Breast Reconstruction

(Includes Breast Reconstruction with Tissue Expanders, Breast Implants, Latissimus Dorsi Flap and TRAM Flap)

Breast Reconstruction Questions

What are my options for breast reconstruction?
There are three commonly used techniques for breast reconstruction.

A breast implant may be used to reconstruct a breast. In most cases, a tissue expander (a device similar to an implant) is placed at the time of mastectomy. Then, the expander is enlarged by injected a fluid during weekly clinic visits. As the expander stretches out the remaining skin on the breast, a pocket is created to allow for placement of a breast implant at a second surgery.  

A second option is the use of your own tissue from your back (latissimus dorsi flap). This tissue is used to cover a breast implant and often eliminates the need for tissue expansion but still requires the use of an implant.

The third option is the use of the tissue from your abdomen (TRAM flap) and usually does not require an implant.

There are other options available but they are used only in unusual circumstances.

Which option is best for me?
Each option has its advantages and disadvantages. Not all patients will be candidates for each reconstruction. The best option will depend on your wishes and expectations, your overall health, breast and body shape, and if you have any risk factors for reconstruction such as smoking, obesity or radiation treatment. The choice of reconstruction will be decided by both you and Dr. Spring after she examines you and reviews your health history.

Is breast reconstruction covered by insurance?
Yes, in most cases all procedures associated with breast reconstruction are covered as required by federal law.

How many surgeries are necessary?
The use of a tissue expander is a two stage process and will require a second surgery 4 to 6 months later to exchange it for a breast implant. Breasts can be reconstructed in one stage by using a latissimus dorsi flap to cover an implant or by using a TRAM flap. After the breast is reconstructed, most patients desire nipple reconstruction. This minor procedure is usually done 4 to 6 months later. At that time, minor revisions may be done to the reconstructed breast. After the nipple is reconstructed, the areola (pigmented skin around the nipple) may be reproduced with a tattoo. Some patients desire surgery on the opposite breast to have better symmetry with the reconstructed breast. This may involve a breast enlargement, reduction, or lift. If breast implants are used, you may need another surgery to replace them at some time.

Will I need any more visits before surgery?
Although it is not necessary, you may meet with Dr. Spring again before your surgery to answer any questions and review the procedure.   You will need to have a “History & Physical Exam” a few weeks before surgery which will be done by Dr. Spring (or it may be done by your primary care physician or general surgeon performing the breast cancer surgery). You will have an opportunity to ask any remaining questions that day as we go over the procedure and all operative paperwork.  If you require medical clearance and lab tests before surgery, please plan on arranging for the appointments as soon as possible so that information is available for Dr. Spring to review at your final preoperative appointment.

Where will the procedure be done?
Breast reconstruction at the time of mastectomy is done at Bonner General Hospital.  If you are having a delayed reconstruction with tissue expanders, this is done at Pend Oreille Surgery Center or Bonner General Hospital

What kind of anesthesia will I have?
General anesthesia is used and you are completely asleep during the procedure. If a TRAM flap is being done, an epidural may also be used to provide pain relief after surgery.

How long does the procedure take?
Placement of a tissue expander or breast implant takes about 1-2 hours. Reconstruction with a latissimus flap or TRAM flap takes 4 to 5 hours. More time may be needed if both breasts are being reconstructed

How long will I stay in the hospital?
After reconstruction with only an expander or implant, most patients are able to go home the next day or even the same day with a responsible adult. Patients with a with a latissimus flap spend 2 to 3 days in the hospital while those with a TRAM flap reconstruction spend 3 to 4 days.

Will I have any drains after surgery?
Yes, the drains are usually removed 5 to 10 days after surgery, but may remain for 3 weeks or more.  You will have breast drains as well as abdominal drains for a TRAM flap or back drains for a latissimus flap. 

What medications will I need after surgery?
You will receive a prescription for a pill containing a narcotic/acetaminophen (Tylenol) combination.  You may be given a prescription for a short course of antibiotics. 

Will I need any special bras?
No, but if needed, you will be given a Surgical Bra or Breast Band after surgery.

How often will I need to come back after surgery?
Dr. Spring will see you in 3 to 7 days after surgery or hospital discharge and again after 1 to 2 weeks, 4 to 6 weeks, and after 3 to 4 months. If you would like to be seen at any other time, Dr. Spring will be happy to do so.  If you have breast tissue expanders, you will come to the office every 2 weeks on average to have the expanders inflated with saline.

Will there be any sutures to remove after surgery?
In most cases, there are no sutures to remove except for those associated with drains.  Some sutures around the belly button or the breast may need to be removed in the office.

What are my restrictions after surgery?
After reconstruction, you may shower the second day after surgery but be very gentle with your breasts for the next 2 weeks. Light regular activity is allowed during the first week but should be limited if it causes discomfort. Avoid heavy straining or lifting more than 10 pounds (about the weight of a gallon of milk). You should sleep on your back for the first 1 to 2 weeks.  Do not drive if you are using narcotic pain medications. After reconstruction with only an expander or implant, you may resume regular activity as tolerated after 2 weeks. After latissimus flap reconstruction or TRAM flap reconstruction, you may resume regular activity in 4 to 6 weeks.

How long before I can return to work?
This depends on the type of work you do. Those who perform mostly desk work will be able to return sooner than those who require heavy activity at work. After reconstruction with only an expander or implant, most patients are able to return to work in 1 to 2 weeks. Patients with a with a latissimus flap reconstruction may return to work  in 2 to 3 weeks while those with a TRAM flap reconstruction may need 4 to 6 weeks before returning to work.

Will I need any therapy after surgery?
No, just be sure to move your arms in a full range of motion three times a day in a slow and gentle manner after surgery to prevent stiffness. Start this the third day after surgery.

What can I do to minimize scars after surgery?
Silicone gel sheets have been shown to improve scar appearance after surgery. Please refer to the enclosed Scar Information sheet for details.

 

 

Back to Top