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Reconstructive Surgery After Breast Cancer

Pain And Discomfort After Surgery

Reconstructive surgery after breast cancer treatment

You will likely have some pain after surgery. For most people, this pain is temporary.

The bruising and swelling from the surgery may take up to 8 weeks to go away .

Starting after the mastectomy, you will be numb across your chest, from your collarbone to the top of your rib cage. Unfortunately, this numbness usually doesnt go away. You may get some feeling back over time, but it will never be the same as before surgery.

Learn about managing pain after surgery.

When To Perform Reconstructive Surgery

Another question that worries women is whether to perform the reconstruction in the same operation as the excision, or if it’s better to recover completely first. Ihab said that each case is individual. There are cases with an option for immediate reconstruction during surgery to remove diseased tissue, yet in some cases the decision is more complex.

The woman has to decide if she’s interested, and age also plays a role. From a medical point of view, there’s also a question of whether radiation is necessary or not, and whether skin is to be cut or not. So in some cases, even if the woman wants, postponing restoration is necessary.

Ihab stated that as a doctor, he must explain all the options so women can choose the most comfortable direction. Ihab is in favor of saving patients more and more surgery and they always prefer doing fewer procedures. Yet he always says to new patients, “Welcome to the breast reconstruction clinic, we’ll meet a lot,” because in many cases after the immediate restoration, another small correction or injection of fat is needed to achieve the perfect aesthetic result.

But it does help a woman come out of the surgery feeling that she hasn’t lost her breasts, and this feeling is very important.

Ihab is personally connected with breast reconstruction procedures because he knows when a patient enters the operating room with cancer, when she leaves she often asks if everything went well.

Why Would I Need Reconstructive Surgery

You are most likely to need reconstructive surgery after some types of surgery to remove cancer. For example, you might have a breast removed to treat breast cancer. You may choose to have reconstructive surgery to replace the breast with an implant. Or you might have tissue or nerves removed during treatment for head and neck cancer, skin cancer, or other types of cancer. Reconstructive surgery can help repair the changes to your body from your cancer surgery.

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Should Textured Breast Implants Be Removed

The FDA does not recommend removing textured breast implants or tissue expanders unless you have symptoms. Symptoms may include fluid build-up around the implant, swelling, pain and a lump in the breast or underarm.

Let your health care provider know if you have any of these symptoms.

Some women who have textured breast implants, but have no symptoms, may choose to have textured implants removed. However, the surgical risks of removing implants can be greater than the risk of developing BIA-ALCL.

If youre considering removal of a textured breast implant, talk with your health care provider about the possible surgical risks for you and make an informed decision. These risks should be weighed against the risk of BIA-ALCL before choosing to have textured implants removed.

Breast Reconstruction Using Implants

Flap Reconstruction

Mastectomy removes the entire breast, but the skin and nipple can sometimes be saved. Using a breast implant is one option for reconstructing the shape of your breast after mastectomy. It usually means having at least two operations.

  • The first surgery places a tissue expander, a flat water balloon that will be gradually filled during office visits until a desired size is reached.
  • The second surgery replaces the tissue expander with a breast implant. Additional procedures could be done to reconstruct the nipple-areola area or revisions to improve the overall look.

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What To Consider Before Breast Reconstruction

There are several things you need to consider when reviewing reconstructive breast cancer options, says Manahan. What procedure is best for you depends on many factors, such as:

  • What you do for a living
  • Whether you want to have children after surgery
  • If you have the extra tissue needed for a natural reconstruction
  • How much post-surgery downtime youre comfortable with

If youre going to have a lumpectomy or mastectomy, consult with a plastic surgeon in addition to your breast surgeon. A plastic surgeon can provide guidance on the various breast reconstruction procedures and work in partnership with your breast surgeon to give you the look you want.

Its okay to take your time to come to a decision, says Manahan. You might not know if you want implants, or whether you want to use belly or thigh tissue, or if youre going to need radiation. But you can still move forward with the mastectomy. We can insert a tissue expander to hold a breast-like form under your skin. Then, when youre ready, we can remove the expander and reconstruct your breasts with either implants or your own tissue. Whats important is knowing there are many options for breast reconstruction, and consulting with your surgeon to find the best choice for you.

To learn more about postponing your breast reconstruction, read 7 Things You Might Not Know About Delayed Breast Reconstruction.

A Natural Alternative To Breast Implants

Although using implants lets you recover faster, not everyone likes the way they look or the prospect of needing future surgeries to replace them if they rupture. A natural alternative involves using fat and tissue from another area of your body to fill in your breasts.

