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Reconstructive Breast Surgery

In the past ten years, major achievements have been made in breast reconstruction following mastectomy surgery. No longer do women need to face long, jagged scars that impact their self image. Instead, advanced techniques have given plastic surgeons the tools to rebuild a woman's breast in such a way that her silhouette is once again whole.

Women with breast cancer have two main considerations when considering reconstructive breast surgery -- when to have surgery and what type of surgery to have. All of the options below are available to patients who are good candidates and healthy enough for surgery.

When to Have Reconstructive Breast Surgery

Your breast surgeon and the breast plastic and reconstructive surgeon will help you decide which option is best for you:

  • Simultaneous breast reconstruction - Women have the option to have immediate reconstruction of their breast(s) at the same time as their mastectomy. This is a reasonable option for patients who do not need breast irradiation.
  • Staged breast reconstruction - Many women who require radiation therapy are advised to have staged breast reconstruction instead of simultaneous reconstruction. If radiation is done on a newly reconstructed breast, over time it can alter its cosmetic appearance, making an implant hard, painful, deformed, contracted or even exposed. It may also cause severe fibrosis or shrinkage of the fatty tissue that may have been used in rebuilding the breast.

A tissue expander will be inserted after mastectomy to keep the breast skin that was saved during the skin sparing mastectomy procedure stretched and supple in preparation for the final reconstruction, which will be done several months after radiation is completed.

  • Delayed breast reconstruction - A woman may opt for delayed reconstruction if a plastic surgeon was not involved after her mastectomy. Many women did not know their breast reconstruction options at the time of mastectomy. More and more they're discovering that surgically recreating their breasts is possible and is required to be covered by insurance as a result of a federal law passed in 1998.

Types of Breast Reconstruction

A woman's breast can be reconstructed in one of two ways:

  • Implants -Implants are made out of silicone or saline or a combination of both, and can be inserted during or after a mastectomy. They are placed underneath the chest muscle versus on top of it, as in the case of breast augmentation.
  • Flaps - Flap procedures are done by plastic and reconstructive surgeons who specialize in microsurgery. During flap reconstruction, a breast is created using tissue taken from other parts of the body, such as the abdomen, back, or buttocks, or thighs, which is then transplanted to the chest by reconnecting the blood vessels to new ones in the chest region. We are pleased that to offer plastic surgeons who provide this level of microsurgery and the Chester County Hospital has the equipment and staff needed to provide this type of surgery.

Most breast centers are still performing flap surgery the "old fashioned" way if they do not have surgeons with these skills. These older procedures (TRAM Flaps and latissimus dorsi flaps) result in the patient sacrificing either her abdominal muscles or her upper back muscles. While those procedures were the best options decades ago, today we know that there is a higher risk of hernia, weakness, abdominal bulging, and limits on physical activity with these older procedures. There are no physical limitations with the more sophisticated procedures performed at our Breast Center.

Paying for Reconstruction

Federal and state laws require insurance companies to pay for all or part of the cost of breast reconstruction at any time after removal a patient's breast tissue. This includes any surgery required on the opposite breast for symmetry. Our staff is experienced in working with all major insurers for these procedures. We will work with you to keep your out-of-pocket expenses to an absolute minimum.

Recovering from Breast Reconstruction

Please note: These are general guidelines and may not apply to every patient. Always follow your doctor's specific instructions for care after surgery.

How Do I Care for My Drainage Device?

You may be discharged from the hospital after breast cancer surgery with an external drainage device in place. The drain will continuously remove fluid from the surgery site into an external collection device. You will be responsible for emptying it. Your health care provider will show you how to care for your drain before you are discharged from the hospital.

The amount of fluid that is drained over a 24-hour period will gradually decrease. The color of the fluid may also change from a cherry-red to a yellow-red, and then to a straw-colored fluid. Usually the drainage system is removed within one week after surgery.

When Can I Get my Incision Wet?

