In breast cancer, either part of the breast is removed, oncoplasty, or the entire breast, mastectomy. Breast reconstruction occurs after mastectomy due to cancer or risk of cancer. Breast reconstruction can either take place at the same time as the mastectomy – direct reconstruction or at a separate surgery, late reconstruction.
The women who undergo preventive (prophylactic) mastectomy due to a high risk of breast cancer have undergone an investigation and gene test that shows that they are carriers of a BRCA gene. You then usually choose to do a direct reconstruction.
One of the advantages of direct reconstruction is that the patient’s own breast skin and sometimes even the nipple can be saved to a greater extent. However, direct reconstruction is not always suitable and is therefore not always offered as an alternative.
The goal of breast reconstruction is to create as natural a breast as possible with good symmetry in terms of size, shape and texture. Every woman is unique with different conditions and it is not certain that all the techniques are suitable.
To be considered for breast reconstruction, you need to be nicotine-free at least 6 weeks before surgery and have a BMI below 30, to reduce the risk of complications.
Main methods of reconstruction
In mastectomy, reconstruction can be done with the help of implants/expanders or own tissue. The options below are the most common, but there are also other methods used in isolated cases. Common to the different techniques is that they are done in several stages. First, volume and shape are created. After that, any symmetrizing surgery is done on the second breast, new nipple and pigmentation of the areola.
- Non-radiation damaged skin
- 1 step or 2 steps (expander prosthesis which is then changed to permanent implant)
- May be difficult to achieve symmetry (in case of unilateral reconstruction)
- Implants do not “age”
- Surgery time about 1-3 hours
- Care time 1-3 days
The length of care is calculated at three days, including the day of enrollment. If the operation is done in day surgery, you go home the same day.
Preparing for the operation
Tobacco use in connection with surgery carries an increased risk of complications. You should therefore be smoke- and nicotine-free six weeks before and six weeks after surgery.
In connection with the operation, you will receive a bra that you will use until the first return visit. Then you can use your own bra, but it is important that it is without jumpers, has wide shoulder straps and is wide in the side.
The stitches usually disappear by themselves. The operating area is re-laid before you go home and you get a new dressing on the first return visit. It is possible to shower three days after surgery. Use a mild soap and do not shower directly on the operating area with the shower jet. It is fine to bathe after four weeks if the wounds are completely healed.
We recommend that you continue taping the surgical area for at least two to three months to relieve the wound edges. Surgical tape, e.g. Micropore, available for purchase at pharmacies. Feel free to lubricate the scars with softening ointment and avoid sunbathing on the scars the first year after surgery.
The healing process
A normal healing process involves a slight redness and itching at the edges of the wound. Nodules can form when the body overproduces tissue to heal the wounds. You may have bruises that change in color. Wound healing problems may possibly occur. If you experience increased redness, swelling, tenderness, pain, fever or liquid sores, you should contact the plastic surgeon’s office.
Return visit to the plastic surgeon’s office
You will be called to a return visit to the nurse after one week and to the doctor after one to two months.
It is good to know that many times a breast reconstruction may need some kind of adjusting surgery to achieve the final result. Sometimes this means that even the healthy breast is operated on for better symmetry. It is very rare that the reconstructed breast looks exactly like the removed breast, but the goal is for there to be a reasonable symmetry between the breasts. However, the end result can be difficult to predict due to, among other things, different tissue conditions and degree of scarring. Radiation produces many times a higher degree of scarring.
- Hematoma (blood accumulation in the surgical area)
- Capsular contracture (connective tissue capsule around implants that produce pain)
- Tissue necrosis (parts of the tissue die)
Please note that these are general routines and that it can be changed based on individual needs.