Breast

Breast reconstruction can happen at the same time as the mastectomy is performed, known as immediate reconstruction or it can happen in a delayed fashion after the mastectomy and the incisions have healed. Reconstruction can also be done in stages. Who gets an immediate vs delayed reconstruction and a single vs staged reconstruction will depend on several factors that will be determined by your plastic surgeon and cancer team.

The answer to this will depend on your certain situation (need/history of radiation, desired breast size, skin laxity, etc) and is something that your surgeon will discuss with you. In some circumstances, your own tissue can be augmented with an implant or fat grafting to improve the shape and volume of your new reconstructed breasts.

For DIEP or free flap surgery, the procedure can take anywhere from 8-12+ hours if one or both breasts are being reconstructed and is usually followed by a 3-5 day hospital stay where the newly reconstructed breasts can be monitored to ensure the blood flow is properly maintained. For a latissimus dorsi flap reconstruction, the surgery can take anywhere from 3-5 hours and is usually followed by an overnight stay to ensure pain is well controlled.

Any time a space that is not naturally present in the body is created the body leaks fluid into that area until it can sufficiently heal. While the body can absorb a lot of the fluid, there is a limit to its capacity before it begins to accumulate in the space, which can lead to infection and other complications. Until the fluid production reaches a certain level, a drain is used to help prevent its accumulation and is important for this procedure.

The use of your own tissue, in many instances, can give a more natural look and feel to the breast reconstruction when compared with implants as the tissue will stretch and lay more like natural breasts would. The tissue can grow and shrink in proportion to your body like natural breasts would if you gain or lose weight. There is no need to replace your own tissue after a certain time like you would an implant. There is no risk of rejection since its your own tissue and the risk of infection in the breast in significantly decreased compared to using implants.

Most of my patients describe a soreness in the lateral chest wall but have also described muscle spasms and electric-like pains that can vary in timing. Because the nerves to the breast skin are cut to remove the breast tissue, the breast skin is largely numb and insensate with many patients getting back some sensation over time.

For the DIEP flap reconstruction, you’ll have to sit, sleep and walk in a slightly hunched position for the first few weeks until your skin relaxes. You’ll also need to avoid any heavy lifting for a period of 6 weeks as well. You’ll be placed in a supportive/sports bra at the time of surgery and be asked to wear it continuously for the first 4-6 weeks to allow the implants to heal into their proper positions. You’ll also be asked to avoid any heavy lifting or overhead activities for the same period.

I generally recommend patients undergoing autologous breast reconstruction to plan for at least 2-3 weeks off of work to allow themselves time to heal and recovery. If your job requires standing for prolonged periods of time or any heavy lifting, then you may need to be out as long as 6 weeks.