Breast Reconstruction

What kind of outcome is typical for breast reconstruction?

The final results of breast reconstruction can help lessen the negative psychological and physical impacts of your breast cancer surgery, though reconstructed breasts shouldn’t be expected to look and feel like the breasts that were removed.

What are the alternatives to breast reconstruction?

Alternatives to breast reconstruction surgery include custom breast forms and off-the-shelf breast prosthetics, post-mastectomy bras, and other clothing. You can also choose to use no prosthetics at all.

What are the possible side effects of local anesthesia?

Some possible side effects of local anesthesia include nausea and vomiting, dizziness, headaches, blurred vision, twitching muscles, drop in blood pressure, continuing numbness, weakness, and tingling. 

What are the possible side effects of general anesthesia?

Some of the possible side effects of general anesthesia include nausea and vomiting, dry mouth, sore throat, muscle aches, headache, bruising (from the IV), itching, shivering and feeling cold, difficulty urinating, and sleepiness. In older patients, memory loss and temporary confusion are possible. 

What are possible side effects and complications of breast reconstruction?

Some of the possible side effects include infection; blood clots; bleeding; wound healing problems; problems associated with anesthesia; extreme tiredness; fluid build-up in the breast or the donor site; breast pain; changes in breast sensation; breasts that aren’t symmetrical; implant rupture or deflation; increased risk of revision surgery to replace or remove the implants; and the formation of scar tissue that affects the way your new breast looks. 

How safe is breast reconstruction surgery?

In general, severe complications from breast reconstruction are unlikely. But smoking can impede healing, so if you’re a smoker your surgeon might recommend that you stop, at least during the time of your procedure. You should also know that Hancock Regional Hospital has been rated one of the safest hospitals in America by The Leapfrog Group, a national nonprofit health care watchdog organization; and was named the safest hospital in Indiana on the Lown Institute Hospital Index.

How do I know breast reconstruction is right for me?

Breast reconstruction is a good choice if you’ve had surgery to treat breast cancer and want to permanently regain your breast shape. You should understand that a reconstructed breast won’t be exactly like the breast that was removed. 

Do I have options for anesthesia for breast reconstruction surgery?

Most people having breast reconstructive surgery use general anesthesia. With this option, you are asleep during the procedure. It can also be combined with local anesthesia to reduce pain.

Are there other procedures that are associated with breast reconstruction?

Two procedures you might want to know about as you consider breast reconstruction are listed below.

Nipple reconstruction and tattooing 

• As part of the reconstruction process, you can also choose to have your nipple reconstructed and tattooed to make the skin darker and more natural looking. Nipple reconstruction is usually an outpatient procedure that uses skin from your new breast to form the new nipple. If you decide to have your nipple reconstructed, get a tattoo, or both, this process is generally the last stage of breast reconstruction and can be done about four months after your breast reconstruction is complete.

Fat grafting 

• Following reconstruction, some women experience abnormalities in the shape of one or both breasts. When this happens, a fat grafting procedure, in which fat is obtained by liposuction and then injected into the breast, can be used.

What issue does breast reconstruction solve?

Breast reconstruction restores one or both breasts to near normal shape, appearance, symmetry, and size following mastectomy, lumpectomy, or other trauma. 

How is breast reconstruction done?

Breast reconstruction surgery can be achieved through a variety of different techniques that can begin when you have your mastectomy, or it can be scheduled at a later time. Breast reconstruction usually requires at least two procedures. The process you and your surgeon ultimately choose will be determined based on your body type, medical history, previous therapy and surgeries, and your discussions with your surgeon.

If You Choose Silicone Implants 

Breast reconstruction using implants involves surgically placing a breast-shaped silicone pouch— filled with either silicone gel or saline—into your chest following your mastectomy. If you choose silicone implants, your surgeon might recommend a process that involves a single surgery to place the implants at the same time your mastectomy is done. Another possibility is a two-stage process which begins with inserting a balloon-like tissue expander—which stretches the skin and soft tissue in the breast area, making room for the implant—into your chest for a few months and then replacing it with the breast implant in a future procedure. 

If You Want to Use Your Own Tissue

If you and your surgeon decide to use your own tissue for your breast reconstruction, your surgeon will relocate tissue from your abdomen, back, buttocks, or thigh areas to your chest to form your new breast. Depending upon the surgery that’s right for you, your surgeon might move the tissue by tunneling through your skin to the chest area, keeping it attached to its original blood supply. In other cases, your tissue will be relocated by detaching it from the donor area in your body and then reattaching it in your chest area, forming a new breast. If your tissue is detached, it will be reattached using a technique called microsurgery, when a microscope is used to connect the tiny vessels to a new blood supply.

Why might I have to wait to schedule breast reconstruction?

