breast reconstruction after mastectomy. It's ideal if your breast cancer surgeon and the plastic surgeon work together. Then they can coordinate your breast surgery and reconstruction plan.

Your plastic surgeon may:

  • Talk with you about your reconstruction choices and the pros and cons of each option.
  • Review your medical history and examine you to better understand which reconstruction options may be possible. The options your surgeon recommends may depend on your body shape, overall health and your cancer treatment.
  • Discuss whether surgery on the other breast may help your breasts look more alike.
  • Describe the kind of results you can expect with surgery.
  • Explain whether additional operations or procedures may be needed to help you get the result you want.
  • Show you photos of people who have had different types of breast reconstruction.
  • Take photos of your breasts or chest to use for planning the surgery.

Talk with others who have had breast surgery

You may find it helpful to talk with others who have had breast reconstruction. Hearing about their experiences may give you practical information and help you feel more prepared. Ask your healthcare team about local support groups. Or you can contact the American Cancer Society or another cancer organization in your area to find resources. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.

Get ready for surgery

Your care team gives you instructions for getting ready for surgery. Follow these instructions carefully. You may need to:

  • Have tests to check your health before surgery.
  • Adjust any medicines and supplements you take before surgery.
  • Stop smoking before surgery. Smoking may increase the risk of problems with wound healing and other complications.

Plan for recovery at home

Before surgery, think about what help you may need while you recover. You may need to limit driving, lifting, reaching and some household activities for a short time after surgery. Ask your care team what limits to expect so you can prepare ahead of time.

  • Arrange for someone to drive you home from the hospital.
  • Ask family members, friends or other people you trust to help during your first few days at home. This may include help with meals, household tasks, childcare or other responsibilities.
  • Put commonly used items where they are easy to reach so you don't have to lift or reach overhead.
  • Make a plan for chores or errands that may involve lifting or strenuous activity.
  • Set up a comfortable place to sleep and rest in the position your care team recommends.
  • Arrange for help with transportation until your care team says it's safe for you to drive again.
  • Take time away from work for surgery and recovery.

ما يمكن أن تتوقعه

What you can expect depends on whether breast reconstruction is done at the same time as your mastectomy or during a later operation. It also depends on the type of reconstruction you have.

Before the procedure

Breast reconstruction surgery happens in a hospital. When you arrive for your operation, a member of your care team may go over your medical history, medicines and allergies. You may have an intravenous (IV) line placed in a vein so you can receive fluids and medicines during surgery.

Your plastic surgeon may use a marker to draw lines on your chest. These markings help guide the surgery. If you're having flap surgery, the surgeon also may draw lines on the part of the body where the tissue flap will come from, such as the belly.

Breast reconstruction surgery is done using general anesthesia. This means you are in a sleeplike state and don't feel pain during surgery.

During the procedure

If you are having immediate reconstruction, the breast surgeon first removes the breast tissue during the mastectomy. The plastic surgeon then reconstructs the breast. If you are having delayed reconstruction, the plastic surgeon works with the skin and tissue that remain after your mastectomy.

What happens next depends on the type of reconstruction you have.

  • Implant reconstruction. The plastic surgeon may place the breast implant during the operation. Or the surgeon may place a temporary tissue expander. The expander is slowly filled over weeks or months to make room for an implant. If you have a tissue expander, you need another operation later to remove it and place the breast implant.
  • Flap reconstruction. The plastic surgeon takes tissue from another part of your body and uses it to shape the new breast. This means you have an incision on the chest and another incision where the tissue was taken. With some flap procedures, the surgeon also reconnects small blood vessels in the flap to blood vessels in the chest.

Placing an implant or a tissue expander after mastectomy adds about an hour to the length of the surgery. Flap reconstruction generally takes longer than implant reconstruction because the surgeon is operating on more than one part of the body. Flap surgery may add 2 to 6 hours to a mastectomy. With a free flap, reconnecting the blood vessels also may add time to the operation.

Breast reconstruction may take more than one operation to complete. If your reconstruction uses an expander, you need another operation to replace it. All types of reconstruction may require additional procedures to adjust the shape or size of the reconstructed breast. This might involve another surgery or fat grafting. Nipple reconstruction or tattooing also may be done after the breast has healed.

After the procedure

After surgery, you spend time in a recovery area while your care team checks your breathing, blood pressure and pain levels. You then may move to a hospital room.

