What is breast reconstruction?

Breast reconstruction is a procedure in which an expander, an implant, or tissue from other parts of your body are used to try to rebuild a breast when you have a mastectomy (removal of the breast). The best time to have breast reconstruction is usually at the time of the mastectomy.

One alternative to a silicone implant is a saline (salt water) implant. Saline implants seem not to have nearly as many possible side effects as silicone gel implants. A second alternative is to ask your doctor to use tissue from other parts of your body to reconstruct your breast. A third alternative to breast reconstruction would be not to have the operation and accept your changed appearance, or to wear a prosthesis, or artificial aid, inside your bra. You should ask your doctor about these choices.

When is it used?

This operation is designed to rebuild the breast. It will not prevent or cure cancer.

It may help you to remember that although this operation can reshape your breasts, it may not change how you think of yourself or how others think of you.

How do I prepare for breast reconstruction?

There are many support groups for women who have had mastectomies. These support groups are usually made up of former cancer patients and can provide needed emotional support.

You will want to discuss with your doctor what size and contour of breasts you want.

Plan for your care and recovery after the operation. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow the instructions provided by the doctor. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

For the first stage, you will be given general anesthesia. A general anesthetic relaxes your muscles, makes you feel as if you are in a deep sleep, and prevents you from feeling pain.

The doctor will place an expander (a balloonlike object) underneath your chest muscles and inflate it to try to stretch the skin. This process may take a few weeks, depending on how much skin there is and how far it needs to be stretched.

When the skin has stretched to the right size, you will have the next operation. The doctor will place an implant under the skin flap. This implant is a bag or packet that is filled with saline or silicone, or your doctor will use tissue from other parts of your body. If you do not have enough tissue to allow the expansion, the doctor may use tissue from your abdomen or back to build the flap that will reconstruct the breast.

The doctor may reconstruct the nipple and areola (the dark patch of skin that surrounds the nipple) with local tissue or a graft of skin from the underarm or groin, attaching it to your breast. Then the doctor will close the cuts. If the skin used for the new nipple is not colored as you would like, the doctor may color it with dyes or pigments.

What happens after the procedure?

You may be in the hospital 3 to 6 days, depending on your condition. It may take 3 or 4 weeks to heal completely. The doctor will arrange for follow-up appointments to check your progress.

In addition to the scar from the removal of the breast, you will have a scar on your breast, and maybe your back, underarm, or abdomen if skin was taken from these areas.

You will want to have regular checkups, including mammograms, to look for any recurrence of breast cancer.

Ask your doctor what other steps you should take.

What are the benefits of this procedure?

You will have a more normal figure and may feel better about yourself.

What are the risks associated with this procedure?

The risks of silicone implants to the breast include:

• An implant may harden and be painful.

• An implant may rupture and silicone may leak inside the breast.

• There may be infection.

The risks of silicone implants to the body, which are less clear, include:

• Small amounts of silicone may leak out of an implant over a long period, even if the implant doesn't rupture. These small amounts of silicone may cause some women to develop autoimmune diseases such as arthritis, lupus, or scleroderma.

• Silicone may affect a developing baby during pregnancy.

Warning: The US Food and Drug Administration (FDA) stresses that there is no conclusive evidence that the above risks happen. However, many doctors are concerned about the safety of an implant with silicone gel. The FDA has issued new rules limiting the use of implants with silicone gel. As a result, the number of breast surgeries using silicone gel is only a fraction of what it was before the new rules.

According to FDA regulations, you can have a silicone-gel implant if you need to reconstruct your breast after cancer surgery or for another medical condition. Before you can have a silicone-gel implant, you must agree to two things:

• First, you should discuss the possible risks with your doctor and sign an informed consent form. The consent form states that your doctor has explained all the possible risks and that you understand them.

• Second, you must agree to enroll in a special clinical study so that the FDA can get reports on your progress. The FDA hopes that all these data will help them find out what the risks are.

Other risks of breast reconstruction include:

• There are some risks associated with general anesthesia. You should discuss these risks with your doctor.

• Your reconstructed breast may be hard or lumpy.

• Your reconstructed breast may feel too firm.

• Your reconstructed breast may bleed or become infected around the implant.

• Your new nipple and areola may be numb. They may not look the same as your other nipple.

• Your breasts may be unequal in size, shape, position, or contour. You may want further surgery on one or both of the breasts to try to make them similar.

• Your breasts may droop.

• A capsule may form around the implant. That area may become firm or tender and need regular massage.

• Your arm and shoulder movements may be restricted or painful.

• The implant may need to be removed.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• The skin over the breast becomes irritated or starts to peel off.

• You have redness or unusual drainage from the cuts.

• You have fever or unexpected pain.

Call the doctor during office hours if:

• You have questions about the procedure or its result.

• You want to make another appointment.