Author: Dr. Steven Pisano
What tips do surgeons offer when planning for breast reconstruction?
Do’s:
Do seek experience. Breast reconstruction is complicated. Broadly speaking, there are two main categories of breast reconstruction—implant based and tissue based. Within each of these categories there are many options. Seek a practice whose physicians are experienced with all methods of reconstruction. Just as important, look for a practice in which breast reconstruction is the primary focus of the practice. Volume matters; you want to find a practice that does a large number of breast reconstructions year in and year out. In March of 2013, we at PRMA performed our 5,000th breast reconstruction with 4,500 being tissue transplant reconstructions with the DIEP flap.
Do research your options. Do your homework. Become an informed patient and learn the basics of implant based and tissue based reconstruction. Search “Breast Reconstruction” and this will get you started. The PRMA website has a ton of information. You’re not going to medical school, but you want to have a basic understanding of what each of the major types of reconstruction looks like and how it is performed. As your breast cancer treatment unfolds, make your oncologic surgeon and oncologist aware that you are interested in breast reconstruction and that you are aware of the various types of reconstruction.
Do set the timing. Breast reconstruction can be immediate or delayed. At PRMA we prefer to do the reconstruction immediately, that is, at the time of the mastectomy. An immediate reconstruction allows the patient to wake up with at least the breast mound in place; with a nipple-areola sparing mastectomy and immediate reconstruction the breast may look almost normal. On the other hand, not all breast cancer patients are candidates for immediate reconstruction. For example, patients who are advised to have radiation therapy may be better served by having a delayed reconstruction. Post-mastectomy chemotherapy in our practice, does not require a delayed reconstruction. But, for whatever reason, some breast cancer patients may not be ready for an immediate reconstruction, and the additional recovery that it entails.
Do choose your team. Choose a reconstructive surgeon who is Board Certified by the American Board of Plastic Surgery. Choose a plastic and reconstructive surgery practice that has a staff that is experienced and dedicated to breast reconstruction. Choose a facility that is well-run in general and has a good reputation for nursing care and is accustomed to performing reconstructive breast surgery specifically.
Do set realistic expectations. The reconstructed breast may not look like the native breast. It may end up being a different size, shape or texture. It may have a reconstructed nipple that lacks normal sensation and erectile function. Not all mastectomies are the same and some oncologic surgeons are more aggressive than others and remove more soft tissue from the breast. Radiation therapy may render the native remaining breast and chest wall skin tight and tethered to the underlying chest wall, which along with the mastectomy, contributes to what we at PRMA term a large “absolute tissue defect.” After reconstruction there may be asymmetry between the reconstructed and native breasts or in the case of bilateral reconstruction, between the two reconstructed breasts.
Don’ts:
Don’t let anyone talk you out of breast reconstruction. Make it clear to your surgeon, oncologist, radiation oncologist, significant other and children that you are interested in breast reconstruction. The vast majority of breast cancer patients are candidates for some type of reconstruction, whether implant or tissue, immediate or delayed.
Don’t settle for reconstruction that is not right for you. Pursue the type of reconstruction that fits your needs and appeals to you most. An experienced reconstructive surgeon will help you in your decision making process. He or she will review the pros and cons of the major types of reconstruction and determine whether you are a candidate for one type of reconstruction verses the other.
Don’t be impatient in your recovery. Breast reconstruction takes time, energy and patience. In our practice at PRMA, the time to complete breast reconstruction takes from four months to one year, maybe longer if chemotherapy and or radiation therapy is required.
Don’t be hindered by location. You may live in an area in which breast reconstruction is not available. Or it may be that you are interested in a tissue reconstruction such as the DIEP flap but no one performs it in your area. Consider traveling to a practice that offers breast reconstruction. PRMA has become a destination practice for breast reconstruction and patients routinely visit us from all over the United States, Mexico and Canada for breast reconstruction.
Don’t compromise your cancer treatment. Taking care of the breast cancer comes first. Reconstruction may need to be put off in the case of a large, aggressive tumor. Chemotherapy and radiation therapy may take priority over reconstruction. The vast majority of women are candidates for some type of reconstruction; it just may be that the reconstruction is delayed.
A study published in Plastic and Reconstructive Surgery examined the abdominal recovery rates and patient satisfaction after breast reconstruction with different abdominal flaps: the DIEP, SIEA and muscle-sparing free TRAM.
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The Importance of Quitting Smoking Before Breast Reconstruction Surgery
What is the best timing for breast reconstruction surgery?