After breast cancer surgery, your incision should be kept clean and dry for one week after surgery. Because of this, sponge baths are preferable to showers. You may bathe in a bathtub if you are able to keep the area dry. Small pieces of tape (called steri-strips) will remain over the incision site and can be removed between 10 and 14 days after surgery.

Do not go swimming until you have discussed this with your physician at your follow-up appointment.

When and How Do I Change my Bandages?

You will be wearing a special bra (surgi-bra) that holds bandages in place after the surgery. Your doctor will tell you when you are able to stop wearing the bra. You should change the dressings once a day, but your health care provider will show you how to do this.

If possible, it's a good idea to have someone help you change the bandages as you lie in bed.

What Should I Take for the Pain?

You will be given a prescription for pain medication after breast cancer surgery. Ask your doctor about taking over-the-counter pain relievers in addition to, or instead of, your prescription pain medicine. Do not take aspirin or products containing aspirin for the first three days after the procedure.

How Do I Care for the Skin Near the Incision?

The area may be black and blue right after breast cancer surgery. This will go away in a few days. You may feel numbness, tingling, or discomfort on the inner part of your upper arm or in your armpit. This is normal. With your doctor's approval, try to increase your exercise routine and take a mild pain reliever such as Tylenol. A warm shower may also provide comfort, but remember to wait one week after surgery before taking a shower.

When shaving under your arm or applying deodorant, look in the mirror to avoid irritating the incision.

As the incision heals, it may feel thick and tough. You may massage the area with a mild lotion, vitamin E, or pure lanolin. Avoid highly perfumed lotions and any product containing alcohol, because they may be irritating. After several weeks, the scar will soften.

What Exercises Should I Do After Breast Cancer Surgery?

Exercising is important after breast cancer surgery. To regain mobility, perform these stretching exercises several times every day, starting the day after surgery.

  • Arm lifts. While standing or sitting on the edge of a chair, lift both arms over your head, with your elbows "touching" your ears. Hold for a count of five and repeat.
  • Arm swings. While standing, swing both arms forward and back from your shoulders (like a pendulum). Try to keep your elbows straight. Increase the distance of the swing each time. Repeat 10 times.
  • Wall climbing. Stand facing a wall, with your feet close to the wall. Put your arms out in front of you with your hands on the wall. Climb the fingertips of both hands up the wall, until your arms are stretched over your head. Climb your fingers back down the wall. Repeat 10 times, trying to reach higher each time.

When Can I Drive After Breast Cancer Surgery?

Most women can resume driving 10 to 14 days after breast cancer surgery. Ask your doctor about specific recommendations for your situation.

What Follow-Up Exams Will I Have?

Regular follow-up exams are very important after breast cancer treatment. Your doctor will continue to check you closely to be sure that the cancer has not returned. Regular checkups usually include exams of the chest, underarm, and neck. From time to time, you may have a complete physical exam, blood tests, mammogram, and a chest X-ray. Your doctor may order scans and other exams as well.

Should I Do Breast Self-Exams?

A woman who has had cancer in one breast has a higher-than-average risk of developing cancer in her other breast. You should continue to practice monthly breast self-exam, checking both the treated area and your other breast. Report any changes to your doctor right away.

What Else Do I Need to Know?

It is best not have blood drawn, or an injection given, in the arm on the side of your body where you had breast cancer surgery. If it is necessary that blood be drawn -- or drugs given -- in this arm, be sure to tell the health care provider that you have had breast surgery.

When Do I Call the Doctor After Breast Cancer Surgery?

When you go home from the hospital after breast cancer surgery, call your doctor if you have:

  • Swelling in your arm or hand, near the incision, or under your arm. (A small amount of swelling is normal for about one month after surgery. Sometimes, elevating your arm on pillows will reduce some of the swelling.)
  • A fever over 100 degrees Fahrenheit.
  • Increased drainage from the incision.
  • Increased pain not controlled by your pain medication.
  • Other physical problems such as pain, loss of appetite or weight, changes in menstrual periods, or blurred vision. Also report dizziness, coughing or hoarseness, headaches, or digestive problems that seem unusual or that don't go away.

Last Updated: 7/15/2013