Reconstructive Surgery
Reconstructive Surgery

Side Effects
  The side effects may vary depending upon which technique is used for the breast reconstruction. The side effects range from swelling, pain, infection to breasts of different sizes, shapes, and nipples in different locations. Positive side effect of the abdominal flap is that the woman also experiences a "tummy tuck"
How You Can Help the Cancer Patient Before the Breast Reconstruction Surgery

  • Breast cancer survivors vary greatly in their desire for breast reconstruction. Many of the younger patients prefer to have reconstruction. Indian Health Service (IHS) contracted health services is unlikely to cover reconstruction and alternative sources of financial aid for such surgery need to be pursued- ideally by someone other than herself (to reduce the likelihood of her becoming overly stressed and concerned).

So the breast was removed and I had the immediate reconstruction following that, it was a very long surgery… It was eight hours under anesthesia, it was difficult. … but I am very happy with the results. Candi Miller (Haida)
… as we started with part of my reconstruction, it was incredible… I had an infection in my chest and it was making me heal deformed. And I had a staph infection that was just all over my chest from the mastectomy … it was just sucking my chest in and it made me feel really distorted… But they were still able to do the implants and that was fine. I questioned that, because … I feel bad that I have to ever question my identity as a woman and what it is that makes me feel like a woman shouldn't be on the outside, it should be on the inside. I did get the implants and I healed, it took along time but, uhm. I stayed in bed, I took care of myself. I had a lot of help… by this point … they were doing my surgeries in stages because they couldn't do it all at once. (The areola and nipple reconstruction) In some states, they don't think that's allowable, or necessary for a woman to have this finished. And I, I was so outraged, because (the State) declined me. They started my procedure and then they said that it wasn't necessary and that I wouldn't be able to be finished. And I couldn't believe this. I was so outraged, but I wasn't going to give up. I mean … the government …(was) … deciding what's right for me. And I sent them my pictures, and I called, and I'm like "This is crazy… I'm a thirty-two year old woman. How can you tell me that this isn't necessary? This is necessary." And it was a matter of communicating and not giving up hope. Alisa Gilbert (Tewa Pueblo)

  • Be available to discuss her thoughts about reconstruction and how it may or may not affect your personal or intimate relationship.

Questions to Ask Your Plastic Surgeon Before You Have Breast Reconstruction

  • What are the different choices of reconstruction surgery? What type do you think is best for me? Why?
  • Should I have the reconstruction at the time of my mastectomy or should I wait until later? How much later can I have it done? If I need to have chemotherapy, should I wait until I have finished that treatment?
  • What are the advantages and disadvantages of having reconstruction at the time of my mastectomy? Of waiting to have it until later?
  • What are the side effects and risks that I should consider?
  • Will you be using tissue expanders? A saline-filled implant? Can you use my own tissue?
  • Will you explain how the surgery will be done? What kind of anesthesia will you use?
  • What will I look like after the surgery? What kind of scars will I have and where will they be?
  • What will my new breasts look like? Will it match my other breast? Will it change over time? Will I have to have anything done to my other breast?
  • Can I have my nipple reconstructed? How will it be done?
  • What is your experience with this operation?
  • Do you have any before-and-after pictures you can show me?
  • May I talk with someone who has had the operation?
  • How many operations will I have to have? Will I need to be in the hospital each time? For how long? How long will I need for recovery?
  • Will I be in much pain?
  • Will I need to wear a special bra after my operation?
  • How much will it cost? Will my insurance cover any part of it?
  • What can be done if the surgery is not successful?

(Printed with permission, Morra and Potts, Choices, Avon Books, 1994, p. 330.)

Operation Choices for Breast Reconstruction

Expander Can be of several types. Empty silicone sack or double envelope with silicone layer and empty sack implanted under skin and muscle, gradually filled with saline (saltwater) solution through a valve over a period of weeks, stretching skin. Local or general anesthesia. Inpatient or outpatient. Surgery takes 1 to 2 hours.

Most common type of reconstruction. Provides greatest flexibility in breast size. Requires additional office visits (15 to 30 minutes) to add saltwater solution to stretch skin. May be uncomfortable for some women. Can have problems with valve. Another operation often needed to convert expander to permanent implant.

Implant, also called fixed-volume implant Sack, filled with silicone gel or saline fluid, implanted under the skin and chest muscle. General or local anesthesia used. Can be outpatient or inpatient. Surgery takes 1 to 2 hours. Short recovery time. Low rate of complications. Implants filled with silicone gel can be used only if a woman is enrolled in a clinical trial. Saline filled have silicone layer or envelope that contains filling.

Latissimus flap, also called back flap. Muscle called latissimus dorsi, and eye-shaped wedge of skin moved from back to chest wall and sewn in place, leaving tissue attached to original blood supply. Inpatient with general anesthesia. Surgery takes 2 to 4 hours. May need blood transfusion. Major surgery that can be painful. Need to stay in hospital 3 to 6 days. Scar left on back or side. May have drain in for several weeks. May have fluid buildup in back area. May have slight bulge under arm that will shrink in time.

TRAM flap (transverse rectus abdominous myocutaneous), also called tummy tuck. Fat, skin and muscle taken from stomach area and moved up to form breast. Tissue usually remains connected to abdominal blood supply, although in some cases microsurgery used. Inpatient, with general anesthesia. Surgery takes 3 to 5 hours, with general anesthesia. Surgery takes 3 to 8 hours. May need blood transfusion. Major surgery that can be painful. Hospital stay of several days. Recovery period may take several weeks, including inability of patient to stand straight for days or even weeks. Healing problems may occur, including thick tissue on flap. Scar in abdominal area.

Microsurgery, also called free flap. Muscle and fat from other parts of body, such as buttock or thigh, are cut free from blood supply, moved to breast and reattached to breast blood supply by microsurgery. Inpatient with general anesthesia. Surgery takes 3 to 8 hours. May need blood transfusion. Major surgery that can be painful. Hospital stay of several days. Recovery period may take several weeks, including inability of patient to stand straight for days or even weeks. Healing problems may occur, including thick tissue on flap. Scar in abdominal area.

Nipple Can be made from existing skin, pinched and tacked to make nipple, or created from tissue from other nipple or groin and attache to breast mound. Areola reconstruction may also be done. May need tattoo to match color of other breast. If created from other nipple or groin, that area will feel tender for about 2 weeks.

(Printed with permission, Morra and Potts, Choices, Avon Books, 1994, p. 357.)


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