Breast Reconstruction Surgery

UW MEDICINE | PATIENT EDUCATION

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Breast Reconstruction Surgery

Options after a m astectom y

This handout explains the most common procedures that are used at University of Washington Medical Center (UWMC) to reconstruct a breast after mastectomy.

At the Center for Reconstructive Surgery, our goal is to help your body regain as much form and function as possible.

DRAFT

Your clinic visits will be at the UWMC Center for Reconstructive Surgery.

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Cen ter for Recon structive Surgery | Box 35616 5 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .1217

Abo ut Breast Reco nstructio n

Many wom en report a sense of wholeness and well-being after breast reconstruction. They also say that they have m ore confidence and a better quality of life.

If your cancer was found early, breast reconstruction m ay begin during your m astectom y surgery. But som etim es reconstruction cannot be done right away.

The tim eline and type of breast reconstruction we suggest for you m ay

Your surgeon will talk with you about your options for breast reconstruction, and the risks and benefits of each.

depend on:

? Whether you had chem otherapy, radiation, or other breast cancer tr eatm en ts

? Your breast size and shape, an d whether you have had other breast

D R A F T surgeries ? Other health conditions such as:

? Obesity, with a body m ass index (BMI) greater than 30

? Diabetes

? Heart disease

Talk with your provider about which type of breast reconstruction is right for you. Your surgeons will help create a care plan that m eets your needs.

Reconstruction Steps

Breast reconstruction involves m any steps. There is usually a healing tim e of about 3 m onths between each step. The whole process often takes about 1 year, but m ay be shorter or longer.

Creating a breast mound (may be more than 1 step)

Revision surgery and

Nipple reconstruction

symmetry

procedures

Nipple areolar tattooing

Ste p 1: Cre atin g a Bre as t Mo u n d

The first step in breast reconstruction is surgery to create a breast m ound. Your surgeon m ay use an im plant, your own tissues from another place on your body, or both.

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Page 2 o f 12 | Bre as t Re co n s tru ctio n Su rge ry

Cen ter for Recon structive Surgery | Box 35616 5 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .1217

Many tim es, an adjustable im plant called a tissue expander is placed during m astectom y. This im plant will help preserve and prepare your skin for reconstruction later.

During your surgery, you m ay have:

? Tissue expander, followed by an im plant later

? DIEP (deep inferior epigastric perforators) flap

? Latissim us dorsi (back m uscle) flap

Step 2: Revisions and Sym m etry

The second step in breast reconstruction is refining the shape and size of the reconstructed breast(s). This is called revision surgery.

Revision surgery often involves using liposuction to rem ove fat from the abdom en and thighs. This fat is then m oved to the reconstructed breast.

If reconstruction is on only one side, this step m ay also include surgery on the natural breast to im prove sy m m etry (m aking your breasts look m ore like each other). This m ight involve a breast lift, breast reduction, or augm entation.

Revision and sym m etry surgeries are usually outpatient procedures, also called day procedures. This m eans you will not stay overnight in the h os p it a l.

Som e wom en have m ore than 1 revision surgery to achieve the breast shape and size they want. These surger ies will be about 3 m onths apart so that your body has tim e to heal.

Step 3: Nipple Reconstruction

A nipple can be reconstructed after the breast mound has "settled." Nipple reconstruction is usually done about 3 m onths after revision surgery.

In nipple reconstruction, skin from the new breast m ound is raised and folded to create a nipple. This procedure is usually done in the clinic using local anesthesia (m edicine that num bs only the area where your doctor will be working).

In som e cases, this step can also be done during step 2 when you are under general anesthesia (m edicine that m akes you sleep).

Ste p 4 : N ipple Tatto o in g

Nipple tattooing adds color around your new nipple(s) to create a new areola. This is done in the clinic about 3 m onths after nipple reconstruction. For lasting results, a second tattoo appointm ent m ay be needed about 1 m onth after the first.

If you decide not to have nipple reconstruction, we can do a 3D tattoo. This will m ake it look like you have a nipple.

