Breast Augmentation After Mastectomy
Breast cancer is one of the most common cancers among women. One treatment for breast cancer is mastectomy, which removes the breast tissue and may involve other nearby organs. During this procedure, a woman loses a significant number of breast tissues that can cause her to lose volume and shape in her breasts. However, it is possible to restore a natural-looking breast by using an implant.
In this guide, we review the aspects of Breast Augmentation After Mastectomy, stages of breast reconstruction after mastectomy, immediate breast reconstruction after mastectomy for cancer, and problems with breast implants after mastectomy.
Breast Augmentation After Mastectomy
Breast reconstruction after a mastectomy is a personal decision. Many women opt to have breast augmentation after mastectomy, but not all of them do. In this article, we’ll discuss why people choose to have breast augmentation after a mastectomy and the benefits and risks of having this procedure performed.
Why do women opt for breast augmentation after mastectomy?
Women with a mastectomy may want to look more like the natural self they remember, or they may be looking for a solution that will make them feel more confident and less self-conscious.
If you’re considering breast augmentation after mastectomy, it’s important to talk with your doctor about what you hope to achieve from this procedure. Your surgeon can help guide you toward a plan of action based on the goals you have for surgery.
What is the procedure like?
The procedure is performed under general anesthesia, which means you will be asleep and pain-free during the operation. A small incision is made in the crease of the breast, and an implant is inserted through this opening. If a breast prosthesis was not used during reconstruction surgery, another small incision may be necessary to place it behind your pectoral muscle (chest). The incision lines are then closed with stitches or surgical staples.
What is the recovery like?
The recovery process is different for each patient. It depends on the type of surgery you undergo, your overall health and how well you follow your doctor’s instructions.
Many women who have had a mastectomy can get back to their normal routines in about two weeks or less. This may include taking care of themselves without help from others, returning to work and resuming physical activities that were interrupted by surgery. After one month, most women report feeling like themselves again.
However, it’s important to remember that everyone heals differently — you may find yourself with more pain or fatigue than other people who have undergone the same procedure as you did. That doesn’t mean there’s anything wrong with your surgical result; it just means that additional time is needed for healing before returning fully to normal activities and responsibilities at home or at work.
How long will the results last?
Though you can expect your results to last for several years, the longevity of your breast augmentation results depends on a number of factors. These include:
- The type of implant used
- How well you take care of your body and maintain the appearance of your skin (through exercise, diet, etc.)
- The technique that was used during surgery
It’s important to note that this method isn’t guaranteed to work indefinitely; some women may require additional surgeries over time. However, if you want to maximize the life span of your implants and keep them looking as good as possible for as long as possible, it’s important that you take care of yourself after surgery. It’s also important not to abuse alcohol or drugs while recovering from breast augmentation surgery; both substances have been shown in studies at increasing risk levels for developing capsular contracture (CC), which causes scar tissue around the implant surface area.
Is it safe to get breast implants after a mastectomy?
Yes! Reconstructive surgery is a safe and effective option for women who have had a mastectomy, as it can improve the quality of life and self-esteem. Reconstructive surgery may also improve body image, sexual function, and overall quality of life.
In addition to breast reconstruction and nipple reconstruction (if necessary), some women choose to undergo liposuction on their abdomen or thighs after undergoing a mastectomy in order to remove excess fat deposits that were left behind by the surgical procedure.
How much does breast augmentation after mastectomy cost in Atlanta and Sandy Springs, GA?
The cost of breast augmentation after mastectomy can vary depending on the type of implant used, the procedure performed and whether you have insurance. The average price for breast augmentation with implants is $4,871 in Atlanta and Sandy Springs, GA. In general, full coverage plans will pay a large portion of this cost while patients who don’t have full coverage often pay out-of-pocket for their medical bills.
Full Coverage Plans
If you have a full coverage plan through a major company like Blue Cross Blue Shield or Aetna, your insurance should cover most if not all of your costs associated with surgery. You may still have to pay some co-pays and deductibles but it’s likely that these amounts will be small since most major companies cover up to 80% of the total cost (if not more). If you don’t know what your current deductible is or if you want to check into other options before proceeding with surgery then please contact us today so we can go over your options together!
Breast reconstruction is an important step for some women after a mastectomy.
Breast reconstruction can help you feel more like yourself. Breast cancer survivors may have undergone a mastectomy, but they don’t have to lose their breasts. Breast reconstruction is an important step for some women after a mastectomy. It can help make them feel better about themselves and lead healthier lives.