In the past, doctors removed muscle, fat and skin from the abdominal wall, the back, the inner thighs or the buttocks and moved it to the chest to form breasts. This procedure was painful and had a long recovery. But now an updated technique lets you use your own tissue with less pain and faster healing. During this surgery, called a perforator flap procedure, your surgeon moves only skin, fat and tissue not muscle to your chest area. Not everyone is a candidate for this procedure, depending on anatomy and previous surgical history, but its a good option for some women.

Using your own tissue creates a more natural look. And you can also have a tummy tuck, thigh lift or buttock lift at the same time if you have tissue removed from those areas.

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Resources For Patients Without Insurance

No one should be denied cancer treatment because they cant afford it. If you do not have insurance, and even if you do, there are a number of charitable organizations you can turn to as a way to decrease the financial burden, including:

These are not the only organizations willing to help. Be proactive and reach out for help.

Is Breast Cancer Surgery Considered Major Surgery

Foregoing reconstructive surgery after breast cancer

Mastectomy is considered a major surgery for the below reasons: The procedure involves permanent removal of either one or both breasts, which itself is a major risk factor. Usually, the procedure may last up to 4 hours depending on the severity of the disease. It is performed under general anesthesia.

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What Is The Recovery Like For Breast Reconstruction

Breast reconstruction is major surgery that can require several days in the hospital, followed by weeks of recovery at home. The length of recovery depends on the type of reconstruction performed.

After surgery, patients may have:

  • Limited activity for up to two months
  • Pain, bruising, swelling or soreness
  • Restrictions on movement
  • Movement, rupture or leakage of implant
  • Needing implants removed
  • Additional surgery to fix complications

Change In The Nipples Position After A Nipple

If your nipple has settled into a position that feels or looks unnatural, it may be possible to reposition it, depending on whether your nipple was in the center of your breast before the mastectomy or whether it had already begun to descend from the effects of aging. Sometimes a surgeon may recommend removing the nipple altogether and reconstructing a new nipple using skin from somewhere else on the body. A nipple tattoo, which creates a realistic-looking areola and nipple out of tattoo ink, may also be an option. You should know, though, that if the nipple is removed, its impossible to preserve lactation.

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Should A Woman Choose Implants Or Flap Reconstruction

As with any surgery, both options have benefits and risks to consider. In either case, family and social support is key to successful recovery. Breast cancer and reconstructive surgeries can be emotionally and physically taxing it is essential for patients to understand what to expect during recovery and to prepare for potential challenges.

More About This Trial

Breast cancer reconstruction surgery

Doctors often treat breast cancer with surgery. Some women have an operation to remove their whole breast . They often choose whether or not to have breast reconstruction after their mastectomy.

This creates a breast that is similar size and shape to their own. But the reconstructed breast may not be identical. And people can see the differences when they are undressed. So not everyone wants to have reconstruction.

Doctors and nurses give support, and help people decide what to do. But it can be difficult to decide. And some women find it difficult to talk about it.

The researchers in this trial have developed a tool to help women in this situation. It is called PEGASUS. This stands for Patients Expectations and Goals: Assisting Shared Understanding of Surgery.

It asks women about:

  • how they feel about their breasts
  • their expectations of the reconstruction surgery
  • how important the surgery is for them

The main aims of this study were to find out:

  • whether PEGASUS can help women decide whether to have breast reconstruction or not
  • what women and health care professionals think about the PEGASUS tool

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Smoking And Body Weight

Smokers and women who are overweight have an increased risk of complications for all types of breast reconstructive surgery .

If you smoke or are overweight, talk with your plastic surgeon about problems that may occur after surgery with implant or flap procedures, such as delayed wound healing, infection and reconstruction failure.

Sometimes, its best to delay breast reconstruction until after quitting smoking or losing weight to lower these risks.

Your plastic surgeon or health care provider may discuss ways to quit smoking and/or lose weight before you have reconstruction.

Breast Reconstruction Can Improve Your Quality Of Life

Some patients don’t have the opportunity for or are not interested in reconstruction when they are first treated for breast cancer, says Manahan. “We can still offer breast reconstruction at any point, and it often helps patients feel better about their overall experiences and what their bodies have had to face.”Leading studies that compared quality-of-life assessments for women before and after breast reconstruction, Rosson and Manahan found that reconstruction, whether immediate or delayed, can greatly improve a womans sense of wholeness and well-being.Breast reconstruction can also alleviate pain and chest tightness associated with radiation treatment and, in some cases, improve nipple sensation.

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Loose Skin Or Drooping Breasts From Heavy Implants

Heavy implants may pull on the skin and loosen it, causing the breasts to droop. It may be possible to correct this by repositioning the implant to a more symmetrical position and tightening the skin. Surgical mesh may be used to secure the implant like an internal bra. In some cases, the implant may need to be replaced with a smaller one.