In some cases it takes time for a patient’s body to be ready for surgery—for example, if you have another medical issue including another surgical procedure or an illness, we might wait to schedule surgery. Your health and safety are our top priorities, so we schedule surgeries when they’re best for our patients. If you smoke, it may be necessary for you to stop smoking and wait for a period of time before your procedure, as smoking can impede the healing process.

Will the surgical team know my health history?

Your health history will be compiled and available to the team before, during, and after surgery. If you’re a Hancock Health patient, we will be able to access your records within our system. If you aren’t, we’ll work with your doctors to get the necessary information. 

How should I decide which surgeon’s advice to follow?

You should work with the surgeon with whom you feel comfortable, whether that’s one of our surgeons or not. 

Do I have to get a second or third opinion for breast reconstruction surgery?

You can always get a second or third opinion, but it isn’t required. 

What should I bring to my first appointment with a surgeon to talk about breast reconstruction?

• Insurance information
• Medical records, including your medical history, from your primary care physician, your oncologist, and the surgeon who is performing your mastectomy
• A list of your surgical goals 
• You should also be prepared for your surgeon to take photographs of your chest

Do I need a referral to see a surgeon about breast reconstruction surgery?

Your health insurance provider may require you to get a referral from your primary care provider to see a surgeon about a breast reconstruction surgery.

How long does it take the anesthesia to wear off?

It takes about an hour for general anesthesia to wear off, but you may notice the effects for a day or so. It usually takes 30 minutes to an hour for local anesthesia to wear off, but the effects can last longer. It takes several hours for intravenous sedation to wear off though the effects can last for 24 hours. 

What do I need to bring to the hospital the day of my breast reconstruction surgery?

Since you’ll be staying in the hospital for one to five days, depending upon your procedure, you’ll want to bring the things that will make you more comfortable including your robe and slippers. You’ll also want a pillow from home, entertainment and headphones, earplugs and an eye mask, glasses, face and body wipes, and a large T-shirt (to wear right after your procedure).

Why am I asked for my name and date of birth every time I get medicine?

It’s a safety precaution to make sure you’re receiving the medication that’s prescribed for you.

Why are there so many people on my surgery team?

In addition to the surgeon, you have an anesthesiologist, nurses—some of them specialize in working with patients and others assist the surgeon—and support staff, who will check you in and out, compile your records, and more. They all work together, performing their individual jobs, so your procedures are as successful as possible. 

Will I need someone to take me home after breast reconstruction surgery?

You will probably stay in the hospital for a few days. But when it’s time for you to go home, you will need someone to drive you. Since this is a safety procedure, we’ll help you arrange a ride home if you don’t have one.

What should I expect right before breast reconstruction surgery?

• You’ll arrive two to three hours before your surgery and be escorted to the preoperative waiting area.
• You’ll remove all of your clothing and jewelry, and put on a hospital gown. (Your valuables will be placed in a secure area or may be given to a family member.) 
• You’ll sign any necessary paperwork and a preoperative nurse will take your vital signs, review your medications, and answer any questions.
• You’ll meet your surgery team and they’ll mark the location for the breast reconstruction  on your body. 
• You’ll meet your anesthesiologist and the members of your surgery team. They will mark the location of your surgery on your body. 
• An I.V. (intravenous line) will be placed in your hand or arm, so medications—including general anesthesia—can be administered. If you’re using a different kind of anesthesia, you’ll receive an injection.
• When it’s time for your surgery, you will be wheeled into the operating suite on a stretcher.

Why can’t I eat before surgery?

There’s a risk of aspiration, which means breathing foreign objects, like food or saliva, into your lungs. This can occur because the anesthetic for surgery can impair your body’s ability to stop the contents of your stomach from entering your lungs. 

How should I prepare for breast reconstruction?

Prior to your surgeries you may be asked to get lab tests or a medical evaluation. If you smoke, you’ll probably be asked to stop for several weeks or months, and you’ll also likely be instructed not to take aspirin, anti-inflammatory drugs, and herbal supplements because they can increase bleeding. Your surgeon will also probably tell you not to eat anything after midnight on the day of your surgeries. (Not sure where to go to get your lab tests? Check out Gateway Hancock Health, where you’ll be able to get in and out quickly and pay, on average, 70% less than you’ll pay at a hospital.)

How long will I be in the hospital after breast reconstruction surgery?

Following breast reconstruction surgery, you will likely stay in the hospital from one to five days. The length of your stay will depend on your procedure and how quickly your body begins to recover.

How long will I be under for breast reconstruction surgery?

You will be anesthetized during the entire surgery, waking up soon after the procedure is complete.

How long does breast reconstruction take?

Breast reconstruction surgery typically takes one to six hours. 

When will my family be informed about how I’m doing?

Our associates will get information from the surgical team in the operating room during your surgery and keep them updated.

What will happen during breast reconstruction surgery?