Mary
I had a dbl mastectomy in 2006 & radiation on one Sid in 1998. I use to be a smoker and was told I couldn’t have reconstruction surgery I’m on Medicare
PRMA Plastic Surgery
Hi Mary, as long as you are not currently smoking, you may be a candidate for breast reconstruction. Please give me a call at 800.692.5565 and we can go over your medical history and discuss options. -Brandy
Lisa
I had breast reconstruction perform on me after my r mastectomy and reduction on my left. I now have a r breast high on my chest and flat and l breast full and hanging lower the nipples are not close to even and the r nipple is longer, smaller in diameter and the areola is smaller in diameter on the r side, too. My plastic surgeon stated he 800 cc was the largest he was allowed to put in and I should be greatful; sometimes you can mess up a good thing; look where I came from; he did a B- to A+ job; I don’t know what is good when I see it. He want to do another breast reduction on my l side. Insurance stated there are better ways to repair my breast than fat injections. I want to feel and look as good as I did before the cancer. I can not fit into a bra, swim suit or top without one side being too large or too small. Is there any one that can help me or am I stuck looking like this forever. I was a size 38 H before the mastectomy.
PRMA Plastic Surgery
Hi Lisa, PRMA surgeons routinely perform corrective breast reconstruction on patients that are unhappy with a previous reconstruction. Are you interested in going another reconstruction route – the DIEP flap maybe? Let me know if you’d like some more information, I’d love to help! -Brandy
Diane
I had a blateral and am very unhappy with the outcome. Also can anyone tell me, can u still get breast cancer back after a bi- lateral mastectomy
PRMA Plastic Surgery
Hi Diane, the chances of a breast cancer returning after a mastectomy is less than 1%. I’d love to talk with you more to get some additional information regarding your previous reconstruction. Please feel free to call me at 800.692.5565 or email me @ patientadvocate@prmaplasticsurgery.com. -Brandy
Julie
I had a bilat mastectomy in 2007 with expanders then in early 2008 saline inplants replaced the expanders. My left implant can be felt through my skin, has a weird indentation next to me sternum and is a totally different shape and size than the right. I can’t find a bra that is comfortable to wear because the cups don’t fit correctly and I have what feels like jelly under my skin where the bra band would go around under my armpits to be fastened. I have had 13 ! surgeries to try and correct the problem. I hade to have nipple grafts also and they aren’t the same either. It looks like my left one is cold (erect) all the time and the right one is flat. The color has never been tattooed on but they did change color and look like my “real” nipples used to. I had an injection into the right one to change the shape to look more like the left one and all the filler has eventually come out of what looked like a blackhead. I had 800cc implants inserted but they seem to have settled quite a bit and feel like they sag. I know I am almost 50 and shouldn’t have a set of breasts like an 18 year old, but I was wondering what I might be able to do to fix them, make them more alike and possibly be a bit larger…?… I am willing to travel some distance, my original PS is 300+ miles away. Any help you can give me would be greatly appreciated.
PRMA Plastic Surgery
Hi Julie, in order to determine what can be done in your situation, we ask that you complete our virtual consultation form. This will allow one of our surgeons to review your case (photos, medical history etc) and give their recommendations. You can find the form via this link—>https://prma-enhance.com/patient-forms/virtual-consultation. Let me know if you have any questions or need more information. You can reach me @ 800.692.5565 or via email @ patientadvocate@prmaplasticsurgery.com. -Brandy
Bennie
I had double lumpectomy a year ago that left indents in both breast and received radiation treatments. I am hoping to get breast that look normal. Being a small person of 108 lbs. i have no fat to use, would augmentation be the route to look at? Do have 1st appointment set for April.
PRMA Plastic Surgery
Hi Bennie, implants may be the way to go if you don’t have enough tissue. The only way to tell for sure is to see you in person or for you to complete our virtual consultation form. You can find the form here: https://prma-enhance.com/schedule-your-consultation/. Let me know if you have any other questions. -Brandy
Kathy
I had a bilateral mastectomy with immediate reconstruction using implants. They were placed under the muscle and don’t show at all. I was a small B before the surgery, and I was supposed to be bigger. Now I feel like I’m smaller than before. It has only been 3 weeks, and my doctor keeps saying I’m going to love them after I heal, but so far I’m very disappointed. When will I start to love them?
PRMA Plastic Surgery
Hey Kathy! I am sorry to hear you are not happy with your results yet. You are still really early out of surgery, so more than likely your results are going to change. I will say it is important to keep open and honest communication going with your doctor so he is aware of your concerns. Keep your spirits high!