- Many women who undergo breast-conserving surgery (lumpectomy) or partial mastectomy may choose to have breast reconstruction at the same time.*
- Women who have had a bilateral, or both breasts removed should wait at least three months before deciding whether to pursue reconstructive surgery.*
stages of breast reconstruction after mastectomy
With a few exceptions, regardless of the type of reconstruction selected, two surgical procedures or “stages” will likely be needed to complete your full breast reconstruction. In some cases, however, you may be able to have the reconstructive process completed in a single operation.
Surgery may include nipple reconstruction as well as a procedure on the unaffected breast to produce symmetry. While the majority of women prefer to have nipples reconstructed as this minor procedure greatly enhances the aesthetic results and the natural appearance of their reconstructed breast, not all women choose to do so.
Our practice offers breast reconstruction surgery in Connecticut and New York City. If you live outside of these areas, you can comfortably return home between stages of treatment.
PROCEDURE-SPECIFIC TIMELINES
Below, you will find timelines that are typical for each type of breast reconstruction that the surgeons of the Advanced Reconstructive Surgery Group offer. Depending on individual patient circumstances, the time course to complete reconstruction may vary.
MICROSURGICAL PERFORATOR FLAP BREAST RECONSTRUCTION:
STAGE I: Creating a Breast with Natural Tissue
At the first stage of natural-tissue breast reconstruction, transferring borrowed tissue to the mastectomy site restores a breast. The tissue is sculpted to restore the natural shape and form of the breast as closely as possible. Women who undergo this type of surgery generally stay three nights in the hospital for monitoring, but typically have minimal pain.
STAGE II: Refining Your Breast Reconstruction And Nipple Reconstruction
About three months or more after the first stage of reconstruction, a relatively short outpatient procedure can be done to refine the shape of your reconstructed breasts, and to reconstruct nipples, if that is part of the surgical plan. You’ll be able to go home the same day as this procedure and most women can return to work or other non-vigorous activities after only a few days. The shape of your reconstructed breasts will be carefully refined, as will the donor the donor site, to achieve the best possible aesthetic results. If you have had only one breast reconstructed, a breast lift, breast augmentation or breast reduction can be done on the unaffected breast at this time to improve symmetry.
To learn more about natural tissue reconstruction, click here
ONE-STAGE BREAST IMPLANT RECONSTRUCTION
Direct-to-Implant reconstructions, also called “One-Step Reconstructions,” or “One-Stage Reconstructions,” are generally our preferred, and our patients’ preferred approach to breast implant reconstruction. That’s because when it is possible to perform such procedures, at the same surgery, an implant can be placed directly in the space created by the mastectomy, and therefore there is no need to undergo tissue expansion. Furthermore, the potential for chronic problems—including discomfort, reduced strength, and reduced mobility—associated with lifting of the chest wall muscles in the more traditional tissue expander-implant approach, is dramatically reduced. Women who have a one-stage breast implant reconstruction generally go home the day after surgery.
To learn more about one-stage breast implant reconstruction, click here
TISSUE EXPANDER/IMPLANT RECONSTRUCTION
STAGE I: Creating Space for a Breast Implant by Tissue Expansion
A tissue expander will be placed under the pectoralis muscle of the chest, typically at the time of a mastectomy. In the weeks following surgery, by injecting sterile fluid or air at a series of office visits, the expander will be gradually enlarged in order to expand the tissue at the mastectomy site to make room for an implant.
STAGE II: Replacing a Tissue Expander with a Breast Implant
Following completion of the expansion process, at a second surgery approximately 4-12 weeks following the initial procedure, the tissue expander is exchanged for a breast implant. A nipple reconstruction can sometimes be done at this stage, but often it is done during a short additional procedure. You’ll be able to go home the same day as this procedure and most women can return to work or other non-vigorous activities after only a few days. If you have had only one breast reconstructed, a breast lift, breast augmentation or breast reduction can be done on the unaffected breast at this time to improve symmetry.
immediate breast reconstruction after mastectomy for cancer
The decision to undergo breast reconstruction after a mastectomy is a personal one. Not all women are candidates for breast reconstructive surgery, and some choose not to pursue this option. For many women, however, restoring the appearance of one or both breasts may help improve their physical, emotional and social well-being.
It is important to recognize that breast reconstructive surgery is an elective process tailored to each patient’s needs and goals. While breast reconstruction in a single operation is possible for some women, the majority of women will require more than one procedure, typically over several months.
Patients may have many breast implant options, and each technique has a unique set of considerations. Recommendations are based on many factors, including the patient’s overall health status, breast size and shape (both natural and desired), as well as the specifics of her cancer, such as its type, size and location within the breast.
