Things You Should Know About Breast Reconstruction Surgery

Women irrespective of their shape, size, height, and other physical factors are true warriors. Woman in her life undergoes a myriad of bodily changes that affect both physically and emotionally which start when she hits puberty and goes on. So never let a diagnosis make you think less of yourself. It is one such hurdle you are going to proudly overcome.

One of the most common cancers among women is breast cancer. The World Health Organisation (WHO) says that at the end of the 2020 survey, about 7.8 million women were globally diagnosed and living with a history of breast cancer in the past 5 years. There are many different methods used for treating women with breast cancer such as radiation therapy, hormone therapy, chemotherapy, and surgeries like mastectomy and lumpectomy.

Breast Cancer Reconstruction

Any of the above procedures can be done to treat breast cancer or prevent women who are at high risks of developing it shortly. Of all the treatment options, surgeries require confidence and courage as it is a procedure performed to remove either one or both breasts or their parts if affected. The lymph nodes and other nearby chest tissues are also removed sometimes.

Waking up after a life-changing surgery with a single breast or not even one affects psychologically. Hence, immediate or delayed breast reconstruction after mastectomy is performed according to the interest and treatment plans of the patient.

Reconstruction of the breast is a surgery, part of the breast cancer treatment, performed for rebuilding and restoring the appearance, shape, symmetry, and size of either one or both breasts to nearly normal form. In case, a single breast is affected by cancer, it alone will be reconstructed whereas the other breast is recommended with procedures like breast- reduction, lift, or augmentation to improve the shape, size, and symmetry.

Often breast reconstruction involves multifold procedures done in different stages which are either performed post-mastectomy or delayed to a later time. As there are many different breast reconstruction options available, it is more important to understand the process rather than the operation. You should confirm your decision only after being completely educated about breast reconstruction procedures.

Best timings for Breast Reconstructive Surgery

The timings are either immediate or delayed in the treatment process.

• Immediate or simultaneous reconstruction is performed during the mastectomy surgery itself or at least the process is started.
• The delayed construction or post mastectomy breast reconstruction is carried out months or years later which provides time to think about the options available and does not interfere with other cancer treatment procedures.
• The advantages of immediate breast reconstruction surgery are that it boosts self-confidence, is lower in cost, and has a good psychosocial effect. But in the case of additional therapy, such as radiation after mastectomy might affect the reconstruction site and hence, it needs a modification. Therefore, most patients opt for delayed treatment plans because breast reconstruction after cancer surgeries might be a lot more to accept and take in personally.
• An alternative procedure for immediate surgery is a staged reconstruction process in which the surgeon places breast reconstruction expanders such as tissue expanders temporarily for the muscles and skin to slowly stretch and prepare for the reconstruction.

Types and Categories

Reconstructing Breast or breasts can be categorized into three different types. They are

• Implant-based Breast Reconstruction

Implant-based breast reconstruction is one option for rebuilding the shape and symmetry of the breast after surgery. There are different types of implant techniques available which are used in surgery. These implants are made up of a flexible outer body consisting of silicones and an inner filling of saline or silicone gel. In saline implants, the breast reconstruction implant is filled with germ-free sterile saltwater whereas using silicone implants for breast reconstruction uses silicone gel which tends to provide a natural breast tissue look alike.

• Using flaps for breast reconstruction

Flap reconstruction also known as autologous or autogenous reconstruction is performed by using the own tissues of the patient. These tissues are grafted from other parts of the body such as skin, fat, or sometimes muscles to rebuild the shape and contour of the breasts. The tissue flaps used for breast reconstruction are usually grafted from the belly, buttocks, or inner thighs to create a breast mound.

• Combination of both

In some cases, the surgeon recommends using both the implant and the patient’s tissue for breast reconstructive surgery.

Note:

After the above reconstruction procedures, other necessary procedures required for achieving symmetrical breasts are performed. The opposite breast is changed higher (mastopexy), larger (augmentation), or smaller (reduction) in size and shape according to the preferences. Oftentimes, people get confused between breast augmentation and reconstruction but they are completely different. The main difference between breast augmentation and reconstruction is that augmentation (boob job) is done to increase the size of breasts whereas reconstruction, as the name suggests, is rebuilding the breast which is removed because of cancer.

Breast Reconstruction India

In India, Breast reconstructive surgery is not well known among people. Even though breast cancers among Indian women are increasing every year, less knowledge and awareness about breast cancer and its treatment plans are predominant among women in society. About 1% or less than 1% of the breast cancer population undergo breast implants reconstruction after mastectomy.  

Many hospitals have volunteered to provide breast reconstruction awareness campaigns and programs to avoid the void feeling and anxiety after a mastectomy and to enlighten women about the different options available to them. Many women step back from reconstruction procedures because of the cost. Breast reconstruction surgery cost is expensive like any other plastic surgery ranging anywhere between 80,000 to 3 lakh rupees in private hospitals depending on the type and timing.

Things to consider before Breast Reconstructive Surgeries

As it is one of those procedures that completely transform a person physically, emotionally, and psychologically. It is very important to openly talk and discuss the options, treatment plans, and their stages, follow-ups, recovery, etc.

