Breast Reconstruction with Tissue Expanders/Implants (First stage)
This operation is performed to restore a more normal appearance to the breast or breasts after a mastectomy. Deformities are commonly caused by cancer, trauma, and congenital abnormalities. Breast cancer treatment remains the most common indication for mastectomy. According to the American Cancer Society roughly 209,ooo women were diagnosed with invasive breast cancer in 2010. For patients undergoing mastectomy for breast cancer, reconstruction is performed immediately (same time as mastectomy) or in a delayed fashion after a minimum of six months.
Anesthesia type: General
Length of surgery: 2 hours for delayed reconstruction; 3-4 hours for immediate reconstruction
Risks: Infection, bleeding, poor scars, asymmetry, delayed wound healing, seroma, need for revision procedures, tissue expander deflation or exposure
Average recovery time: Patients who undergo a delayed breast reconstruction with a tissue expander usually go home the same day as the surgery. These patients will typically return to work within one week. Patients who undergo immediate reconstruction usually spend 1-2 nights in the hospital. They will usually return to work within two weeks. In both cases, drains are placed in the operating room, and are usually removed withing 1-3 weeks depending on outputs. Patients are allowed to resume normal activity within 3-4 weeks, and will typically start to feel back to normal within 8-12 weeks.
Duration of effect: Tissue expanders are typically only left in place for a few months unless chemotherapy and/or radiation therapy is indicated.
Breast Reconstruction with Tissue Expanders/Implants (Second stage)
Permanent implants are placed roughly three months after tissue expansion has been completed, or at a later date if chemotherapy and/or radiation is required to adequately treat the breast cancer. Both saline and silicone gel filled breast implants can be used for the second stage, although silicone gel filled implants are much more common. Silicone gel filled implants tend to feel softer and have less visible and palpable rippling (wrinkling). Most second stage breast reconstructions are performed on an outpatient basis.
Anesthesia type: General
Length of surgery: 1-2 hours depending on unilateral or bilateral reconstruction; additional time may be necessary to perform any additional procedures such as pocket adjustments, fat grafting or port removal.
Risks: Infection, bleeding, poor scars, asymmetry, delayed wound healing, seroma, need for revision procedures, implant deflation, rupture or exposure
Average recovery time: Patients almost always go home the same day as the surgery, and will typically return to work within one week. Suctions drains are used infrequently. Patients are allowed to resume normal activity within 3-4 weeks, and will typically start to feel back to normal within 6-8 weeks.
Duration of effect: Younger patients should plan on at least one implant exchange operation within the first 10-12 years after surgery.
Breast Reconstruction with a Flap
This procedure utilizes the patient’s own tissue to reconstruct the breast. Skin, fat, and muscle can used from the abdominal region. This is known as a TRAM flap procedure. Sometimes, tissue from the back can be used in combination with a permanent implant.
Anesthesia type: General
Length of surgery: 4-6 hours
Risks: Infection, bleeding, poor scars, asymmetry, delayed wound healing, seroma, need for revision procedures, hernia, wound dehiscence, implant exposure
Average recovery time: Return to work in 2 weeks; start to resume normal activity in 4 weeks; feeling back to normal in 6-8 weeks
Duration of effect: >10 years
