Breast Reconstruction

Breast reconstruction is a surgical process that rebuilds the breast after cancer treatment or an injury. Breasts can be built back up using implants or the patient’s own tissue, and the timing of the reconstruction depends on the patient. Some women begin reconstruction at the same time as their mastectomy, while others wait until they have finished their cancer treatment. The work is usually completed with more than one procedure, so the tissue has time to heal or adjust.

Patients often come to us looking for help with:

• Single or double mastectomy results that have left a flat or uneven chest
• Lumpectomy defects such as dents, divots or contour irregularities
• Congenital absence of breast tissue or noticeable side-to-side asymmetry
• Skin tightness, firmness or shape changes following radiation therapy
• Loss of the nipple and areola during cancer surgery
• Scarring or distortion left behind from previous breast procedures

Most women who have had a mastectomy or lumpectomy can be considered for reconstruction. The best candidates are healthy enough for surgery and ready to take on a multi-step recovery process. Candidacy also depends on:

• A clear understanding of how reconstruction fits into the overall cancer treatment plan, including any chemotherapy or radiation
• Stable weight and well-managed conditions, such as diabetes or high blood pressure
• Not smoking or being willing to stop several weeks before surgery and through the full recovery period
• Realistic expectations about how the final result will look and feel
• Enough donor tissue on the abdomen, back or thighs if a flap technique is being considered

Patients who are not ready for reconstruction right away can still be excellent candidates years later. There is no time limit on choosing this step.

During your first consultation to discuss reconstruction surgery, it is important to disclose where you are in the treatment process and which cancer surgeon is treating you, as well as provide any necessary pathology reports. This discovery phase will help guide the reconstruction process so patients end up with a new breast that is the size, shape and look they want.

As your surgery date gets closer, your team may ask you to:

• Pause blood thinners and certain supplements about a week before surgery. This includes aspirin, ibuprofen, fish oil, vitamin E and herbal products like ginkgo or St. John’s Wort. Always confirm with your prescribing doctor before stopping any medication.
• Get lab testing. Some cases require more extensive lab testing and medical evaluation.
• Stop using nicotine in any form. Cigarettes and vapes both restrict blood flow, which is especially risky for flap reconstruction. Plan to stop at least four to six weeks before surgery.
• Skip alcohol for at least two days beforehand. Alcohol thins the blood and can increase swelling during recovery.
• Coordinate help at home. You will need a driver on surgery day and someone to assist you for the first several days.
• Set up your recovery space. Stock front-closing tops, extra pillows for propping yourself up and any prescribed medications before you head to the hospital.

On the day of your procedure, you will check in and meet with your surgical team for any final questions. Your surgeon will mark the surgical sites and confirm the goals you discussed during your consultation. Breast reconstruction surgery is performed under general anesthesia at an accredited surgical facility.

When the reconstruction is complete, your surgeon will close the incisions and place small drains to manage fluids as you heal. You will wake up in a recovery area where your nursing staff will monitor you. If you are going home the same day, a loved one will be able to drive you.
Some patients may be required to stay in the hospital to be monitored for complications. Patients who have had reconstruction using a flap technique will usually be required to stay in the hospital for two to five days.

The recovery process can be somewhat lengthy, but many view it as the final step in their cancer journey; thus, the experience can be very rewarding. Most women are thankful to have had the opportunity to restore their breasts and are satisfied with their results.

Your recovery may look different depending on which type of reconstruction surgery you have. Here is a general timeline of what to expect:

• First week: You will feel sore and tired, with swelling around the surgical sites. drains are typically still in place, and your team will show you how to care for them at home.
• Weeks 2 to 4: Most patients begin to feel more like themselves. drains usually come out during this window once output is low enough.
• Weeks 4 to 6: Many patients return to desk work and resume light daily activities. driving is usually possible once you are no longer taking prescription pain medication.
• Weeks 6 to 8: With your surgeon’s clearance, you can ease back into exercise. Flap patients may need a little longer before resuming upper-body workouts.
• Months 3 and beyond: Swelling continues to fade, and the rebuilt breast settles into its final shape. Additional steps, such as fat grafting or nipple reconstruction, are often scheduled now.

• Wear your surgical bra or compression garment as directed. It supports the healing tissue and helps reduce swelling.
• Sleep on your back with your upper body slightly elevated. Avoid sleeping on your side or stomach until your surgeon clears it.
• Take medications on schedule. Staying ahead of pain and following your antibiotic plan makes a big difference.
• Care for your drains and incisions exactly as instructed. Watch for unusual redness, fever or sudden changes in drain output.
• Avoid heavy lifting for several weeks. Anything heavier than a gallon of milk should wait until you are cleared.
• Keep every follow-up appointment. These visits let your surgeon track your healing and adjust the plan if needed.
• Protect your scars from the sun. Use sunscreen and scar therapy products as recommended to help the lines fade.