Immediate Breast Reconstruction
What Will My Experience Be Like With Immediate Breast Reconstruction?
If you are considering breast reconstruction, the process may seem intimidating. You probably like to do background research before you make an important personal decision, yet the need to proceed with treatment does not allow you to do this, at least to your desired level. I hope this section of the website will give you a better understanding of the breast reconstruction experience.
IMMEDIATE BREAST RECONSTRUCTION WITH A TISSUE EXPANDER FOLLOWED BY AN IMPLANT
This is the most common sequence that I follow for my breast reconstruction patients. At the first stage of reconstruction, I place a tissue expander partially covered by acellular dermal matrix as soon as the general surgeon completes the mastectomy. Several weeks after this surgery, you will begin the process of expansion. You will visit my office where we will add saline solution to the expander over a number of weeks, which stretches and shapes the new breast. The second operation is an outpatient surgery in which I remove the expander, place a form-stable implant, and carry out fat transfer. If you are having a single breast reconstruction, I may carry out surgery to balance the opposite breast to the reconstructed breast at this time. At a third operation I will create the nipple and provide additional fat to the breast.
If you come to see me to learn about breast reconstruction, but you have not yet selected a general surgeon, I will arrange for an expedited referral to one of our breast oncologic surgeons at Rush. We understand your desire to proceed with surgery and will make every effort to coordinate our schedules so that we can quickly proceed with surgery, if you desire.
You will be admitted to Rush University Medical Center the day of your surgery.
The combined mastectomy and tissue-expander reconstruction will take several hours. Surgery will be longer if it is a double reconstruction.
During your surgery, I will inject long-acting local anesthetic to help block the pain reflexes.
My goal is to minimize your discomfort during the recovery. After the operation I will talk to you and your family to let you know that everything went well. Since you are waking up from surgery, your recollection of this conversation will probably be a little fuzzy.
You will most likely spend two nights in the hospital after reconstruction.
Some patients are ready to go home the day after surgery, and some require an extra night’s stay.
Except in unusual circumstances, I will visit you early in the morning on your first day after surgery.
I will review with you things that you can do to optimize your recovery. You will also be cared for by an expert team of doctors that make up the plastic surgery team at Rush.
When you leave the hospital, you will be protected by a dressing that resembles a bulky tube top and is held in place by a gentle stretch bra.
You will most likely have one or two drains, and you will know how to care for them. You will keep the dressing in place until your first postoperative visit to my office several days after discharge. My team will contact you at home to see how you are settling in, and we are always available for your questions.
We will see you several times in the first weeks after surgery.
We will remove the drains and give you instructions for exercises to avoid tightness in the area under your arm. We will guide you to a smooth return to light activity, and we will let you know when it is safe to return to more vigorous exercise.
We begin tissue expansion around the third week after surgery.
You will find a convenient day and time to visit us at the Chicago or Winnetka office, and you will come in for weekly expansions. We know your time is important, so we make every effort to make the visits convenient and efficient. During your expansion visits we will follow your progress with healing, return to complete activity, and arm motion. We offer weekly expansions for your convenience, but if you are planning a vacation or business trip or just want to take a break, you are perfectly free to do so.
For some patients, additional treatment such as chemotherapy or radiation therapy will be necessary.
Once these treatments begin we will take a break from tissue expansion and resume expansion once you therapy is completed. We will give you specific guidelines that are based on your precise treatment plan.
When you have completed the stretching process of tissue expansion, you will have a rest period and then proceed to the second stage of reconstruction.
This is an outpatient surgery, usually on a Friday. During this surgery I will remove the expander, place a form-stable implant, and carry out fat transfer. This is also the time when I will modify your opposite breast, if you desire, in order to balance the reconstructed breast. This may consist of a breast reduction, a breast lift, a breast augmentation, or a lift with augmentation.
Most of our second stage patients come to see us three or four days after the surgery.
We remove the dressing and fit you with a gentle support bra. Most patients are able to return to light activity, including work if desired, within several days of this visit. Even though the recovery from this second surgery is generally easier than expected, it is important that you be gentle with your body and maintain a mild level of activity. We will give you specific instructions based on the particular surgery that you undergo.
Nipple reconstruction is a powerful step in breast reconstruction.
It is usually best to wait for the breasts to “settle in” so that the placement of the nipple or nipples will be optimal. I often add additional fat to the reconstructed breast at the time of nipple reconstruction. Occasionally I will make minor modifications in the reconstructed breast or the natural breast to optimize balance and shape.
Our patients return very quickly to light activity after nipple reconstruction.
It is important to protect the nipple during the healing phase with a simple “bumper cushion” dressing, which we will explain to you.
Once the nipple is healed we will provide color to the reconstructed nipple and areola during a visit to the office.
Patients are almost always amazed by the power of this simple step.
IMMEDIATE BREAST RECONSTRUCTION WITH A FLAP FROM THE BACK OR THE ABDOMEN
The two main flaps that plastic surgeons use for breast reconstruction are the abdominal flap, which takes fat and overlying skin (if necessary) from the central abdomen and the back flap, which involves a large muscle from the back with an overlying ellipse of skin and fat.
With the abdominal flap, the plastic surgeon takes excess skin and fat from the central abdomen and moves it to the breast. The blood supply to this flap comes from vessels that run along the length of the rectus (sit-up) muscle and travel up from the muscle to the overlying fat and skin. There are several ways to keep a good blood supply to the flap. One option is to free up the entire rectus muscle from its fascia and keep the muscle attached at its upper end beneath the ribs, while releasing it at its lower end near the pelvis. The muscle and the attached fat and skin are passed through a tunnel into the area of the breast and trimmed to the appropriate dimension. The other option is to rely for circulation on the vessels that enter the lower end of the rectus muscle (free TRAM or DIEP flap). These vessels and a section of the muscle with overlying skin and fat are carefully released and the vessels are cut and attached to vessels near the breast with microsurgical techniques. The area from which the flap was taken must be carefully repaired.
With the back flap the latissimus dorsi muscle (commonly referred to as the lat) is used to carry skin and some fat to the area of breast reconstruction. The muscle is released from its attachments near the spine so that it can be brought around to the chest. The blood supply comes from vessels that enter the muscle near its attachment at the base of the arm, and these are carefully protected. Some women carry enough fat in the back area that it can supply the necessary volume for the reconstructed breast. More commonly an implant is placed beneath the flap.
As you can imagine, the recovery from surgery with the abdominal flap and the back flap is considerably more involved than when tissue expanders and implants are used. At the very least, there will be several more days of hospitalization and a longer period before a patient can return to normal activity. There are also additional scars to contend with, either on the back or on the abdomen. As I have discussed earlier in this website, there are also potential long-term functional issues that should not be ignored.
Schedule Your Private Consultation Today
During a private consultation, Dr. Cook can go over all of your breast reconstruction options, including immediate and delayed breast reconstruction, and help you decide which treatment is best for you. He is available to address all of your questions and concerns. To learn more, contact his practice today at 312-751-2112 or send an email.