Camilla
I was diagnosed with DCIS last Sept. Because of size of effected area, I had a mastectomy along with expander in Oct. Turned out because of size and placement it was decided i should also have radiation. that happened in Feb. Decided to move forward with implant with some fat in July. End of July infection, was on IV antibiotics for 2 weeks. They were not sure what caused the infection, radiation or fat/implant. Feeling good now but not sure if i should continue with this or start over with a flap. Any suggestions?
PRMA Plastic Surgery
Hey Camilla! What an exhausting journey you have been on! I am so happy to hear you are feeling good now. Should continue with your current reconstruction plan or if you should start over with a flap is a really great question. It is important to research all of your options thoroughly, and consult with your current surgeon on his opinion. PRMA does offer a virtual consultation. If you would like to fill it out, I would be happy to forward your case onto one of our physicians to review and provide you with a second opinion. The virtual consultation can be found at https://prma-enhance.com/schedule-your-consultation/.
Donna
Hello. I had bi lateral mastectomy 2 years ago because of breast cancer. I have implants I am on my 5th surgery because one or both implants always gets capsular contraction. Am I too old for DIEP surgery? I am 59. Thank you.
PRMA Plastic Surgery
Hey Donna! You are not too old!! I would love to chat with you about your options. You can give us a call at 800-692-5565 and we’d be happy to talk with you and schedule you a consultation.
Valerie
I had DCIS high grade with central comedo-type necrosis , DCIS are negative for ER – PR -. Had segmental mastectomy surgery in Nov.2014.DCIS high grade measuring 0.3mm approximately 5.0mm from the closest deep margin, additional margins DCIS high grade with central comedo-type measuring 5.0mm in maximal linear dimension less than 1.0 mm from the closest lateral. Before I found out I had cancer I wanted to have breast reduction. I was going to haven it done in August 2015’ the plastics surgent said it was fine to do it . The cancer doctor said I have to wait until Nov. Should I wait., plus I’m worried about being ER –
PRMA Plastic Surgery
Hey Valerie! Without evaluating you in person, or knowing much of your medical background, we are not in a place to say. It is best to consult with a surgeon you trust and perhaps get a second opinion from another local surgeon.
Gloria
Hi there, I am a 30 yr breast cancer survivor. At age 30 I had DCIS, lumpectomy and radiation on L side. at age 58, a different cancer came in the same breast in March 2014, I had a mestectomy & deip flat at the same time. The right side has a very small implant for balance and look great. However, the left side looks completely deformed, it is not shaped like a beast. I am ok with the clevish. I feel so sad that I went through all of this and when I look at myself without cloths, I see a mestectomy. I am considering another flap using my back tissue but do not know if I have enough fat. Do I need fat or skin? Not wanting another scar but I think I rather have one than live with a deformed looking breast.
PRMA Plastic Surgery
I’m so sorry to hear you feel this way Gloria! Thank you for your openness and honesty. The back flap you are referring to (LAT flap) uses skin, tissue, and muscle. We would strongly advise you to consult with a plastic surgeon specializing in breast reconstruction as there are other flaps to consider as well, such as the GAP and TUG. Keep your head high Gloria! Please let us know if we can help in any way!
Alex
It is necessary to stop smoking and using any nicotine containing products at least 3-4 weeks before a breast augmentation procedure. Smoking causes vasoconstriction so it decreases the amount of oxygen in the blood and decreases the amount of blood travelling to the body tissues. Smoking and use of nicotine can cause wound formation, high rates of capsular contracture, aging of skin and the collagen break down.
Diane
My name is Diane, I was diagnose of breast cancer in 2014, I had my left breast totally off and I told my Doctor to remove the right side but he only took like the top part of the breast and still have the base of the breast so I got expander inside in both of my breast and got it the sized I want of both of them and got the implants into my breast and sewed them up. My biggest concerned is the my right breast kinda sits the way I had it before, but my left one sits higher of the base and it’s not the same as size the tight breast sits up higher and definitely are not the same and I have lots of scars and seeing lopsided breast. What can I do about this?
PRMA Plastic Surgery
Hello Diane! Thank you for sharing! There are options available to help achieve better symmetry. Before we could provide you with any surgical recommendations, we would need to consult with you. We offer a free online virtual consultation at https://prma-enhance.com/schedule-your-consultation/. If you fill this out one of our surgeons can review your situation and provide your with their recommendations before you use any resources to come in for a consultation.