Background Information:

What are the other Names for the Procedure?

• Breast Reconstruction, NOS
• Mammaplasty
• Reconstruction of Breast

What is Breast Reconstruction surgical procedure?

A Breast Reconstruction procedure involves reconstructing or rebuilding the female breast after removal of the breast tissue, called mastectomy.

What part of the Body does the Procedure involve?

Breast Reconstruction involves the female breasts, chest muscles, back muscles, and sometimes the abdominal wall muscles.

Why is the Breast Reconstruction surgical procedure Performed?

Breast Reconstruction is performed for any of the following reasons:

• Cosmetic purposes
• Psychological needs

What are some Alternative Choices for the Procedure?

An alternative to Breast Reconstruction surgery is to use an external prosthetic, or a custom made bra that matches the other breast.

What are the Recent Advances in the Procedure?

The Flap Reconstruction technique used for Breast Reconstruction is considered good, with great results. The recent advances are methods that aim at improving the reconstruction technique and are known as Deep Inferior Epigastric Artery Perforator (DIEP), and Superficial Inferior Epigastric Artery (SIEA) Breast Reconstruction surgery. 

A very recent technique that is still under research aims at creating biodegradable computer aided scaffolds that will aid in Breast Reconstruction and breast tissue engineering. This technique could completely replace implants, with the patient’s own tissue itself. 

What is the Cost of performing the Breast Reconstruction surgical procedure?

The cost of Breast Reconstruction procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Breast Reconstruction and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.umgcc.org/breast_program/breast9.htm#d

http://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction.html?sub=Breast%20reconstruction%20risks%20and%20safety%20information#content

http://www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastReconstructionAfterMastectomy/breast-reconstruction-after-mastectomy-after-surgery

http://medicalxpress.com/news/2011-12-advances-breast-reconstruction.html

http://www.imaginis.com/cosmetic-reconstructive-breast-surgery/advances-in-breast-reconstruction

Prior to Breast Reconstruction surgical procedure:

How is the Breast Reconstruction surgical procedure Performed?

Breast Reconstruction is performed by either using an artificial implant or by grafting fat or muscle, removed elsewhere from the patient’s body. Depending on the technique used to reconstruct the breast, the procedure followed varies. The two most common techniques used to reconstruct the breast are: 

• Tissue Expander

In the Tissue Expander technique the physician inserts a tissue expander under the chest muscles. The tissue expander is an empty or partially filled, implant case that is refilled with saline water every 2-3 months, before being finally replaced with a permanent implant.

• Flap Reconstruction

In the Flap Reconstruction technique; the muscle, fat and skin is removed from the back, abdomen, buttocks, inner thigh, and other areas to reconstruct the breast. The muscle, fat and skin is usually from the patient, or a volunteering donor. In most cases this muscle flap is constructed into a mold at the mastectomy site, where usually the blood vessels are still intact or can be rechanneled. This procedure is the most preferred one as it offers good cosmetic results. 

Similarly the nipple and areola area can also be reconstructed. In either case (Tissue Expander or Flap Reconstruction); the other untouched breast may need minor surgical procedure to establish symmetry in both breasts.

Where is the Procedure Performed?

A Breast Reconstruction procedure is performed in a hospital. The patient is admitted, undergoes the procedure, and is discharged as per the instruction of the physician.

Who Performs the Procedure?

The surgery is performed by a plastic surgeon, or an oncology surgeon (rare), or a general surgeon with support from an anesthesiologist.

How long will the Procedure take?

The procedure may take anywhere between 2-4 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• No particular preparations are needed prior to the procedure
• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

A physician will request your consent for the Breast Reconstruction procedure using an informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Breast Reconstruction procedure using an informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Breast Reconstruction surgical procedure?

• The physician determines the need of mammogram, ultrasound, blood test, urine analysis, chest x-ray and electrocardiogram
• Additional studies including stress test, echocardiogram may be recommended on a case by case basis

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Breast Reconstruction surgery? 
• What does the procedure involve?
• How will the procedure help?
• Am I a suitable candidate for Breast Reconstruction?
• How will my breast look, post-surgery?
• What options are available, if I am not happy with the surgery?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Breast Reconstruction surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia is administered during the procedure.

How much Blood will you lose, during the Procedure?

The amount of blood loss is generally minimal, but if complications arise during the procedure, it could lead to a further loss of blood.

What are the possible Risks and Complications during the Breast Reconstruction surgical procedure?

The possible risks that may arise during a Breast Reconstruction surgery are:

• Excessive bleeding
• Blood clot formations
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Breast Reconstruction surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Breast Reconstruction surgical procedure:

What are the possible Risks and Complications after the Breast Reconstruction surgical procedure?

The possible risks and complications that may arise after a Breast Reconstruction surgery are:

• Excessive scarring, called keloid formation, might occur
• Surgical wound infection
• Hematoma (a pocket of blood in the wound)
• Seroma (collection of fluids around the implant)
• Discoloration of healing skin
• Capsular contracture; an abnormal immune response of the body against the implant causing the scar around the implant to tighten
• Limited shoulder movement
• Abdominal hernia (if abdominal wall was used for reconstruction)
• Failure of the surgery

What is the Prognosis after the Surgery?

• Post-surgery discomfort and swelling is expected for about 6 - 8 weeks. However the scars may take 1-2 years to heal, but will never completely fade away
• Most of the patients are usually happy with the outcome of the procedure. However, it takes time to emotionally adjust to the reconstructed breasts as one’s own

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain around the surgical wound
• Swelling & redness
• Bleeding or fluid drainage
• Fever
• Dizziness
• Signs of infection

What Post-Operative Care is needed at Home after the Breast Reconstruction surgical procedure?

At home, the following post-operative care is recommended, after a Breast Reconstruction procedure:

• Keep the surgical wound clean and dry
• Wash the surgical wound with soap
• Use warm compress to reduce swelling and pain
• Complete the course of prescribed medication
• Avoid taking non-prescribed medications
• Exercise to regain arm mobility, as directed by the physician

How long does it normally take to fully recover, from the Procedure?

It takes about 6-8 weeks for the patient to recover completely from the procedure. 

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

A Breast Reconstruction procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Breast Reconstruction surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• The plastic surgeon, or an oncology surgeon, or a general surgeon
• An anesthesiologist (if anesthesia was administered)

The patient is advised to inquire and confirm the type of billing, before the Breast Reconstruction procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA