Cosmetic Surgery Tips

How Many Surgeries Are Required for Breast Reconstruction

The breast is usually reshaped in two stages, or surgeries. During the first stage, a tissue expander is used. An implant is placed during the second stage. Sometimes, the implant is inserted in the first stage. In general, breast reconstruction typically requires 2-3 surgeries and/or procedures (including tattooing) over the course of about a year for optimal results regardless of which procedure a patient decides is best for their needs.

In this guide, we review the aspects of How many surgeries are required for breast reconstruction, problems with breast reconstruction after mastectomy, breast reconstruction surgery using belly fat, and breast reconstruction surgery after mastectomy.

How many surgeries are required for breast reconstruction

The number of procedures needed for breast reconstruction might vary based on the patient’s preferences, the reconstruction technique used, and the particulars of her breast cancer therapy. Following a mastectomy or lumpectomy, a breast mound is intended to be recreated through the complicated procedure of breast reconstruction.

Implant-based reconstruction and autologous tissue reconstruction are the two basic types of breast reconstruction.

Breast implants are used in this form of reconstruction to restore the breast mound. Two procedures are normally required for the reconstructive process. Tissue expanders are inserted behind the chest muscles during the initial operation in order to progressively extend the skin and muscle over a period of weeks or months. The tissue expanders are replaced with permanent implants during following operations, and corrections may be necessary to obtain the ideal form and symmetry.

Autologous Tissue Reconstruction: In this technique, the breast is rebuilt using the patient’s own tissue, generally from the back (latissimus dorsi flap), buttocks (SGAP or IGAP flap), or abdomen (TRAM flap). Autologous tissue repair typically necessitates longer hospital stays and repeated surgeries. The tissue is removed from the body, reshaped into a breast mound, and then transferred to the chest during the initial operation. To improve the shape, modify the symmetry, or undertake nipple repair, more procedures can be required.

The number of procedures needed for breast reconstruction might vary based on the particular circumstances and objectives of the individual. Some patients might only need one operation, whilst others could need several to get the desired result. Nipple and areola reconstruction, fat grafting for body contouring, or revision procedures to improve the outcomes are a few examples of these extra operations.

Understanding the precise surgical approach suggested for your case requires a detailed conversation with a plastic surgeon who specializes in breast reconstruction. To choose the best course of action and establish the approximate number of procedures needed, they will consider your medical history, inspect the surgery site, and talk with you about your desired goal.

Breast reconstruction is a highly customized surgery, and the total number of operations required might vary depending on the kind of reconstruction, if further procedures are required, and the patient’s healing and recovery time. Your plastic surgeon will collaborate closely with you to create a thorough treatment plan that takes into account your unique requirements and objectives as well as the timing and coordination of any further cancer therapies or concerns.

problems with breast reconstruction after mastectomy

Even though breast reconstruction after a mastectomy can be a good choice for many women, it’s vital to be aware that there may be difficulties and consequences. Following a mastectomy, frequent issues that may occur with breast reconstruction include:

Infection: Breast reconstruction involves the same risk of infection as any surgical operation. This might happen right after surgery and need for further care, including antibiotics or, in extreme circumstances, removal of the implants or tissue.

Capsular contracture is a problem that can happen when scar tissue builds all around the breast implant, making it tighten and solidify. This may cause discomfort, alter the contour of the breasts, and perhaps call for more procedures to fix.

Problems with implants: When breast implants are used for reconstruction, difficulties such implant rupture, implant misplacement, or implant visibility may occur. These problems can call for further operations or implant removal and replacement.

Complications connected to the donor location can occur with autologous tissue reconstruction, which uses tissue from another region of the body. These might include concerns with the blood supply to the transplanted tissue, infections, or complications with wound healing.

Asymmetry or unsatisfactory outcomes: In breast reconstruction, it can be difficult to produce symmetrical and aesthetically attractive outcomes. Women can have final results that are unsatisfactory in terms of shape, size, or appearance. To overcome these issues, further procedures or adjustments could be necessary.

Impact on the mind and emotions: Breast reconstruction can have a profound effect on a person’s mind and emotions. It might be difficult to get used to the changes in one’s body image, live with scars, and handle the emotional effects of breast cancer and therapy.

The dangers, issues, and restrictions associated with breast reconstruction must be thoroughly discussed with your plastic surgeon. They can provide you individualized information based on your particular circumstances and assist you in making an educated decision on the surgery.

It’s crucial to remember that not everyone qualifies for breast reconstruction, and there are other possibilities, such as using breast prosthesis or forgoing surgery. The circumstances and desires of each person should be taken into account when making decisions about breast reconstruction following mastectomy. Throughout the process, seeking assistance from medical experts, support groups, and loved ones can be helpful.

breast reconstruction surgery using belly fat

A diagnosis of breast cancer can be terrifying enough. Finding out that mastectomy (surgery to remove one or both breasts) is required to treat the cancer can compound the devastation. For some women, the feelings surrounding the loss of one or both breasts can be nearly as overwhelming as the cancer diagnosis itself.

Recent advances have expanded the range of reconstruction options available to women today. Patients can get excellent cosmetic results whether they choose to have the procedure done with breast implants or using their own tissue, generally known as flap surgery.

At Memorial Sloan Kettering Cancer Center (MSK), our plastic surgeons are working tirelessly to refine reconstruction options, and many of them are innovators in the field. Establishing good communication with patients is key to their success.

MSK also has physician assistants specially trained in tattoo artistry, who create remarkably realistic 3D nipples and areolas for hundreds of patients a year. You can learn more here.

To help you better understand your choices, we spoke with MSK plastic and reconstructive surgeon Michelle Coriddi, MD.

“Reconstruction involves multiple options, and deciding on the best one is personal,” says Dr. Coriddi. “I take time with each patient to discuss all of their options and the likely outcome of each one.”

What is the goal of breast reconstruction, and what factors do you take into consideration when making a recommendation?
The goal of breast reconstruction after mastectomy [the removal of a breast] is to restore the breast mound, or mounds, and achieve symmetry. At MSK’s Center for Advanced Reconstruction, breast surgeons who perform mastectomies, plastic surgeons who reconstruct breasts, and specialists in realistic nipple tattoos work closely with medical oncologists, radiation oncologists, and with the patients themselves to develop the best surgical treatment and breast reconstruction strategy.

The factors I consider in making recommendation to my patients include:

What does a breast implant reconstruction procedure entail?
A breast implant is the most common form of breast reconstruction, and it involves the use of either a silicone shell filled with either saline (sterile saltwater) or silicone (gel). At MSK, we most commonly use silicone because it’s softer and feels more like a natural breast.

For many of our patients, implant surgery involves a few steps.

Is there an ideal candidate for breast implant reconstruction?
The best candidates for implants tend to be smaller- to moderate-breasted women. Fuller-breasted women can have implant reconstruction, but if they received a unilateral mastectomy [when one breast is removed], we sometimes need to do a reduction on the natural breast in order to achieve symmetry. Similarly, for women with a smaller breast size, we may need to do a breast augmentation of the natural breast to achieve symmetry.

Implants can rupture or get infected, which may require another procedure down the line. Additionally, the U.S. Food and Drug Administration (FDA) has required monitoring silicone implants for rupture with an imaging study every few years. However, implants can provide excellent results and are a great option for many women.

Is there risk associated with breast implants and cancer?
The FDA has stated that a small number of cases of squamous cell carcinoma (SCC) had been found in the scar tissue of women with breast implants. Additionally, the FDA has stated that around 1,000 cases of breast implant-associated anaplastic large cell lymphoma have been found in association with certain textured implants. While the findings appear rare among the millions of women with implants, any new change in or around a breast implant — such as swelling, pain, a new lump, or a new rash — should be evaluated by a doctor. 

What is soft tissue flap breast reconstruction surgery?
Flap reconstruction makes use of a woman’s own tissue — including skin, fat, and occasionally muscle — to reconstruct the breast. That tissue and skin can be obtained from a variety of places, and the area and method we choose will depend on factors such as the amount and quality of tissue available as well as the patient’s preference.

Pedicled TRAM flap reconstruction, the original method, involves using tissue from the area below the belly button. The skin, fat, and at least one abdominal muscle are tunneled underneath the skin upward into the breast area but remain attached to their blood vessels in the abdomen. This allows the transferred tissue to continue to get its blood supply from where it originated, making it the simplest of the flap procedures. The downside is that it requires sacrificing muscle, which potentially can affect function in the abdominal region.

At MSK, our overall approach is to sacrifice the least amount of abdominal muscle possible to preserve abdominal function, and in most cases no muscle at all. We can do that using either — the free muscle-sparing TRAM flap or free DIEP flap. These procedures involve the relocation of tissue and also reconnecting the tissue’s blood supply, which means that microvascular surgery techniques are required to complete them. [Microvascular surgery refers to surgery that’s performed on very small blood vessels using an operating-room microscope and a variety of tiny, special instruments.] In a free muscle-sparing TRAM flap, very little muscle is removed, and in DIEP flap no muscle is spared at all.

Aside from the abdomen, other areas that often have a lot of tissue are the thighs and the buttocks. The TUG and DUG flaps utilize skin, fat, and a small piece of muscle from the thigh to reconstruct the breast. The gluteus flap utilizes the buttock as a source of skin and fat for breast reconstruction.

What are the benefits of using your own tissue for breast reconstruction?
Using your own tissue makes for the most natural-feeling breast. So if you want a larger, softer breast, a flap is a very good choice. Additionally, it usually provides the best match with a contralateral natural breast if you are undergoing a unilateral mastectomy. With flaps, the newly reconstructed breasts tend to age the same way as a natural breast. You have to have enough tissue available to donate, whether it’s from your abdomen, thigh, or buttock. For women who are too thin, implants can be a great alternative.

What are the risks or downsides to flap surgery?
It takes longer — doing a flap will often add three to six hours to a mastectomy, whereas a tissue expander usually adds only about 45 minutes. The main downside of doing a flap is the potential impact it has on the area you’re taking the tissue from. If muscle is removed, you risk a weakening of the abdomen.

What factors might prohibit reconstructive breast surgery?
As a general rule, we at MSK like to consider all patients as potential candidates for breast reconstruction surgery. The ones who aren’t candidates tend to be patients with very advanced disease or those with other serious health conditions.

We generally recommend reconstruction at the time of mastectomy, unless there are some special circumstances. This allows us to use a lot of the natural breast skin during reconstruction and allows women to get back to their normal life as quickly as possible. That said, we see patients at all stages, including women who have had a mastectomy without reconstruction or who underwent mastectomy at other hospitals and are now reconsidering their original decision not to have reconstruction.

Additionally, if you have had a mastectomy without reconstruction and radiation, an implant reconstruction may no longer be a good choice for you. Your surgeon will go over all options and help you decide what is best.

breast reconstruction surgery after mastectomy

Following a mastectomy, a process called breast reconstruction surgery is used to restore the breast’s natural structure and look. It is an option for women who have had a mastectomy and want to improve their body image while restoring the shape of their breasts. Breast reconstruction can be done right away (immediate reconstruction) or later (delayed reconstruction) following a mastectomy. An summary of breast reconstruction surgery following mastectomy is provided here:

The timing of breast reconstruction depends on whether it will be done concurrently with the mastectomy (immediate reconstruction) or separately (delayed reconstruction) after the mastectomy site has healed. The time is influenced by a number of variables, including as the kind and stage of the breast cancer, the requirement for radiation treatment, and personal preferences.

Reconstruction Methods: There are several breast reconstruction methods, and the choice is made based on a variety of criteria, including body type, cancer treatment regimen, and personal preferences. Autologous tissue reconstruction and implant-based reconstruction are the two basic kinds of breast reconstruction.

