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By Mayo Clinic staff
The breast reconstruction process begins with the placement of a breast implant or tissue expander, either at the time of your mastectomy surgery (immediate reconstruction) or during a later procedure (delayed reconstruction). Breast reconstruction often requires multiple operations — even if you choose immediate reconstruction — so you'll likely face follow-up procedures later on.
Breast implants
A breast implant is a round or teardrop-shaped silicone shell, filled with salt water (saline) or silicone gel. A plastic surgeon places the implant behind the muscle in your chest (pectoral muscle) in a manner similar to what occurs during breast augmentation surgery.
Some women are able to have the permanent breast implant placed at the time of the mastectomy in a one-stage process. However, most women require a two-stage process, using a tissue expander before the permanent implant is placed.
Tissue expanders
Tissue expansion is a process that stretches your remaining chest skin and soft tissues to make room for the breast implant. The process takes place gradually, typically over several months.
Your surgeon places a tissue expander, similar to a balloon, under your pectoral muscle at the time of your mastectomy. The tissue expander has a small valve that your doctor can access by inserting a needle through your skin. Over the next few months your doctor or nurse injects saline into the valve, filling the balloon in stages. This gradual process allows the skin to stretch over time. You may experience moderate discomfort or a sensation of pressure as the implant expands.
After the tissue expansion process is complete, your surgeon performs a second surgery to remove the tissue expander and replace it with a permanent implant. Some tissue expanders are designed to be left in place permanently, so the second operation may be less extensive and require only local anesthesia.
Recovery
You may be tired and sore for a few weeks after your surgery. Your doctor can prescribe medication to control your pain. You may have drainage tubes in place for a short time after your surgery to remove excess fluids that collect in the surgical site. The drainage tubes remain in place until the amount of fluid draining substantially decreases.
You'll also have stitches (sutures) in place after your surgery. They'll probably be absorbable sutures, though, so you won't need to have them removed. Scarring is permanent, but the scars generally fade over time.
Getting back to normal activities may take up to six weeks or more. Take it easy during this period. Your doctor will let you know of any restrictions to your activities, such as avoiding overhead lifting or strenuous physical activities. Don't be surprised if it seems to take a long time to bounce back from surgery — some women report that it took as long as a year or two before they felt completely healed and back to normal.
Generally, you'll follow up with your plastic surgeon on a yearly basis to monitor your reconstructed breast. Make an appointment sooner than that, however, if you have any concerns about your reconstruction.
Nipple reconstruction
Breast reconstruction may also entail reconstruction of your nipple, if you choose, including tattooing to define the dark area of skin surrounding your nipple (areola).
Future breast cancer screening
If you've only had one breast reconstructed, you'll need to have screening mammography done regularly on your other breast. Mammography isn't usually necessary on breasts that have been reconstructed, as the mastectomy removes most of your breast tissue. You may opt to perform breast self-exams on your natural breast and the skin and surrounding area of your reconstructed breast. This may help you become familiar with the changes to your breast after surgery, so that you can be alert to any new changes and report those to your doctor.
Your doctor may recommend that you have a magnetic resonance imaging (MRI) test done every few years on your reconstructed breast to check for signs of implant rupture.
- Breast reconstruction after mastectomy. American Cancer Society. http://www.cancer.org/acs/groups/cid/documents/webcontent/002992-pdf.pdf. Accessed July 21, 2010.
- Surgery choices for women with early-stage breast cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/SurgeryChoicesESBCPDF. Accessed July 21, 2010.
- Breast reconstruction. American Society of Plastic Surgeons. http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Reconstructive_Procedures/Breast_Reconstruction.html. Accessed July 21, 2010.
- Hu E, et al. Breast reconstruction. Surgical Clinics of North America. 2007;87:453.
- Reavey P, et al. Update on breast reconstruction in breast cancer. Current Opinion in Obstetrics and Gynecology. 2008;20:61.
- Wilhelmi BJ, et al. Breast reconstruction. In: Townsend CM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa.: Saunders; 2007. http://www.mdconsult.com/das/book/body/207919050-3/0/1565/0.html. Accessed July 21, 2010.
- Wilkins EG, et al. Breast reconstruction in women with breast cancer. http://www.uptodate.com/home/index.html. Accessed July 21, 2010.
- Atisha D, et al. Prospective analysis of long-term psychosocial outcomes in breast reconstruction. Annals of Surgery. 2008;247:1019.
- Walsh MF (expert opinion). Mayo Clinic, Rochester, Minn. July 22, 2010.
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