Every procedure has its own set of pros and cons so sitting down with your surgeon and thoroughly discussing every doubt and confusion that arises is strongly insisted. The healthcare team will completely analyze and go through your medical history and current health condition to provide the best suitable treatment options for you. The factors that might be of help to the patient as well as the surgeon are

• The overall health condition (either smoking or not smoking).
• Cancer cell's location, type, and severity.
• If the patient has undergone or will be undergoing other cancer treatment procedures such as chemotherapy, radiation therapy, etc.
• Is surgery required in one or both breasts?
• The number of surgeries a patient is willing to take.
• What is the patient’s mentality about the time needed for recovery?
• Does their insurance policy cover cosmetic treatment?

Recovery

The procedure is performed with general anaesthesia and so some discomfort after the surgery is common. It may persist for the first few days therefore pain relief medicines will be prescribed. Nurses will completely aid in both on and off-bed activities until your body is ready to perform them. In the first few days of hospital stay, moving your arms slightly will be allowed under the surgeon or other professional's supervision. Later on, sitting in a chair and walking is being practiced on the second day with the help of a nurse.

The length needed for a hospital stay completely depends on the operation type and how effectively you are recovering. In case of implant reconstruction 1 to 2 days and for a flap procedure, 5 to 6 days is required. Soreness, bruising, and swelling on the recreated area can be noticed for the first 2 to 3 weeks. After reaching home, certain precautions in daily activities such as bathing, showering, and wound care will be advised by the surgeon. Getting back to a regular lifestyle might take up to two to three months from the surgery.

Frequently Asked Questions

1. What is considered breast reconstruction?

Breast reconstruction is a surgical procedure performed after a mastectomy to rebuild either one or both breasts. It is done to restore the appearance, shape, size, and symmetry of the single or double breast for patients who have undergone breast cancer treatment.

2. Is Breast Reconstruction a Major Surgery?

Yes, it is indeed a major surgery that completely changes a patient's lifestyle. Reconstructing a breast is an overwhelming and huge personal decision to make.

3. How long does it take to recover from Breast Reconstruction Surgery?

The recovery completely is contingent on the kind of operation and the patient’s overall health. Normally, women can get back to their daily activities after six to eight weeks of the surgery. Even after returning to a regular lifestyle, listening to your body and comforting it is very important for a speedy recovery. Having frequent follow-ups and annual mammograms are recommended. The plastic surgeon, as well as the team, will closely monitor your health for at least four to six weeks.

4. Do implants feel better than expanders?

The expanders are used before placing an implant to allow gradual stretching of the muscles and skin. Hence, they are firm and tight as sterile saline is introduced weekly to attain the correct size as well as allowing the chest tissues to heal from a mastectomy breast reconstruction. Once the permanent implants are placed, the patient feels more comfortable and normal than with the expanders in place. As the permanent implant fits into the pocket, the tightness will decrease quickly.

5. Can I sleep on my side after Breast Reconstruction?

Sleeping on the sides or stomach is not permitted immediately after surgery as it may put unnecessary stress and pressure on the healing tissues and incisions of your breast. In an implant-based reconstruction scenario, side sleeping may lead to mispositioning of the placed implant.

After two weeks from the reconstructive surgery, side or stomach sleeping can be gradually included. However, stomach sleeping is not advisable in just a two-week length. The normal sleep positions can be restored after six weeks and only if you are comfortable with them.

6. How do Breasts feel after Reconstruction?

Life with a new breast is different. You have to be both physically and emotionally prepared for it. As the nerves are cut down during mastectomy and reconstructive surgeries, a numb feeling persists for a long time. Even though the nerves tend to regrow, it might only restore some feelings in the breast when touching it but cannot be expected to fulfil the same way as the original breast. Those tingling sensations might take up to a year or more to show up in the rebuilt breast.

It is very important to remember that the ultimate goal of reconstruction is to create a breast that feels as natural as possible but it can only mimic and not bring back the original breasts into the picture. Hence, scars and loss of sensation will be inevitably present.

7. What happens if you lose weight after Breast Reconstruction?

Implant reconstructed breasts do not gain or lose weight according to the body. But rapid weight loss or gain after surgery will affect the look of the breasts. Hence revision surgery will be recommended in case of implant used breast reconstruction to restore the balance between breasts. This issue does not arise with a flap procedure because it is made up of own grafted tissues which lose or gain weight according to the body. Significant weight changes will affect the balance between reconstructed and natural breasts which with the help of your plastic surgeon can be well handled.

8. Is Breast Reconstruction covered under Insurance?

Insurance coverage varies widely for the reconstruction of breasts. Some insurance policies will cover for performing procedures in the affected breasts but will not provide a penny for alterations in the other breast. Other insurance plans may provide for external prosthetic materials or reconstruction surgery but not both procedures.

It mainly depends on the company, the nature of the health insurance taken, and their guidelines regarding the required procedure. Almost every insurance company does not cover cosmetic surgeries as it is not essential to live a normal life or preserve the quality of life. Therefore, finding out whether the procedure falls under cosmetic or reconstructive procedures will be of better help.

Hence, a careful reading of policies, clarifying all doubts with the insurer, and re-checking the insurance policies is strongly recommended.

9. Can belly fat be used for Breast Reconstruction?

Yes, it can be used by a process called flap tissue procedure. The most common donor area for this type of reconstruction is lower belly fat. As excess fat is stored in the belly, it can be tummy tucked as a donor for rebuilding the breast which looks and feels more natural than an implant-based surgery.

10. What type of implant is best for Reconstruction?

Though there are both advantages and disadvantages to any surgery performed, the best suitable implant procedure is advised only by the plastic surgeon according to the overall health condition of the patient.