Breast reconstruction – delayed vs. immediate
Breast reconstruction is categorized by two components: the timing of the reconstructive surgery and the type of surgery performed. Breast reconstruction can be performed at the same time as the mastectomy (sometimes referred to as “immediate reconstruction”), or the reconstructive surgery can be performed any time after the mastectomy (sometimes referred to as “delayed reconstruction”).
The delay can range from weeks or even years after the original mastectomy was performed, but is mainly influenced by the need for radiation therapy after mastectomy. In these cases, breast reconstruction is usually delayed or postponed until after radiation treatments are completed and the patient is given time to heal.
Each patient is different, and the timing of surgery is determined by collaboration between the patient, the breast oncology surgeon, and Dr Beale, the reconstructive surgeon.
Autologous (your own tissue) vs. implant-based reconstruction
Breast reconstruction surgery comes in two general types: autologous breast reconstruction and implant-based breast reconstruction. In general, implant-based reconstruction is performed by placing a tissue expander under the breast skin and chest muscle during the mastectomy procedure.
A tissue expander is a balloon-like device that is filled with liquid in order to stretch skin and tissue, creating room for an implant. The expander is slowly inflated every week in the office over a three- to eight-week process. Once the expansion is reached for final breast size, a second surgery is performed to remove the expander and replace it with an implant.
Autologous breast reconstruction – where does it come from?
Although autologous breast reconstruction can utilize tissue from many areas of the body to recreate the breast, including the inner thigh, flank, and back of the thigh and buttock, the most common tissue or “flap” used is the TRAM flap or DIEP flap.
The DIEP Flap
A DIEP flap or deep inferior epigastric perforator flap is similar to the TRAM flap, except when harvesting the same ellipse of abdominal skin, the small blood vessels are used without taking any muscle with the flap. This way, women are left with all their stomach muscles in place, leading to a speedier recovery with increased abdominal strength.
As an ancillary benefit of the DIEP flap procedure, the skin used from the lower abdomen is the same tissue addressed during a tummy tuck. This means that patients not only benefit from a natural breast reconstruction, they also get the benefits of a tummy tuck at the same time.
Further nuances of breast reconstruction
Further steps common to all types of breast reconstruction are nipple reconstruction and “matching procedures.” Nipple reconstruction is necessary unless a “nipple sparing” mastectomy was performed, for which a small sub-set of patients are candidates.
For patients who undergo a traditional mastectomy, a final surgery will be performed to create a raised nipple using small flaps on the reconstructed breast. After healing, tattooing can be used to give the reconstructed nipple a fleshy color to resemble an areola, thus completing the reconstructive process.
For patients who have undergone autologous or implant breast reconstruction on just one breast, “matching procedures” consisting of breast lifts and/or breast augmentation to make the native breast symmetric with the reconstructed breast.
Recovery following breast reconstruction
After implant-based reconstruction, a one to three-day stay in the hospital is necessary, depending upon whether one or both breasts were reconstructed.
After DIEP flap breast reconstruction, patients will stay one to two nights in the ICU in order to monitor the flap, and then approximately two nights in a regular hospital room. Most patients are able to return home three to six days after surgery. The recovery related to the use of the abdominal tissue adds a little extra time, but most patients resume normal activity within several weeks and may exercise fully in four weeks.
Subsequent stage surgeries done after the initial reconstructive procedure are usually outpatient surgeries that do not require an overnight stay in the hospital. Drains are routinely used in both the placement of tissue expanders and in all autologous reconstructive procedures. Drains are removed after four to ten days.
If you have insurance, you may be covered
Breast cancer is certainly traumatic enough without considering the financial aspect of treatment. For this reason, the office of Dr Evan Beale accepts Aetna and most forms of health insurance in cases of medically necessary procedures—such as breast reconstruction following mastectomy.
If you would like to learn more about your coverage, or to explore other financing options, our office is ready to assist you with your needs. Our top priority is helping you gain total confidence following breast cancer, and that certainly includes reconstructing your breasts and restoring your confidence.
As always, our goal is to help our patients get necessary treatment following breast cancer, allowing them to feel whole once again.