Your recovery depends in part on the surgery you had. If you had immediate breast reconstruction, your body is healing from mastectomy and reconstruction. If your reconstruction involved flap surgery, the area where the flap was taken also is healing.

  • Hospital stay. People who have breast reconstruction may stay in the hospital. How long you stay may depend on your surgery and your overall health. Some people can go home the same day after reconstruction with an implant. After flap reconstruction, you usually stay in the hospital for a few days.
  • Drains and support garments. After surgery, you may have one or more drainage tubes to remove fluid while you heal. If you go home with a drain, your care team shows you how to care for it and empty it when needed. You may be given a special bra or another support garment to wear home. Your care team tells you how long to wear it.
  • Pain, tiredness and other symptoms. Medicines used for anesthesia and to help with pain may make you feel groggy or cause nausea and vomiting. Medicines can help manage nausea. Your care team watches you closely until the grogginess wears off. You may have pain around your incisions. Muscle spasms in your chest also can cause discomfort. Your care team works to help you manage the pain. You also may feel tired for several weeks.
  • Recovery time. Recovery varies from person to person and depends on the operation. Flap reconstruction generally takes longer to recover from than implant reconstruction because both the chest and the donor site need to heal. In general, it may take 2 to 4 weeks to heal after implant reconstruction. Flap surgery recovery generally takes 4 to 8 weeks.
  • Returning to activities. Your care team may encourage you to get out of bed and begin walking soon after surgery. When you go home, you may be asked to avoid lifting heavy things and to avoid reaching overhead for a few weeks. It's typical to limit strenuous activity for about 4 to 6 weeks while the incisions heal.

Your care team gives you instructions on how to care for yourself after surgery. Follow these instructions carefully.

النتائج

The results of breast reconstruction might not be clear right away. It takes time for the tissue on your chest to heal. As you heal, you'll likely meet with your surgery team to talk about the results.

The goal of breast reconstruction is to give you the most natural look and feel possible after breast surgery. But breast reconstruction can't make your breast look or feel the same as it did before cancer. It is important to be realistic about what you can expect from breast reconstruction.

What breast reconstruction can do:

  • Give your breast shape.
  • Help your breasts look more symmetric under clothing or in a bathing suit.
  • Help you avoid needing to put a breast-shaped form, called a prosthesis, inside your bra.

What breast reconstruction may do:

  • Improve how you feel about yourself and your body.
  • Take away some of the physical reminders of your cancer.

What breast reconstruction won't do:

  • Make you look the same as before your mastectomy.
  • Make your reconstructed breast have the same sensation that it had before surgery.

How results may change over time

Your reconstructed breast may change as you heal and over time. Scars from breast reconstruction, including where tissue was taken for flap surgery, may fade over time. But these scars may never go away completely.

Feeling in the reconstructed breast may return over time. But the reconstructed breast may not have the same sensation it had before mastectomy.

The appearance of your breasts may change over time. If only one breast was reconstructed, your breasts may look less alike as your skin ages or your weight changes. A reconstructed breast with an implant may not change in the same way as the breast on the other side. A reconstructed breast with a flap may change more like the rest of your body. Some people choose another procedure later to improve the breast shape, replace an implant or help the breasts look more alike.

Breast cancer screening after reconstruction

Screening mammograms typically aren't done on reconstructed breasts. If your surgery involved mastectomy and reconstruction on both breasts, you likely won't have mammograms for breast cancer screening. Your care team examines your breasts as part of your follow-up appointments.

If your surgery involved mastectomy and reconstruction on one breast, the other breast may still need screening. Talk with your care team about which tests you should have for screening and how often to repeat them.

Periodically do breast self-exams to check for new lumps, bumps or changes in the scars. Tell your healthcare team if you notice any changes. Your care team may recommend imaging tests, such as ultrasound or MRI, to take a closer look.

If you had reconstruction with implants, your care team may recommend having an ultrasound or MRI of the implant every few years. This is to check for signs of implant rupture, not for signs of cancer recurrence.

Breastfeeding after reconstruction

If your surgery involved mastectomy and reconstruction of both breasts, breastfeeding is not possible. Mastectomy, including nipple-sparing mastectomy, removes all the tissue that makes breast milk.

If your surgery involved mastectomy and reconstruction of one breast, it may be possible to breastfeed using the other breast. Other breast cancer treatments may affect your ability to breastfeed. Talk about this with your care team. The team can help you understand how your treatments can affect breastfeeding.

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