Breast reconstruction is an option for a woman who has lost a breast due to cancer or other conditions. Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy. If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.
Good candidates for this procedure:
Patients who are about to or have already gone through a mastectomy
Patients who want to improve symmetry of size and position of breasts
What to expect: Consultation
We are relieved that you detected the cancer early and are going through the stages of eradicating it. It is common for patients to come in before their mastectomy to see all the options they have after. The first and foremost step is to get the cancer treated! Breast reconstruction is like icing on the cake.
All cosmetic consultations are complimentary and serve as a great opportunity to gain further insight by voicing your concerns and having questions answered. During the initial consultation, Dr. Hsu will ask some questions to get to know you and determine if you are a good candidate for breast reconstruction.
During the consultation, Dr. Hsu will first ask about the area in question, and determine what specific goals you have for your breasts after surgery. He will then make some careful measurements of your breasts, using multiple measures in order to plan the surgery and individualize it for you. The measurements during the consultation, before surgery, are a key part of the surgical planning. He will also ask about your medical history, including existing medical conditions, past surgeries, tobacco usage, daily medications, supplements, and allergies. Make sure you let Dr. Hsu know which cancer treatment you have undergone because different treatments will change the algorithm for reconstruction. After giving a thorough examination, Dr. Hsu will voice his opinions about going forth with the procedure. In order to reach your aesthetic goal, both you and Dr. Hsu will work together to decide all the necessary details that will ultimately give you the best results.
On the day of surgery, come in early to fill out paperwork, meet the anesthesiologist, and the staff will prep you for surgery. Dr. Hsu will meet you in the pre-operative area before surgery to make markings on the areas planned for surgery and answer any last questions you may have.
Breast reconstruction in general can be divided into two types: implant based and natural tissue based or sometimes referred as flap reconstruction. The most popular is implant based reconstruction done either at the time of the mastectomy or months/years later to re-create the breast mound. This is completed in two stages. Usually we cannot just put an implant in immediately like we would in a breast augmentation because during the mastectomy, the cancer surgeon will have removed a decent amount of skin so the remaining skin will be too tight to withstand the implant. Therefore, Dr. Hsu will place a tissue expander implant that is made of a certain material where we can inject a little bit of saline every week or two weeks directly into the implant to gradually stretch out the tissue and skin. Once we have reached the desired volume or the skin has stretched out to match your other breast, we will give it a couple of months to stabilize. The second step of the reconstruction is to take out the tissue expander and put in your new silicone or saline implants. Dr. Hsu will usually use the same incision site as your mastectomy to minimize scarring. After the procedure is done, you can also opt for nipple reconstruction. The nipple is created by lifting up a little bit of skin and folding it upon itself kind of like origami and the color can be filled in by a tattoo artist. The idea is to make the nipple look as close as possible to natural nipples, but you have to keep in mind that it won’t be perfectly the same. However, our wish is to try to make it as realistic as possible.
The second type of breast reconstruction breast cancer survivors get is called natural or flap reconstruction. This is a more extensive operation that will require anywhere from two days to a week of hospital stay and is usually done in an academic medical center like UCLA or USC. One method of flap operations we do is to use the tissue that we would usually remove from tummy tuck procedure and swing it to the mastectomy area to create a breast with your own tissue. Another method is to take muscle from the back and swing it forward to create a breast.
Recovery & Post-operation:
After the surgery, Dr. Hsu will wrap dressings around the surgical area which will remain there for the first week during healing. You will also need to wear a surgical bra for about a week to aid the healing process. It is not recommended to lift elbows above your shoulders, but you can still use your arms for different things. During the recovery period, walking is encouraged to help quicken the healing process and minimize clots. Dr. Hsu will be available 24 hours afterward for any immediate concerns.
It is crucial to keep the surgical area dry until Dr. Hsu gives his approval to shower. To clean the rest of your body, you can bathe from the chest down. Swelling & bruising will peak about 48 hours after surgery but will then decrease significantly in the first two weeks. Most patients can return to work after two weeks, but many patients return even sooner. The biggest limitation for post-operative patients is driving, which should be avoided while taking pain medication. Patients usually stop taking pain medication after five to seven days and plan their work schedules accordingly. Six weeks is usually an appropriate time to return to most types of exercise and activity.
Dr. Hsu likes to follow patients after surgery for an extended period of time to make sure the patient is satisfied and healing well. Most follow up appointments are scheduled immediately after surgery and for up to a year afterward.
The rate of recurrence of cancer after breast reconstruction is very rare. In reality, cancer can spread to skin and neighboring tissues, but the remaining tissue is so small that it’s not difficult to detect any sign of remaining cancer. Another protective measure is that most patients are closely monitored by their oncologist after their mastectomy.
Dr. Hsu's view on Breast Reconstruction.
The most important issue for breast reconstruction patients is really not the plastic surgery -- it is the cancer treatment surgery that is performed by the general surgeon before I get involved. The primary focus should be on removing the breast cancer and maximizing the chance of long-term survival for the patient.
Nonetheless, breast reconstruction is very helpful in getting patients to feel more “back to normal” or whole again. This is what I’ve heard from many of the breast reconstruction patients that I’ve treated. Breast reconstruction has gone through multiple evolutions over the past few decades and there has been a significant increase in the number of reconstructive options. These options should be discussed in detail after a thorough assessment and examination by the surgeon. In my experience, surgery on the opposite side breast is nearly always performed as well, in order to maximize symmetry between the two sides.
Overall, I enjoy breast reconstruction very much because I think that it helps to restore form to patients who often are facing a difficult time, and it is very rewarding.