Breast Augmentation/Reconstruction

Breast Reconstruction with Implants

Breast Reconstruction with Implants

Your surgeon can help you decide whether you are able to have reconstructive surgery and what type is best for you. You will be advised to wait if now is not the best time for you. For instance, you may be advised to wait if you need radiation treatments after surgery. 

Cross section of breast showing tissue expander after mastectomy.Breast reconstruction can be done at the same time as the mastectomy procedure. Or it can be delayed until a later time. One kind of reconstruction is the breast implant. A breast implant is a fluid-filled shell inserted during surgery to reform the shape of the breast. Your healthcare provider will talk to you about different kinds of implants, how they work, what's done to check on the implants in the long term, and what you can expect with this surgery.

Inserting a tissue expander

Often the breast area is prepared for a breast implant with a tissue expander. This is an empty implant shell that is inserted during surgery. The tissue expander is slowly filled with fluid or air over several weeks. This is done to stretch the chest skin and muscle to make room for a breast implant.

The tissue expander can be put in through the same cut (incision) as the mastectomy. When the muscle and skin are stretched enough, the expander may be left in place. Or it may be replaced with an implant.

Placing the implant

Most breast implants are shells filled with fluid or gel. To insert the implant, a small incision is made, often through the mastectomy scar. The implant is placed under your chest muscle. Recovery may take 3 to 6 weeks. It may take many months before the bruising and swelling go away and you can see the final results. You may have more surgery later to create a nipple and an areola. Surgery may also be needed to match your remaining breast to the reconstructed one. Expect the reconstructed breast to be firmer than your normal breast.

Risks of breast implant

Any type of surgery has some risk. Some problems related to breast reconstruction with implants include:

  • Bleeding

  • Fluid collection in the surgical area (called a seroma)

  • Anesthesia problems (problems with the medicines used to do the surgery)

  • Bruising and swelling

  • Trouble healing

  • Implant problems

  • Infection

  • Muscle weakness

  • Scar tissue

The most common problem of breast reconstruction done with implants is called capsular contracture. This is when the scar or capsule around the implant begins to tighten. In some cases, this (and other) problems are severe enough to need a second operation.

Talk with your healthcare provider about what problems to look for and when to call them. Make sure you know what number to call with questions or problems, including after office hours, on weekends, and on holidays.

Women who smoke are at higher risk for problems after surgery. These include slow healing, more noticeable scars, and taking longer to recover. Talk with your healthcare provider and get help quitting before surgery.

Breast Reconstruction with Flap Procedures

Breast Reconstruction with Flap Procedures

A flap procedure uses your own tissue to form the shape of a breast. The 2 most common types of flap procedures are the TRAM flap and the LD flap.

These surgeries are named based on what part of the body the flap tissue is taken from. The surgeries are explained below. Less often, tissue may be moved to the chest from the buttocks or thigh. Flap reconstruction surgeries leave you with 2 surgical wounds: the chest and the site where tissue was removed. 

Your surgeon can help you decide whether to have reconstructive surgery and what type is best for you. You will be advised to wait if now is not the best time for you. For instance, you may be advised to wait if you need radiation to your chest after surgery.

Talk with your healthcare provider about what the surgery is like and what you can expect after surgery. Also be sure you know what your breast shape will look like and how the donor flap site might be affected.

Front view of female breasts and abdomen showing TRAM flap breast reconstruction.

Front view of female breasts and abdomen showing LD flap breast reconstruction.

 

TRAM flap

The TRAM (transverse rectus abdominis myocutaneous) flap uses stomach muscle, fat, and skin. A flap of skin and fat is removed from the lower part of the stomach. Then the flap may be tunneled under the skin from the stomach to the mastectomy site. Or it may be cut free and moved there. The flap is then formed into the shape of a breast. The new breast shape feels soft to the touch. This surgery also makes your belly flatter and tighter, as if you had a "tummy tuck" procedure.

LD flap

The LD (latissimus dorsi) flap uses muscle, fat, and skin from the upper back. The flap of skin and fat is removed from the side of the body, over the ribs. The latissimus dorsi muscle is left attached to the flap. Then the flap is tunneled under the skin to the mastectomy site. There it is formed into the shape of a breast. The new breast feels soft to the touch. In some cases, an implant is needed with this surgery. 

Risks of flap reconstruction

Any type of surgery carries some risk. Some problems related to breast reconstruction with a flap include: 

  • Bleeding

  • Fluid collection in either of the surgery areas (called a seroma)

  • Anesthesia problems (problems with the medicines used to do the surgery)

  • Bruising and swelling

  • Implant problems 

  • Infection

  • Muscle weakness

  • Scar tissue

  • Increased complications in smokers

  • Problems at the donor site, such as muscle weakness

Problems are more common in women who smoke. Don't smoke at least 3 to 4 weeks before and 1 to 2 weeks after your procedure. Smoking can interfere with the healing process. Ask your healthcare provider for help quitting.

Talk with your healthcare provider about what problems to look for and when to call them. Make sure you know what number to call with questions or problems, including after office hours, on weekends, and on holidays. 

Saint Luke’s Plastic Surgery Specialists

Our physicians are dedicated to offering exemplary cosmetic and reconstructive care customized to your needs. You can be assured our entire staff will provide you with outstanding service and medical treatment. We consider it a privilege to help you on this journey.