In most cases, the reconstructive process may begin at the time of mastectomy—a technique known as immediate reconstruction. However, the surgeon may not recommend immediate reconstruction for a number of reasons, such as when the patient is using nicotine products, has an advanced tumor or is morbidly obese. In these cases, or for any woman who has already had a mastectomy without reconstruction, delayed breast reconstruction is often a viable option.
Overview of breast reconstruction
The process of total breast reconstruction depends heavily on the type of mastectomy performed, as well as the additional therapies used to treat the cancer, such as chemotherapy and/or radiation therapy. The process may be different for women who choose to remove both breasts (bilateral mastectomy), compared to those who have just the affected breast removed (unilateral mastectomy).
During reconstruction, the surgeon creates a mound and a skin envelope to resemble a natural breast. This may require a staged approach involving two or three procedures. In most cases, the skin required for reconstruction is preserved at the time of mastectomy, and in many cases, the nipple and areola may also be preserved. Both the breast surgeon and reconstructive surgeon will evaluate and discuss each patient’s breast reconstruction options.
Breast reconstruction is divided into two general categories: implant-based reconstruction and autologous reconstruction, which uses the patient’s own tissue.
Immediate vs. delayed breast reconstruction
Breast reconstruction may be performed at the same time as a mastectomy, or it may be delayed for some time. When the procedure is done simultaneously with a mastectomy, it’s called immediate breast reconstruction. Breast reconstruction performed after a mastectomy or after treatment ends is called delayed breast reconstruction.
Most breast cancer patients who undergo a mastectomy may choose between immediate or delayed breast reconstruction.
Having immediate reconstruction may be preferable because it allows for two surgeries to be completed at once. Immediate reconstruction may also render more natural-looking results, as the skin of the breast may be more easily preserved. Those who are concerned about living for some time without breasts may also prefer this option.
However, delayed reconstruction may be the preferred option for patients who want to focus on treatment or need more time to decide. It may also be the safest option for some, particularly those who:
Such health conditions or treatments may delay or complicate the healing process. When the breast tissue doesn’t heal properly after reconstruction, recovery time may be longer, and scarring and infections may occur. Complications related to improper wound healing may require additional surgery.
People who smoke are often advised to delay breast reconstruction until they have abstained from smoking for at least two months. Likewise, those who require radiation therapy after surgery usually need to delay breast reconstruction, as radiation therapy increases the chances of scarring, improper healing and infections.
While delayed reconstruction may be the right option for some, the appearance of the reconstructed breast may not be as natural-looking afterward, as it would be following immediate reconstruction. When reconstruction is delayed, skin from another area of the body may be needed to cover the new breast, as less of the original skin may be preserved.
Patients shouldn’t hesitate to ask questions about breast reconstruction, including:
Implant-based reconstruction
This technique uses a silicone gel implant to create the breast mound. Saline implants may be an option, but they are not typically recommended, mostly because the newer generation of silicone gel implants offers a more natural look and feel. Multiple implant options are available to provide volume, shape and projection, allowing each patient to choose an option tailored specifically to her.
The surgeon may place the silicone gel implant at the time of the mastectomy in a process called direct-to-implant reconstruction. However, the process is typically completed in two operations, known as two-stage implant-based reconstruction. In the first stage, the surgeon places a temporary tissue expander after the breast tissue is removed, then gradually fills the expander over time to stretch or shape the skin envelope. In the second stage, the surgeon removes the tissue expander and inserts the more natural silicone gel implant into the skin envelope.
Traditional implant-based reconstruction involved placing the devices completely or partially beneath the chest muscle, in a process known as subpectoral reconstruction. In the majority of today’s cases, this is no longer necessary. Instead, a prepectoral reconstruction technique is used, leaving the muscles attached to the chest wall and placing the implant above them, similar to a natural breast. This procedure often reduces post-operative pain and recovery time, in addition to providing better aesthetic results.
Surgeons do not typically recommend implant-based reconstruction for women who have had, or who will require, radiation therapy as part of their treatment. Implant-based reconstruction operations do not take as long as autologous procedures, and recovery often takes two to three weeks. Implants come with a unique set of considerations and possible risks, and our reconstructive surgeons discuss these with each patient. Our surgeons also discuss how acellular dermal matrix, a biologic mesh often used to hold or support the implants, may play a role in the reconstruction.
Autologous reconstruction
Compared to implant-based reconstruction, autologous procedures typically require more time and a longer recovery period. However, because they take advantage of the patient’s own tissue, these techniques may yield more natural and longer-lasting results.
