What To Expect Between Breast Reconstruction Stages
By: Courtney Floyd
Regardless of the type of breast reconstruction procedure being performed, more than one surgery is typically needed to achieve the best cosmetic results. A second procedure, referred to as “Revision Surgery” or “Stage 2 Reconstruction” takes place about three months after the initial reconstructive surgery.
Many patients are unsure of what to expect during the “in-between” phase.
For autologous (flap) breast reconstruction patients there may be a visible “skin island” on the reconstructed breast. This patch of skin is from your donor site (eg tummy, thigh, buttocks). For patients who have enough native breast skin remaining following the mastectomy, the skin island is usually removed completely, or made smaller at stage 2.
Donor site contouring and scar revision may also be performed during stage 2. Contour defects like the ones seen below over the flanks (known affectionately as “dog ears”) are a common concern for women following DIEP flap reconstruction and are easily revised through scar revision. Liposuction can also be performed to create a smoother silhouette.
For patients who opt for implant reconstruction, tissue expanders are replaced with permanent silicone or saline implants during the second stage of breast reconstruction.
Fat grafting is one of the most commonly performed procedures used during revision surgery for all breast reconstruction procedures. Fat is liposuctioned from one part of the body, purified, then reinjected into the breast to correct minor contour irregularities, add volume, and improve tissue thickness and quality over implants. Fat grafting can also be used to create better symmetry between the breasts.
For patients choosing unilateral breast reconstruction, a breast lift or reduction on the unaffected breast may be necessary to improve symmetry.
For patients who did not undergo nipple-sparing mastectomy, nipple reconstruction can also be performed at stage 2 in most instances. The reconstructed nipple and areola can later be tattooed to add color. Patients can choose between a 2D tattoo that adds color only, or a 3D tattoo which also adds more detail to make the final result even more realistic. Of course, tattoos are also an option on their own, without surgical nipple reconstruction for patients who don't want a projecting nipple.