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Page 3 o f 12 | Bre as t Re co n s tru ctio n Su rge ry

Cen ter for Recon structive Surgery | Box 35616 5 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .1217

A tissue expander stretches the skin and muscle to create a pocket for the permanent breast implant.

Bre as t Re co n s tructio n w ith Tis s u e Expan de r an d Im plants

Placin g a Tis s ue Expan de r

We cannot place a perm anent breast im plant during your m astectomy. Your skin will be very delicate and will have healin g problem s if there is too m uch pressure underneath.

But, we can place an adjustable im plant called a tissue expander during your m astectom y. This expander is placed under your skin and chest m uscle. Over the new few m onths, we will slowly fill this expander with a saline solution.

The expander can also be placed at a later date, from weeks to years after your m astectom y. This is often done as an outpatient surgery.

Expansion Process

The expansion process starts about 3 weeks after we place your expander. You will com e for clinic visits about every 1 to 3 weeks. At these visits, saline will be added through a port in the expan der. As the size of the expander grows over tim e, your skin and m uscle over it will stretch to create your final breast size.

When your expansion is com plete, your surgeon will rem ove the expander and replace it with a perm anent im plant. This is done as an outpatient surgery. The im plant is softer and m ore natural in feel and shape than the exp a n d er .

At one of your clinic visits, before we place your final im plant, we will talk with you about your goals and the different types of im plants. Som etim es your cancer treatm ent m ay delay this step.

Tim e lin e fo r Re co n s tructio n w ith Im plan ts

Tissue

expander placed (adds 1 to 2 hours to mastectomy surgery)

Visit 3 weeks

after surgery for first expansion and post-op check

(no heavy lifting for 4 weeks)

Tissue

Surgery to

expander

filled every 1 to 2

exchange expander for

implant

weeks

(at least

(usually 4

3 months

to 8 visits)

after expander

placed)

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Cen ter for Recon structive Surgery | Box 35616 5 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .1217

Risks of Im plant Surgery

In fe ctio n

It is possible to get an infection after im plant surgery. This usually occurs within the first few m onths after surgery. If you get an infection, you will need antibiotics you take by m outh or by IV (intrav enous line).

If an infection is severe, we m ay need to rem ove your expander or im plant. It will be several m onths before we can place a new one.

Rupture

Im plants can leak (rupture). If your im plants leak, you will need another surgery to replace the dam aged im plant. This is m ore likely to happen with older im plants. If you suspect a leak, your doctor will m ost likely want to schedule an ultrasound or m agnetic resonance im aging (MRI) scan. These scans will show if there is a rupture.

Cap s u lar Co n tractu re

Som etim es, the scar tissue in the area around the im plant gets hard and tight. This is called capsular contracture. It is one of the most comm on problem s after im plant surgery.

Capsular contracture is more likely to occur if you have had radiation treatm ent. If it happens, you will likely need another operation to replace the im plant.

If you have had radiation treatm ent, we usually advise having tissue reconstruction instead of reconstruction using an im plant.

Breast Reconstruction with DIEP Flap

Flap reconstruction involves m oving a flap of skin, fat, and blood vessels from another area of the body to the breast area for breast reconstruction.

UWMC doctors most often use the deep inferior epigastric perforator (DIEP) flap m ethod for this surgery. DIEP flap surgery uses a flap from your lower abdom en to rebuild your breast. Your abdom inal m uscle is only slightly affected.

Before surgery, an im aging procedure called a com puted tom ography (CT) scan is done to find DIEP blood vessels in the lower abdom inal wall. Using m icrosurgery (surgery using a m icroscope), your surgeon will rem ove the flap from your abdom en and then connect the tiny arteries and veins in the flap to tiny blood vessels in your chest.

DIEP surgery is m ore com plex than other types of reconstruction. It takes about 6 to 12 hours. After this surgery, you will need to stay in the hospital for about 3 to 5 days.

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Page 5 o f 12 | Bre as t Re co n s tru ctio n Su rge ry

Cen ter for Recon structive Surgery | Box 35616 5 1959 N.E. Pacific St., Seattle, WA 98 19 5 | 20 6.598 .1217

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