The Process for Silicone Implants 

If you are having breast reconstruction with a silicone implant or implants, your surgeon might recommend first placing a tissue expander into your chest area to make room for your new breast. The tissue expander, which stretches the skin and soft tissue, is a balloon-like device that your surgeon can place either behind or in front of your chest muscle. Once it’s in place, saline will be injected into the expander through a valve in your skin over the next few months. That will stretch the skin in increments over time. When the tissue is ready, your surgeon will perform a second surgery, replacing the expander with your breast implant, forming your new breast. 

But if you are having breast reconstruction with implants only, and no tissue expander, your surgeon will place a breast-shaped silicone pouch, filled with either silicone gel or saline, either behind or in front of your chest muscle and that will form your new breast.

The Process for Using Your Own Tissue 

There is a separate set of processes your surgeon will follow if you are having a breast reconstruction using your own tissue. The various techniques are listed below.

Abdominal Tissue 

• Abdomen (pedicle transverse rectus abdominis muscle): Your surgeon uses the skin, fat, blood vessels, and muscle from your abdomen and tunnels under your skin, through your body to the front of your chest, where your new breast is created. In this method, the tissue stays attached to its original blood supply.  

• Abdomen (free transverse rectus abdominis muscle): Your surgeon moves tissue—but less muscle—from the lower abdomen to the front of your chest to create your new breast. In this method, the tissue is detached so your blood vessels must be reattached, which requires microsurgery in which a microscope is used to connect the tiny vessels.

• Abdomen (deep inferior epigastric perforator): Your surgeon moves fat and skin—but no muscle—from your abdomen to the front of your chest to create your new breast. While this method relocates the same tissue from the lower abdomen as the procedures described above, the tissue is detached so the blood vessels must be reattached. This requires microsurgery to connect the tiny vessels. (There is also a less-invasive version of this technique. It involves using the same abdominal tissue but it uses blood vessels that aren’t as deep in your abdomen.)

Back Tissue 

• Back (latissimus dorsi): Your surgeon uses skin, fat, and muscle from your upper back and tunnels it under the skin to the front of your chest to form your new breast. In this method, the tissue stays attached to its original blood supply. In some cases, this procedure can include a breast implant.

Gluteal Tissue

• Buttocks (gluteal artery perforator or gluteal free): Your surgeon uses tissue—but no muscle—from the buttocks to create your new breast. The skin, fat, and blood vessels are detached from the buttocks and moved to the front of your chest, where your new breast is formed. This also requires the use of microsurgery to connect the tiny vessels.

Thigh Tissue

• Thigh (transverse upper gracilis): Your surgeon uses tissue from your inner thigh to create your new breast. Your skin, muscle, and blood vessels are detached from your thigh and moved to the front of your chest where your new breast is formed. This also requires the use of microsurgery to connect the tiny vessels. (A similar procedure, called a profunda artery perforator flap, does not remove muscle from your thigh.)

Will I need to fill any prescriptions or take medication after breast reconstruction surgery?

You might receive a prescription for pain medication, nausea, antibiotics, or all three. You might also have a prescription for antidepressants. 

How soon after breast reconstruction surgery can I eat or drink?

You might not be able to eat or drink right away and you might be asked to follow a clear fluid diet for a short time. After that, you’ll probably be able to return to solid foods—but easy-to-digest items, including soups, pudding, and yogurt, are recommended.

Will I receive pain medication right after breast reduction surgery?

You will receive pain medication immediately after breast reconstruction surgery.

How soon after breast reconstruction surgery will I be up and moving around?

Your nurses will help you get up as soon as possible after surgery, and within a day it’s likely that you’ll be walking without assistance.

When will I get to talk to my surgeon after surgery?

You’ll be able to talk to your surgeon immediately after your procedure, while you’re in the recovery room.

How will I know if breast reconstruction surgery worked?

Your surgeon will discuss your procedure with you but, in the long run, you’ll decide if your procedure worked. If you are pleased with the results, and your new breast or breasts make you feel better and more confident, then your procedure worked. 

What can I expect right after breast reconstruction surgery?

You’ll spend about two to three hours in the recovery room before being transferred to your hospital room. 

What are payment options like for breast reconstruction surgery at Hancock Health?

Hancock Health is committed to helping make great care affordable for all patients. To find out more about payment options, please visit the billing and insurance FAQ page at HancockRegionalHospital.org.

Will Medicare cover breast reconstruction surgery?

Medicare parts A and B will cover the cost of breast reconstruction surgery, but it’s important for your doctor to indicate that the surgery is medically necessary.

Will insurance cover breast reconstruction?

Breast reconstruction surgery after breast cancer is considered a reconstructive procedure and should be covered by health insurance. However, your coverage may only be a part of the total price. To obtain your possible out-of-pocket expenses, use our Price Estimator Tool.

How much does breast reconstruction cost?

Consult the Price Transparency Tool at HancockRegionalHospital.org for an idea of how much breast reconstruction might cost.