Breast Reconstruction

Breast Reconstruction

Breast cancer is one of the commonest cancers among women. Early diagnosis and modern treatment modalities offer an excellent prognosis to many patients. However, treatment involves resection of the breast tumour by lumpectomy or mastectomy, which results in altered anatomy and body image. Breast reconstruction is available to restore the shape and appearance of the breast.

There are two types of breast reconstruction: breast reconstruction using implant and breast reconstruction using the patient’s tissue (flap).

1. Implant reconstruction: Implant can be either be placed immediately following mastectomy or at a later date as a delayed reconstruction after the patient has completed radiation therapy, chemotherapy, and other targeted therapies. Implant reconstruction is usually done in 2 stages. At the first stage, a breast tissue expander is placed under the chest muscle. Over the coming weeks, the expander is gradually inflated with saline. Inflation of the expander will expand the chest’s skin, creating enough space and skin cover for placement of permanent breast implant at the second stage.

2. Flap reconstruction: Breast reconstruction using the patient’s tissue. The tissue is harvested in the form of a flap, usually from either the tummy or the back. Flap reconstruction is preferable in cases where patients prefer to use their body tissue or in cases where the chest condition is not suitable for implant reconstruction. Flap reconstruction usually is done immediately after the mastectomy, although there are cases done later as a separate surgery.

Preparation (for delayed implant reconstruction)

1. Inform the doctor of any pre-existing medical conditions and drug allergy. All medical conditions must be treated and stabilized before surgery.

2. Stop smoking at least one week before surgery. Smoking negatively affects wound healing and increases risks of other post-operation complications.

3. Stop the following medications and supplements from one week before surgery until one week after surgery.

   1. All supplements containing vitamin E, ginseng, ginkgo, garlic, fish oil, and other ingredients that increase bleeding during the procedure. Other supplements, traditional medicine, and herbs, in which ingredients are unknown, have to stop as well.

   2. Medicine that increases bleeding during the procedure such as aspirin, NSAIDs, and warfarin. However, you may need to consult your physician who prescribed the medication before you stop them.

4. On the day of surgery, wear simple and comfortable clothing. Do not wear any jewelry and metal objects on the face and body.

Surgery (delayed implant reconstruction)

Duration: 1-2 hours

Anaesthesia: General Anaesthesia

Hospitalization: Half a day (daycare)

Recovery*: Back to work in 3-7 days, light exercise after one weeks, heavy exercise after 4 weeks. *The speed of recovery and duration of rest may vary from person to person.

Technique: During the first stage, a tissue expander is inserted through the previous mastectomy incision. After that, the expander is gradually inflated over the coming weeks. Once the desired size has been achieved, the expander is taken out and replaced with a permanent breast implant. Some expander can function as a permanent implant after full inflation. In such cases, after the completion of the inflation process, the expander remains inside the chest to function as a permanent implant.

Post-operative Care**

1. What to expect: Swelling usually peaks on the second to third day after surgery and gradually subsides after that. Tight sensation in the chest may be present for one to 2 weeks especially if a large implant is used.

2. Wear a supportive bra for at least one month

3. General care :

   1. Avoid smoking for at least one month. Smoking increases the risk of wound complications.

   2. Sleep on the back. Avoid sleeping on one side to prevent pressure on the breasts.

   3. Adequate rest and sleep are helpful for a speedy recovery.

   4. Be relaxed and calm. Contact the clinic if there are any queries.

4. Medicine: Finish the oral antibiotics as prescribed. Take the painkiller as prescribed when necessary.

5. Wound care: Clean the wound with a clean cotton tip with sterile water/saline and apply antibiotic ointment after that.

6. Physical activity: Avoid heavy physical activity and exercise for at least one month.

7. Follow-up: Come back one week after surgery for suture removal and review.

8. Emergency: If there is heavy bleeding, a rapid increase in swelling or severe pain, immediately contact the clinic/doctor for advice.

** The instructions in this list are only for general guidance. If you have any specific queries or concerns during the post-operative recovery, please contact the clinic for further advice.

