What is breast implant reconstruction?

Breast reconstruction is a type of surgery. It rebuilds your breast after you've had part or all of a breast removed. It is often done for people who have cancer. But people who have problems with breast development can also have this surgery. It usually takes more than one surgery to rebuild a breast.

The breast surgeon who does your mastectomy can refer you to a plastic surgeon with special training in breast reconstruction. You will meet with the plastic surgeon before your mastectomy to discuss the best procedure for you. The surgeon will be able to recommend the type of implant that will work best for your body type.

In this type of surgery, the doctor uses a device called an implant. The implant gives your breast its shape. The nipple and the darker area around it (areola) are usually created later.

Several types of implants are available. Some of the most common implants have a soft silicone shell filled with saline (salt water) or silicone gel. Silicone may create a more natural-looking breast, because its weight and texture is more like breast tissue.

In some cases, an implant is placed during the same surgery that removes the breast. In other cases, a tissue expander is inserted right after the breast is removed. The expander is used to stretch the skin to make room for the implant. This stretching happens over a period of months. Every 1 to 2 weeks, the expander is filled with a little more salt water or air. When the tissues have stretched enough so the implant will fit, your doctor will remove the expander and insert the implant.

You will probably be asleep during the surgery. And you may get a medicine that numbs the breast area. The doctor will try to make cuts in places on your body that won't be seen. These cuts are called incisions. Sometimes the doctor uses the same incisions that were used to remove the cancer. The incisions leave scars that fade with time.

After surgery, you will probably go home the same day or the next day. Many people can go back to work or their normal routine in 3 to 6 weeks. But it depends on the type of work you do.

Your new breast will look and feel different after surgery. With an implant, your breast will likely not have any feeling. Your new breast may be more firm, round, or flat than your other breast. It may also not look the same as the breast that was removed. Some people have surgery on the other breast to make them look as alike as possible.

If you aren't able to have a nipple-sparing mastectomy, you have options if you want your new breast to have a nipple and areola. You can have surgery to create a nipple out of tissue. A tattoo can add color to the raised nipple and create an areola. Another option is a tattoo of a nipple and areola that creates a 3-dimensional look. Or you may use a prosthetic nipple and areola that attaches temporarily to your breast.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• For about 6 weeks after surgery, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags, milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or anything that weighs more than 10 to 15 pounds. Do not lift anything over your head for 3 to 6 weeks.
• You may have pain for a few weeks after surgery. Support the area with your hands or a firm pillow when you bend, cough, or move.
• Ask your doctor when you can drive again.
• Ask your doctor when it is okay for you to have sex.
• You can take your first shower the day after the drain near your incision is removed. This is usually in about 1 week. Do not take a bath or soak in a hot tub for about 4 weeks.
• You will probably be able to go back to work or your normal routine in 3 to 6 weeks. This depends on the type of work you do and any further treatment.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
  If you were given medicine for nausea, take it as directed.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If your doctor gave you specific instructions on how to care for your incision, follow those instructions.
• You may be wearing a special bra that holds your bandages in place after the surgery. Your doctor will tell you when you can stop wearing the bra. Your doctor may want you to wear the bra at night as well as during the day for several weeks. Do not wear an underwire bra for 1 month.
• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing.
• You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage 1 to 2 times every day. Consider having someone help you with this.
• Keep the area clean and dry.

Drain care

• You may have one or more drains near your incision. Your doctor will tell you how to take care of them.

Exercise

• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia, constipation, and blood clots in your legs.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay. This includes housework, especially if you have to use the arm on the side of your surgery.
• Your doctor will tell you when to begin stretching exercises and normal activities.

Elevation

• Prop up the arm on the side of your surgery on a pillow when you sit or lie down. Try to keep your arm above the level of your heart. This will help reduce swelling.

Breast implants work best for women who have small breasts (A or B cup) or for women who have both breasts removed (bilateral mastectomy).

Compared to tissue flap surgery for breast reconstruction, breast implant requires a shorter surgery and has a quicker recovery time.

A breast implant will likely need to be replaced at some point. Some implants have lasted 20 to 30 years, but that is not common. This means that someday you will probably need to have surgery to replace the implant.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Many of the risks associated with breast reconstruction are the same as those with any surgery: infection, poor wound healing, bleeding, or a reaction to the anesthesia used in surgery.

Other risks from breast implants include:

• Capsular contracture. It occurs when scar tissue around the implant hardens and begins to squeeze the implant. Surgery may be needed to remove the scar tissue or replace the implant.
• Changes in the implant. Normal activity or an injury to the breast can damage the implant, causing it to leak, deflate, or rupture. Over time, the implant may harden, develop ripples, shift position, or change shape. Surgery may be needed to remove the implant and replace it if any of these changes occur.
• Results that don't look perfect.
• Uneven breasts. Breasts with implants don't sag with age like natural breasts. This could be a problem if you just have one breast implant.
• Silicone implants that leak. Silicone implants can leak inside the body without causing any symptoms.
• A small risk of getting cancer. Breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a serious cancer that develops near the implant and can lead to death. The risk of getting this cancer seems to be higher for breast implants with a textured surface than for implants with a smooth surface.

Some women are at higher risk for problems from surgery. This includes women who:

• Are obese.
• Have high blood pressure.
• Have diabetes.
• Smoke.
• Are in poor health.

When you wake up from surgery, you will have bandages over the surgery sites. You may wear a special bra that holds your bandages in place. You may have drainage tubes to collect fluid and keep it from building up around the surgery site.

If the implant was placed at the same time as your mastectomy, you may stay in the hospital for 2 or 3 days. If the implant is placed later, you will probably be able to go home the same day.

Most people have soreness, redness, and swelling in the breast after implant surgery. You may need pain medicine for a week or two. Your doctor will give you instructions on how to care for your incision. Your doctor may also prescribe antibiotics to help prevent infection.

You may be able to go back to work or your normal routine in 3 to 6 weeks or sooner. Most people need to avoid strenuous activity for several weeks.

Breast reconstruction is surgery to rebuild the shape of your breast after you've had part or all of your breast removed because of cancer. You may have had a tissue expander or an implant placed during the surgery. If an expander was placed, salt water (saline) or air was added to it to start stretching your skin.

Right after the surgery, you will probably feel weak, and you may feel pain for 2 to 3 weeks. You may have a pulling or stretching feeling in your breast area. You can expect to feel better and stronger each day, although you may need pain medicine for a week or two. You may get tired easily or have less energy than usual. This may last for several weeks after surgery.

You will likely have several drains near your incision. These help with healing. The drains will be removed when the fluid buildup slows. Drains are usually removed in the first few weeks after surgery.

Stitches usually are removed in 5 to 10 days.

If you had an expander placed, you will need to regularly see your doctor every couple of weeks. During these visits, more salt water will be added to the expander. Or if you have an expander that uses air, you may need to add air at home. After several months, this will stretch the skin enough to cover the implant.

Your new breast may feel firmer and look rounder or flatter than your other breast. The new breast may not have the same shape as your breast did before it was removed. Breast reconstruction with an implant won't restore normal feeling to your breast. It may take several months for your breast to heal.

Breast implant surgery can be done to restore the appearance of a breast after mastectomy. It may also be done for women who have problems with breast development.

Breast reconstruction may help a woman feel better about her appearance. Some women say it helps them feel better about their bodies, more alive, feminine, and sexual—and happier about life.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take 1 to 2 hours.