In these procedures, fat and skin may be transplanted from various areas of the patient’s body to create the reconstructed breast, with the area and method chosen depending on the amount and quality of tissue available. The tissue (called a flap) may be removed from the lower abdomen, back, buttock or inner thigh—areas generally referred to as donor sites.
Reconstructive microsurgical techniques are often used to improve the outcomes of autologous reconstruction procedures, creating natural-looking breasts while reducing damage to donor sites. Specially trained microsurgeons use these techniques to remove skin and fat, along with their blood supply (called a free flap), from the donor site. The surgeon then transplants the tissue to the chest, where it is connected to nearby blood vessels and shaped into a breast. This free flap process allows the surgeon flexibility in shaping the breast, and using the primary blood supply aids in the healing process. The procedure is also designed to decrease recovery time compared to other techniques that may cause more damage to the donor site.
Autologous breast reconstruction procedures include:
Deep inferior epigastric artery perforator (DIEP) flap: This reconstructive microsurgical procedure uses skin and fat of the lower abdomen, with its primary blood supply carefully removed from the rectus muscle beneath. Skin and fat may be taken from both sides of the lower abdomen to create two breasts if necessary or desired. The DIEP flap procedure has become the standard of care for autologous breast reconstruction using abdominal tissue, compared to the outdated TRAM flap procedure, which involves completely removing a muscle from the abdomen and inserting mesh. Some muscle weakness may result from DIEP flap reconstruction, but this side effect is uncommon.
“Stacked” DIEP flap reconstruction: In this procedure, reconstructive microsurgery techniques are used to transfer both sides of the lower abdomen to create a single breast, allowing women with limited donor tissue to take advantage of autologous reconstruction.
Superficial inferior epigastric artery (SIEA) flap: In this procedure, a free flap of skin and fat is harvested from the lower abdomen, but a different blood supply is used. This blood vessel is completely above the muscle and does not require manipulation of the muscle. Not all women have this blood supply; in many other cases, the blood supply is not sufficient. Because of the anatomy of this blood supply, many women who undergo reconstruction with a SIEA flap experience less post-operative pain than with a DIEP flap, without any risk of muscle weakness.
Medial thigh-based flaps (TUG, VUG, DUG, PAP): These procedures use the skin and fat from the inner thigh, along with blood vessels that may be removed from the muscles. In some cases, a small muscle from the inner thigh (the gracilis) may be removed with little to no impact on the leg’s muscle function. These procedures may be beneficial for women who are not candidates for the DIEP or SIEA flap.
Buttock-based flaps (SGAP and IGAP): These procedures use the skin and fat from either the upper or lower portion of the buttock, along with blood vessels that may be removed from the gluteal muscles. These techniques may also benefit women who are not candidates for the DIEP or SIEA flap.
Thoracodorsal artery perforator (TAP) flap: This procedure uses skin and fat from the upper back and a small portion of the latissimus dorsi muscle. The technique is not a free flap procedure and is usually used to reconstruct defects caused by a partial mastectomy. It also may be used in combination with an implant for total breast reconstruction, particularly for women who may not be candidates for any of the above-mentioned flaps.
Latissimus dorsi (LD) flap: The LD flap is similar to the TAP flap, in that it involves taking muscle, skin and fat from the upper back. One of the main differences is the LD flap transfers more muscle than the TAP flap.
The final stages of reconstruction
Your doctors may also recommend that some patients undergo additional techniques and procedures to complete the breast reconstruction process, including:
Symmetry procedures on the unaffected breast: Breast reconstruction is designed to create a breast with a more lifted, rejuvenated appearance. For women who undergo a unilateral mastectomy and reconstruction, standard procedures may be performed on the unaffected breast to improve symmetry. These may include a breast reduction, breast lift or breast augmentation. Discuss available options with your surgeon during an initial consultation.
Autologous fat grafting: This technique uses liposuction to carefully remove fat from one area of the body, then transfers it to the reconstructed breast, allowing the surgeon to fine-tune the breast’s volume and shape. Fat is a rich source of stem cells, which are critical to healing. In addition to improving breast shape and volume, transferring fat may help stimulate the formation of new blood vessels and improve skin texture.
Nipple reconstruction: For women who are not candidates for a nipple-preserving mastectomy, traditional nipple reconstruction may be performed using the skin of the reconstructed breast to create small flaps, which are shaped to resemble a nipple that projects from the breast. Once the nipple heals, tattooing may be used to create a more natural pigmentation.
3-D nipple tattoo: Instead of using tissue to build a nipple that projects from the reconstructed breast, some women choose to have a more detailed tattoo applied, using shading to create the illusion of a three-dimensional structure.
problems with breast implants after mastectomy
Breast reconstruction techniques have been improving for more than 20 years. There are fewer and fewer problems. But some women do have complications after surgery.
