What is the Procedure and Recovery after Breast Reconstruction?
If you have been diagnosed with breast cancer and are recommended to undergo surgical removal of some (lumpectomy) or all of the breast (total mastectomy), you have the opportunity for the breast to be reconstructed. This can often happen at the same time as the breast removal procedure, but there are some reasons (such as planned postoperative radiation) why the breast reconstruction procedure might be better performed at a later time.
At the initial consultation, the reconstructive surgeon will take the time to learn more about you and your goals. This will include a thorough history and physical exam, as well measurements and photographs. There will be a detailed description of the different breast reconstruction options, and often the opportunity to see before-and-after photographs of women with situations similar to yours who underwent different reconstructive procedures. It is important to appreciate that breast reconstruction is a process more than a single procedure, and while there is usually one main operation, it is not uncommon for women to choose to undergo one or more small procedures in the subsequent months in order to make small changes that optimize the end result.
What happens during breast reconstruction surgery?
Your breast reconstruction surgery will be done in an operating room, and it will be done under general anesthesia so that you will be asleep and will not feel any pain during the operation.
The breast surgeon the breast removal procedure, and then the breast reconstruction will be performed by the reconstructive plastic surgeon while you are still asleep. If you have breast reconstruction using an implant, it will be placed in the chest either above or below the main chest muscle (pectoralis major). If you have breast reconstruction using your own tissue (“flap”-based breast reconstruction), this tissue will be moved from one part of the body (most commonly the lower abdomen), shaped in order to best meet your surgical needs and goals, and put in place in the chest (above the chest muscle).
During surgery, your doctor may put a thin tube called a surgical drain under your skin. This tube drains blood and fluids from your body, thereby preventing it from accumulating under the surface and becoming a potential source of infection. When you no longer need the drains, they will be removed in the office during one of your postoperative visits. Fortunately, removal of the drains is not painful.
What happens after breast reconstruction surgery?
After breast reconstruction surgery, you will likely stay in the hospital between 1 and 3 nights. During that time your care team will monitor you closely to ensure you are recovering well, and that there are no complications. In almost all cases you will be provided a surgical bra, which helps to support your reconstructed breasts as they heal, and helps to gently minimize swelling. When it is safe to do so, you will be discharged home, and you will be given full instructions about how to care for yourself in the early postoperative period (drains, bathing, medications, etc.).
The overall recovery period after breast reconstruction surgery ranges from about 2 weeks (after implant-based reconstruction) to 4 weeks (after tissue-based reconstruction). Early on, you will likely feel sore and will likely fatigue more quickly than normal, but you should anticipate feeling a little bit better each day.
In most cases your stitches will be the kind that dissolve and therefore do not need to be removed. If you do have stitches that require removal, that is usually done 1-2 weeks after surgery. Your surgical drains are usually removed 1-2 weeks after the operation, as well.
If you underwent implant-based reconstruction, and if the decision was made during surgery to place a temporary, expandable breast implant (a “tissue expander”), then that is usually filled with saline (water) every 1-2 weeks, beginning a few weeks after surgery. Most women undergoing expansion do about 3-4 times, though it will be your decision as to when the expander has reached your desired size. In these situations, the tissue expander is usually exchanged for a permanent implant (filled with either silicone or saline) 3-6 months after the initial operation.