What is Delayed Breast Reconstruction?
Breast reconstruction is a surgery performed to restore the normal shape, size, symmetry, and appearance of one or both breasts after a mastectomy (surgical removal of one or both breasts to treat or prevent the spread of breast cancer). Breast reconstruction can be performed at different junctures, depending upon what works best for your case. Delayed breast reconstruction is a surgery that is performed many weeks, months, or years after a mastectomy. The decision to perform a reconstruction surgery immediately or at a later time may depend upon several factors, such as:
- Your medical condition
- Your breast cancer stage
- Your lifestyle and preference
- Additional treatment measures, such as chemotherapy or radiation required to treat breast cancer
Some surgeons recommend patients to hold off on surgery until after chemotherapy and radiation therapy are completed prior to having breast reconstruction as these therapies can cause the reconstructed breast to change in appearance, texture, colour, and to lose volume. Specifically, radiation therapy has been known to cause unpleasant changes to an implant reconstruction. Cancers that are greater than 5 centimetres in size and that have advanced to the lymph nodes are more likely to require radiation therapy post surgery. Research data also indicate that a reconstructed breast may hamper the efficiency of radiation therapy. Hence, in some cases, surgeons recommend delayed breast reconstruction so as to complete therapy before reconstruction.
Merits and Demerits of Delayed Breast Reconstruction
Some of the merits and demerits of delayed breast reconstruction include:
- Additional cancer therapy such as radiation therapy post mastectomy does not trigger any issues at the site of reconstruction
- Provides ample time for patients to consider various options of breast reconstruction
- Less ideal cosmetic results
- Mastectomy scar on the chest wall
- At times difficult to reconstruct after scar formation
- Need for supplementary surgery and recovery time
Methods of Breast Reconstruction
The 2 main methods of breast reconstruction include:
- Implant Reconstruction: Inserting an implant that is filled with silicone gel or saline (salt water) under the skin and muscle of the chest to create a new breast mound is the most commonly performed technique.
- Flap or Autologous Reconstruction: The patient’s own skin tissue taken from another section of the body, such as the stomach, thigh, or buttocks is used to create a new breast mound.
Preparation for Delayed Breast Reconstruction
In general, preparation for delayed breast reconstruction may involve the following:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to the procedure.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and a mammogram to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- Inform your doctor of any medications, vitamins, or supplements that you are taking.
- Refrain from taking any anti-inflammatory drugs, aspirin, or supplements, as they may increase the chance of bleeding.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You may be instructed to shower with an antibacterial soap the night prior to surgery.
- Refrain from smoking pre- and post-procedure for a specific period of time, as this may hamper proper healing and increase your chances of areolar or nipple damage, tissue necrosis, and other complications.
- You will be given an opportunity to analyze before and after surgery pictures of patients with similar desired breast shape and size.
- A written consent will be obtained from you after the procedure has been explained in detail.
Procedure Involved in Delayed Breast Reconstruction
Delayed breast reconstruction is usually performed under general anaesthesia either in an outpatient or hospital setting. The surgery may take a couple of hours or more based on the size and composition of the breasts.
In general, your surgeon will undertake the following steps:
- Use a marker to draw guidelines on the chest wall to carry out the incisions
- Make an incision accordingly around the previous surgery scar lines
- Develop a pocket above or under the chest wall muscle to insert an implant
- The implant is carefully inserted within the pocket to form a new breast mound
- The implant is then supported with a mesh, which acts as an internal bra to hold the device in place
- A drainage tube may be placed under each arm to drain excess fluid or blood
- Close the incisions with sutures and wrap the breasts with a waterproof dressing
Post-Procedure Care and Recovery
Most people can go home the next day after surgery if no complications are noted. The drains are usually removed in about a week or two from the surgery.
In general, postoperative care instructions and recovery involve the following:
- You may notice sensitivity, tenderness, swelling, and bruises over the reconstructed breast. Pain and anti-inflammatory medications are provided as needed.
- Your physician will also provide you with antibiotics to prevent the risk of infection.
- Refrain from any physical activity using your upper body for at least 2 to 4 weeks to promote healing.
- You will be able to have a shower from the first day after surgery. A waterproof dressing will protect your surgical site.
- Avoid heavy lifting or any strenuous activities as you recover.
- Your doctor will provide you with instructions on diet and wound care.
- You may need to take off from work for at least a week to facilitate recovery.
- You will be able to resume normal activities within a couple of weeks, but may have certain activity restrictions.
- A periodic follow-up will be scheduled to monitor your overall progress.
Benefits of Breast Reconstruction
Some of the benefits of breast reconstruction include:
- Improvement in self-image, self-esteem, and confidence
- Helps you appear more youthful with a firm and well-positioned breast
- Form-fitting clothes, sports bras, and swimsuits will feel and look better
Risks and Complications of Delayed Breast Reconstruction
Delayed breast reconstruction is a relatively safe procedure; however, as with any breast reconstruction surgery, some risks and complications may occur, such as:
- Poor healing of surgical cuts
- Infection at the surgery site
- Anaesthetic risks
- Blood clots
- Necrosis or tissue death
- Uneven breasts
- Accumulation of fluids in breast tissue
- Loss of sensation in the breasts or nipples
- Need for revision surgery