Problems immediately after surgery
Blood clots
After surgery, you’re at risk of blood clots developing in your legs. There is also a small risk of a blood clot in your lungs.
To prevent blood clots, your nurses get you up as soon as possible after your operation. They encourage you to move around or do your leg exercises.
To help reduce the risk of blood clots you may have injections to thin the blood (anticoagulants) before, during and after your surgery. Your surgeon will talk to you about this beforehand if you need to have this.
They may also tell you to stop taking particular medicines for a week or so before your surgery.
Also, during and after your operation, you wear special stockings (called anti embolism stockings or TEDS).
Tell your doctor straight away or go to A&E if you: • have a painful, red, swollen leg, which may feel warm to touch • are short of breath • have pain in your chest or upper back • cough up blood
Wound infection
Infection is a risk in any surgery. If you develop an infection after breast reconstruction, you will need to rest and take antibiotics. Usually, this clears up the infection over a week or so.
Symptoms of infection include:
• a temperature of above 37.5C or below 36C • redness around the breast • fluid seeping from the wound (discharge) • feeling cold or shivery • Feeling generally unwell
If you’ve had an implant reconstruction and the infection continues your surgeon may need to take the implant out. You may need to wait for about 3 months before having another implant.
A wound infection can be a major problem and can delay further treatment. Chemotherapy drugs will stop the natural healing process. You usually start chemotherapy when the infection has cleared up and the wound has completely healed.
Fluid under the wound (seroma)
After any surgery, it is normal for the area to produce fluid. You might have two or more drains into the wound to drain off the fluid. The drains are usually long thin tubes attached to vacuum bottles. Even if you have drains, fluid can sometimes collect under the wound and create a swelling. This is called a seroma. If blood collects, it is called a haematoma.
Sometimes the fluid will be reabsorbed by the body and the swelling will go down on its own. But if the fluid doesn’t go away after a few days, your surgeon or breast care nurse will remove it using a small needle and syringe.
If you’ve had an implant reconstruction and the fluid continues to build up, you might need to have the implant taken out and replaced with another one later.
Seroma used to be quite common after flap reconstruction from the back. But surgeons have improved techniques so that it is now much less likely.
Flap failure
The main problem with body tissue reconstruction is that the flap of tissue used to make the new breast might die. With a flap that stays connected to its original blood supply (a pedicled flap), this is much less likely.
Free TRAM flaps and DIEP flaps have to be disconnected and reconnected to a new blood supply. With these techniques, some people can develop problems with the flap blood supply in the first 48 hours after surgery. If this happens, you will need to go back to the operating theatre urgently to try to save the flap.
About 3 out of every 100 (about 3%) flaps fail completely and the cells in the whole flap die. If this happens, you will need to have surgery to remove the flap.
If your flap fails completely and is removed, you will need to recover fully from the operation. You usually have to wait about 6 to 12 months before you can try to have reconstruction again.
Loss of sensitivity
Your reconstructed breast will feel different to your other breast and have less sensation. After surgery, you might have numbness or pins and needles. The sensation may improve over time but for some people, it may not.
Longer term problems with implant reconstruction
There can be problems after implant surgery, whether you have tissue expansion or the implant put in directly.
Hardening and changing shape of the implant
The main long term problem after implant surgery is that a fibrous covering might form around the implant. Silicone is safe but it is still foreign to the body. It is a normal reaction for the body to form a fibrous capsule around it.
Over some years, the capsule can shrink and squeeze the implant. Doctors call this capsular contracture. It makes the breast painful and hard and changes its shape. If the shape changes a lot, the implant might need to be taken out and replaced.
Leakage of the implant fluid
Many women worry about the implant developing a leak. With newer types of implants, the risk is much less likely. But you could get leakage if you have some major injury or blow to the breast.
Minor bumps and bangs won’t cause a leak and nor will air travel. If the implant does leak, it can make the lymph glands under your arm swell up.
Do contact your doctor or breast care nurse if you notice a swelling or lump, if the breast is painful or the shape of the breast appears different. The implant will need to be removed and replaced if the implant has leaked.
Unequal breasts
Over time your reconstructed breast may no longer match the other one. This can happen if you lose weight or the implant moves. In this situation, you usually have surgery to try to get a better match. It’s not usually possible to make the breasts exactly the same on both sides. But your surgeon might be able to make them more equal.
You could have an operation on your other breast if your weight changes. Or the surgeon could replace the breast implant with a larger or smaller one.