PROCEDURE & RECOVERY


CONSULTATION

It's recommended that you start discussing your reconstruction options with your surgeon at the onset of your treatment for breast cancer. The type of reconstruction, timing, and use of tissue expanders are all variable, and exploring your options early on with your surgeon will help you make the best choice.


COST

Post-mastectomy breast reconstruction is covered by provincial health plans in Canada.


TIMING OF SURGERY

Reconstruction can be performed at the time of your mastectomy or at a later date – both with their advantages and disadvantages.

IMMEDIATE RECONSTRUCTION

The advantage to an immediate reconstruction is the need for only one operation for both the breast cancer surgery and the reconstruction. It’s a longer operation but it also avoids the experience of having one or no breasts (if the mastectomy was performed on both breasts).

DELAYED RECONSTRUCTION

Delaying your reconstruction surgery will allow you to work on your recovery in two phases. You can take the time after your breast cancer surgery to recover and concentrate on follow-up treatment that may be required, like radio and chemotherapy. However, choosing a delayed reconstruction surgery will mean you will have to wait for the restoration of your body contours, a process that may take months.


RECONSTRUCTION OPTIONS

Breast reconstruction can be done with a breast implant or your own tissue, or by a combination of the two. Your surgeon will help you choose the best option based on your specific needs.

WITH YOUR OWN TISSUE (AUTOLOGUS)

The surgeon may use your own fat, skin, and muscle tissue, usually from your back or abdomen, to reconstruct your breast.

WITH A BREAST IMPLANT (ALLOPLASTIC)

A breast implant can be placed under the chest muscles to create a cover for the implant. In some cases, an inflatable expander is necessary to stretch the skin before placement of the final implant in order to recreate a natural-looking breast.

WITH YOUR OWN TISSUE AND A BREAST IMPLANT

In some cases, a combination of both techniques may be recommended. For instance, if you have a slim build and large breasts, the reconstruction may require both an implant and your own tissue to be most successful.


ASK THE RIGHT QUESTIONS

Asking your surgeon the right questions and sharing any concerns you may have are important steps in getting the individual results that are right for you, and helping return your body to its natural shape.

Please consider the following important questions for discussions at your next consultation:


Q:
WHAT BREAST RECONSTRUCTION OPTIONS DO I HAVE?

Q:
WHAT ARE THE RISKS AND/OR COMMON SIDE EFFECTS?

Q:
HOW SHOULD I PREPARE FOR THE SURGERY RECOVERY?

Q:
HOW MUCH TIME IS NEEDED FOR THE RECOVERY PROCESS AND WHEN CAN I RESUME MY REGULAR DAILY ACTIVITIES?

Q:
WHAT HAPPENS IF THE CANCER RETURNS OR DEVELOPS IN THE OTHER BREAST?

ONE-STAGE VS. TWO-STAGE RECONSTRUCTION

ONE-STAGE RECONSTRUCTION

Sometimes the breast cancer surgery and breast implant surgery can both be carried out in one procedure. Not everyone will be an appropriate candidate for this type of surgery, and it should be discussed with your surgeon.

TWO-STAGE RECONSTRUCTION WITH A TISSUE EXPANDER

A tissue expander stretches out the skin and tissue to accommodate the breast implant. An inflatable silicone balloon-type device is inserted into the chest and gradually filled with a saline to stretch the skin, similar to abdominal skin during pregnancy. This creates the room needed for the permanent implant to be inserted later.

Cross Section diagram of removed breast tissue

SIDE VIEW

SIDE VIEW WITH BREAST TISSUE REMOVED

Cross Section diagram of tissue expander

SIDE VIEW

SIDE VIEW WITH THE EXPANSION OF THE SKIN USING A TISSUE EXPANDER

DURING EXPANSION
 
 

Diagram of options for insertion of a tissue expander

FIRST STAGE –
INSERTION OF THE TISSUE EXPANDER

The expander is inserted behind the greater pectoralis muscle and is then regularly filled with a saline solution through a valve. Some patients may experience a slight feeling of tightness in the breast, but usually this quickly passes, and the skin gradually stretches over time.

RESULTS WITH FINAL IMPLANT
BEFORE NIPPLE AND
AREOLA RECONSTRUCTION

Diagram of implant inserted after use of tissue expander

SECOND STAGE –
INSERTION OF IMPLANT

The permanent implant can replace the expander after the skin has expanded an ideal amount, usually 3 to 6 months after the first operation. The procedure involves creating a pocket for the implant, either partially under the pectoralis major muscle (submuscular) or on top of the muscle and under the glands (subglandular).

An expandable breast implant, which combines the functions of both the expander and the breast implant, may be available. This implant is composed of two parts – a pocket of saline solution and a portion of silicone gel – and will act as both the expander and the permanent implant. The right breast size can be achieved by the addition of the saline solution, and the implant does not need to be removed.

NIPPLE AND AREOLA RECONSTRUCTION

If the nipple was also removed, an additional nipple and areola reconstruction can be performed after the initial breast reconstruction surgery. The nipple can be reconstructed in a number of ways, including raising the skin of the reconstructed breast, using skin or cartilage from other parts of the body, or even tattooing. In each case, the operation is minor and relatively painless. It’s important to know that reconstructed nipples usually have no sensation.

POST SURGERY AND RECOVERY

Your experience during recovery is directly affected by what happens during your surgery. Shorter recovery times are now more common, thanks to advances in surgical techniques. During the immediate healing process (up to 3 months), it is generally recommended that you wear a post-operative surgical bra or breast binder to help stabilize the implants. Additionally you will be required to refrain from vigorous exercise or other activities. For more information on what you can expect during and after surgery, speak with your surgeon.

Lee with NATRELLE® breast implants