Breast cancer is one of the commonest cancers among women. Early diagnosis and modern treatment modalities offer an excellent prognosis to many patients. However, treatment involves resection of the breast tumour by lumpectomy or mastectomy, which results in altered anatomy and body image. Breast reconstruction is available to restore the shape and appearance of the breast.

There are two types of breast reconstruction: breast reconstruction using implant and breast reconstruction using the patient’s tissue (flap).

1. Implant reconstruction: Implant can be either be placed immediately following mastectomy or at a later date as a delayed reconstruction after the patient has completed radiation therapy, chemotherapy, and other targeted therapies. Implant reconstruction is usually done in 2 stages. At the first stage, a breast tissue expander is placed under the chest muscle. Over the coming weeks, the expander is gradually inflated with saline. Inflation of the expander will expand the chest’s skin, creating enough space and skin cover for placement of permanent breast implant at the second stage.
2. Flap reconstruction: Breast reconstruction using the patient’s tissue. The tissue is harvested in the form of a flap, usually from either the tummy or the back. Flap reconstruction is preferable in cases where patients prefer to use their body tissue or in cases where the chest condition is not suitable for implant reconstruction. Flap reconstruction usually is done immediately after the mastectomy, although there are cases done later as a separate surgery.

Preparation (for delayed implant reconstruction)

1. Inform the doctor of any pre-existing medical conditions and drug allergy. All medical conditions must be treated and stabilized before surgery.

2. Stop smoking at least one week before surgery. Smoking negatively affects wound healing and increases risks of other post-operation complications.

3. Stop the following medications and supplements from one week before surgery until one week after surgery.

   1. All supplements containing vitamin E, ginseng, ginkgo, garlic, fish oil, and other ingredients that increase bleeding during the procedure. Other supplements, traditional medicine, and herbs, in which ingredients are unknown, have to stop as well.

   2. Medicine that increases bleeding during the procedure such as aspirin, NSAIDs, and warfarin. However, you may need to consult your physician who prescribed the medication before you stop them.

4. On the day of surgery, wear simple and comfortable clothing. Do not wear any jewelry and metal objects on the face and body.

Surgery (delayed implant reconstruction)

Duration: 1-2 hours

Anaesthesia: General Anaesthesia

Hospitalization: Half a day (daycare)

Recovery*: Back to work in 3-7 days, light exercise after one weeks, heavy exercise after 4 weeks. *The speed of recovery and duration of rest may vary from person to person.

Technique: During the first stage, a tissue expander is inserted through the previous mastectomy incision. After that, the expander is gradually inflated over the coming weeks. Once the desired size has been achieved, the expander is taken out and replaced with a permanent breast implant. Some expander can function as a permanent implant after full inflation. In such cases, after the completion of the inflation process, the expander remains inside the chest to function as a permanent implant.

Post-operative Care**

1. What to expect: Swelling usually peaks on the second to third day after surgery and gradually subsides after that. Tight sensation in the chest may be present for one to 2 weeks especially if a large implant is used.

2. Wear a supportive bra for at least one month

3. General care :

   1. Avoid smoking for at least one month. Smoking increases the risk of wound complications.

   2. Sleep on the back. Avoid sleeping on one side to prevent pressure on the breasts.

   3. Adequate rest and sleep are helpful for a speedy recovery.

   4. Be relaxed and calm. Contact the clinic if there are any queries.

4. Medicine: Finish the oral antibiotics as prescribed. Take the painkiller as prescribed when necessary.

5. Wound care: Clean the wound with a clean cotton tip with sterile water/saline and apply antibiotic ointment after that.

6. Physical activity: Avoid heavy physical activity and exercise for at least one month.

7. Follow-up: Come back one week after surgery for suture removal and review.

8. Emergency: If there is heavy bleeding, a rapid increase in swelling or severe pain, immediately contact the clinic/doctor for advice.

** The instructions in this list are only for general guidance. If you have any specific queries or concerns during the post-operative recovery, please contact the clinic for further advice.