Breast implants are used in the implant-based reconstruction method to restore the breast mound. Either behind the residual breast tissue or immediately below the chest muscles, saline or silicone implants are inserted. The size, shape, and location of the implant are chosen depending on the patient’s needs and the intended result.

b. Autologous Tissue Reconstruction: This technique reconstructs the breast using the patient’s own tissue, often obtained from the back, buttocks, or belly (latissimus dorsi flap, SGAP or DIEP flap). To generate a new breast mound, the tissue is surgically transplanted to the chest. While requiring more extensive surgery and a longer recovery period, this procedure frequently results in a more natural-looking and feeling appearance.

Nipple and Areola restoration: To restore a more natural appearance, nipple and areola restoration can be done after the breast mound is made. Numerous methods, such as tattooing, nipple rebuilding utilizing local tissue, or a mix of the two, can be used for this.

Stages of Breast Reconstruction After Mastectomy

Breast reconstruction after mastectomy is a crucial step in the journey of breast cancer patients towards physical and emotional healing. There are several stages involved in the process of breast reconstruction, each with its own set of considerations and outcomes. Understanding these stages can help patients make informed decisions about their treatment options and expectations.

1. Immediate Reconstruction: Some patients may opt for immediate breast reconstruction, which is performed at the same time as the mastectomy. This approach can help preserve the natural shape of the breast and reduce the number of surgeries needed. Immediate reconstruction may involve the use of tissue expanders or implants to create a new breast mound.

2. Delayed Reconstruction: In some cases, patients may choose to delay breast reconstruction until after they have completed other treatments such as chemotherapy or radiation therapy. Delayed reconstruction allows the body to heal from the mastectomy and other treatments before undergoing additional surgery. This approach may involve the use of tissue flaps or implants to reconstruct the breast.

3. Tissue Expander Placement: For patients who choose to undergo reconstruction with implants, the first stage typically involves the placement of tissue expanders. These devices are inserted under the chest muscle and gradually filled with saline solution over several weeks to stretch the skin and muscle to accommodate the final implant.

4. Implant Exchange: Once the tissue expanders have achieved the desired size, they are removed and replaced with permanent silicone or saline implants. The size and shape of the implants are carefully chosen to match the patient’s natural breast and achieve a symmetrical appearance.

5. Nipple and Areola Reconstruction: The final stage of breast reconstruction involves the creation of a new nipple and areola. This can be done using skin grafts, tattooing, or a combination of both techniques. Nipple reconstruction helps to restore a natural-looking appearance to the breast and complete the overall reconstruction process.

| Stage of Breast Reconstruction | Description |
|—————————–|———————|
| Immediate Reconstruction | Reconstruction performed at the same time as mastectomy |
| Delayed Reconstruction | Reconstruction performed after completion of other treatments |
| Tissue Expander Placement | Placement of expanders to stretch skin and muscle |
| Implant Exchange | Replacement of expanders with permanent implants |
| Nipple and Areola Reconstruction | Creation of new nipple and areola for a natural appearance |

Follow-Up operations: Additional operations can be necessary, depending on the reconstruction method used and the specifics of each case. Adjustments to establish symmetry between the restored breast and the surviving breast, revision procedures to improve the shape, or tattooing to match colors are a few examples of these.

The procedure of breast reconstruction is intricate and unique for each patient, with careful attention and cooperation between the patient, the breast surgeon, and the plastic surgeon. Understanding the various alternatives, possible risks, advantages, and expected outcomes of breast reconstruction requires in-depth conversation with your healthcare team. They may offer you individualized advice based on your particular circumstances and assist you in selecting the best course of action.

Following a mastectomy, breast reconstruction can provide considerable physical and psychological advantages for women, restoring their sense of self-worth and wholeness. It’s crucial to have reasonable expectations and realize that a breast reconstruction may not provide outcomes that are exactly like a natural breast. However, a lot of women discover that their path to both physical and emotional recovery depends greatly on breast reconstruction.

Conclusion

Overall, the stages of breast reconstruction after mastectomy are designed to help patients regain a sense of normalcy and confidence in their bodies after cancer treatment. By working closely with their healthcare team and understanding the options available, patients can make informed decisions about their reconstruction journey. It is important for patients to discuss their goals and expectations with their plastic surgeon to ensure that the chosen reconstruction method aligns with their desired outcomes.

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