Help And Support From Someone Whos Been There

Foregoing reconstructive surgery after breast cancer

It’s important to know that there is advice and support out there to help you understand your reconstruction options as well as cope with the changes youre going through if you have chosen reconstruction. Speaking with your doctor or other members of your health care team is often a good place to start. If you would like to talk with someone who has had your type of reconstruction, ask about our Reach to Recovery® program. Reach To Recovery volunteers are breast cancer survivors trained to support others facing breast cancer, as well as those who are thinking about having breast reconstruction. They can give you suggestions, reading material, and advice. Ask someone on your cancer care team to refer you to a volunteer or program in your area or call us at 1-800-227-2345.

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What Is Partial Breast Reconstruction

During a lumpectomy, a portion of the breast tissue is removed to treat a cancer or mass. The purpose of lumpectomy or breast conservation therapy is to treat the cancer or mass without having to remove the entire breast, like in a mastectomy.

The amount of breast tissue removed during a lumpectomy can vary widely. Therefore, the results after lumpectomy are often unpredictable. This can leave a woman with a contour abnormality, deformity or asymmetry. This is especially true when radiation is part of the treatment plan.

Lumpectomy reconstruction or partial breast reconstruction, also known as oncoplastic reconstruction, is an option for patients who have had a lumpectomy and wish to recreate symmetry between the remaining breast and the other side. It can be performed at the time of the lumpectomy or many years later if a deformity exists.

There are numerous options for partial breast reconstruction, depending on the unique aspects of your case, the size and shape of the breasts and the amount of tissue removed. These options include rearranging the remaining breast tissue at the time of the surgery, transferring tissue from the back using the TAP flap or latissimus flap procedures, placing a breast implant, or performing fat grafting by harvesting your own fat with liposuction from other parts of the body.

Is Breast Reconstruction Right For Me

The idea of living without a breast or without part of one affects each woman differently. Itâs a personal decision, and it’s often not easy to make.

You donât have to have reconstruction. You can wear external breast forms or pads, or change nothing at all.

Plastic surgery now gives better results than ever before. You can have breast reconstruction using breast implants or your own tissue.

The operation changes your appearance, but it can have psychological benefits as well. It can add to a sense of wellness for you and your family.

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Whats The Difference Between Breast Reconstructive Surgery And Cosmetic Surgery

Reconstructive surgery repairs body parts impacted by illness, injury or defect. The word reconstructive refers to rebuilding a part of the body after it was damaged or destroyed.

On the other hand, cosmetic surgery is performed to enhance a normally functioning part of the body with the goal of changing the outward appearance.

As an example, getting breast implants with the goal of making clothes fit better would be considered cosmetic surgery. However, getting implants to rebuild one or more breasts after a mastectomy constitutes a reconstructive surgery.

This distinction is important because many insurance companies may cover reconstructive surgeries but may not cover cosmetic surgeries.

Plastic surgery in a cancer setting is not cosmetic, and it may fix a post-procedure deformity, so we recommend discussing it with your doctor.

Choosing Which Type Of Breast Reconstruction To Have

Oncoplastic and Reconstructive Surgery for Breast Cancer Buch

If youve decided to have breast reconstruction, youll still have many things to think about as you and your doctors talk about what type of reconstruction might be best for you. Some of the factors you and your doctors will need to think about when considering your options include:

  • Your overall health
  • The size and location of your breast cancer
  • Your breast size
  • The extent of your breast cancer surgery – if you are a candidate for lumpectomy or mastectomy, and the possibility to keep your nipple
  • Whether you will need cancer treatments other than surgery
  • The amount of tissue available for reconstruction
  • Whether you want reconstructive surgery on one or both breasts
  • Your desire to match the look of the other breast
  • Your insurance coverage and related costs for the unaffected breast
  • How quickly you want to be able to recover from surgery
  • Your willingness to have more than one surgery as part of the reconstruction
  • How different types of reconstructive surgery might affect other parts of your body

Your surgeon will review your medical history and overall health, and will explain which reconstructive options might be best for you based on your age, health, body type, lifestyle, goals, and other factors. Talk with your surgeon openly about your preferences. Be sure to voice any concerns and priorities you have for the reconstruction and find a surgeon you feel comfortable with. Your surgeon should explain the limits, risks, and benefits of each option.

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How Do Surgeons Use Tissue From A Woman’s Own Body To Reconstruct The Breast

In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a womans body and used to rebuild the breast. This piece of tissue is called a flap.

Different sites in the body can provide flaps for breast reconstruction. Flaps used for breast reconstruction most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.

Depending on their source, flaps can be pedicled or free.

  • With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area. Because the blood supply to the tissue used for reconstruction is left intact, blood vessels do not need to be reconnected once the tissue is moved.
  • With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels in the breast area, using a technique called microsurgery. This gives the reconstructed breast a blood supply.

Abdominal and back flaps include:

Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who dont have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps. With these flaps an implant is often used as well to provide sufficient breast volume.


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