The duration of these results are variable and are depended on gravity, aging, and weight changes which will continue to affect the breast reconstruction over time and are depended on whether the patient has or will have radiation therapy.
Breast reconstruction can be performed immediately or delayed. Immediately, means that it occurs at the same time and right after the mastectomy. This means that you are having two surgeries by both the general surgeon who will perform the mastectomy and the plastic & reconstructive surgeon who will perform the reconstruction. Delayed means the reconstruction is done several months or years later. Most patients choose to have an immediate reconstruction since it allows one to have two simultaneous surgeries and only one anesthesia.
A complete breast reconstruction may take three to four stages and over one year for the entire completion of the reconstruction to occur. The reason the complete reconstruction may take more than a year, is because it is possibly interrupted by adjuvant therapies such as chemotherapy and/or radiation.
Although there are numerous approaches of reconstructing the breast, we will discuss three commonest methods. These are Tissue Expanders (TE) and implants, Latissimus Dorsi (back) Flap with a Tissue Expander and implant and a TRAM Flap. In general, flaps will create a much more natural appearing breast; however, the length of the surgery, postoperative recovery and possible risk and complications may be more pronounced and significant.
Tissue Expander (TE) and Implants
Stage I:
A Tissue Expander (TE) is a type of temporary implant that is placed partially under the pectoralis muscle after the mastectomy is done with the purpose of expanding the remaining skin to the appropriate desire of the patient. Once the TE is placed it may be partially filled by the surgeon. Then after 2 – 4 weeks via the aid of a magnetic, the port within the TE is located and the TE is filled with sterile saline (salt water). On average, these “fills” are done every two to three weeks until the skin has been appropriately stretched to accommodate the insertion of the permanent implant. In general, TEs are not meant to look good or feel soft, they have only one purpose – that of expanding the skin. Stage I reconstruction takes approximately 1 ½ hours for one breast and 2 ½ hours for both breast. Most patients spend one to two nights in the hospital and recovery occurs within two weeks or less.
StageII:
After approximately three to four months, the patient is taken back to the operating room where the TE is removed and a permanent implant is placed. It is during this second stage that we perform any aesthetic procedures of the breast and possibly equalize the opposite natural breast. Stage II reconstruction may take 2 to 4 hours under general anesthesia. Stage II reconstruction is an out patient procedure requiring no overnight stays. The postoperative recovery is generally two weeks or less.
Stage III:
After another three to four months, the patient is ready for a nipple-areolar reconstruction. Although there are many various methods to reconstruct the nipples and areolas, I choose to reconstruct them with the patients’ own skin by forming three small flaps and using a skin graft. If the skin has been left to thin from the reconstruction, another method of reconstruction may be chosen by the reconstructive surgeon. Sometimes, no reconstruction of the nipple can be performed because the skin is to thin. In such a case, the nipple-areolar complex is tattooed giving one a two dimensional look to the nipple-areolar region. Stage III is done under general anesthesia and takes approximately 1 ½ to 2 ½ hours and requires no overnight stays. Recovery from this surgery takes approximately five to seven days.
Stage IV:
Three to four months after the last stage, the nipple-areolar complex is professionally tattooed by a medical tattoo artist that will match the appropriate color to the nipples and areolas. This procedure is done in an office setting and requires approximately one hour with very little down time. Most of the time, no anesthesia is required. If needed local anesthesia will be administered.
Latissimus Dorsi Flap with Tissue Expander
Stage I:
After the appropriate mastectomy is performed by the general surgeon, a Latissimus Dorsi (back) flap is performed. A Latissimus Dorsi flap is skin, fat and muscle that is taken from the back, released, transferred and rotated to the chest region to reconstruct the breast. In the majority of cases, this flap requires the use of a tissue expander since by itself the flap is relatively thin and will not result in a full and rounded breast. This type of reconstruction may take anywhere from six to eight hours depending whether one side or both breast are needed to be reconstructed. Most patients will spend three to five days in the hospital and three to five weeks to completely recover at home.
StageII:
After approximately three to four months, the patient is taken back to the operating room where the TE is removed and a permanent implant is placed. It is during this second stage that we perform any aesthetic procedures of the breast and possibly equalize the opposite natural breast. Stage II reconstruction may take 2 to 4 hours under general anesthesia and requires no overnight stay. The postoperative recovery is generally two weeks or less.
Stage III:
After another three to four months, the patient is ready for a nipple-areolar reconstruction. Although there are many various methods to reconstruct the nipples and areolas, I choose to reconstruct them with the patients’ own skin by forming three small flaps and using a skin graft. Stage III is done under general anesthesia and takes any where from 1 ½ to 2 ½ hours with no overnight stay. Recovery from this surgery takes approximately five to seven days.
Stage IV:
Three to four months after the last stage, the nipple-areolar complex is professionally tattooed by a medical tattoo artist that will match the appropriate color to the nipples and areolas. This procedure is done in an office setting with or without local anesthesia and requires approximately one hour. The recovery from this last stage is extremely short.
TRAM (Transverse Rectus Myocutaneous) Flap
Stage I:
After a mastectomy has been performed by your general surgeon, a TRAM flap may have been considered by your plastic and reconstructive surgeon. A TRAM flap consists of skin, fat and muscle that comes from your lower abdominal region and transferred to the chest area to reconstruct the breast. To be a candidate for this procedure, you must have enough tissue to fully reconstruct one or possibly both breast since tissue expanders and implants are not generally used. The procedure may take six to nine hours and the time spent in the hospital may be four to six days. The postoperative recovery at home may last four to six weeks.
Stage II:
After approximately three to four months of your last stage, stage II consists of constructing the nipple-areolar complex. Although there are many various methods to reconstruct the nipples and areolas, I choose to reconstruct them with the patients’ own skin by forming three small flaps and using a skin graft. Stage II is done under general anesthesia and takes any where from 1 ½ to 2 ½ hours with no overnight stays. Recovery from this surgery takes approximately five to seven days. Additional work on the breast may also be considered during this stage if required. These procedures are meant to enhance the aesthetics of the breast or possibly improve the opposite naturally appearing breast.
Stage III:
Three to four months after the last stage, the nipple-areolar complex is professionally tattooed by a medical tattoo artist that will match the appropriate color to the nipples and areolas. This procedure is done in an office setting with or without local anesthesia and requires approximately one hour. The recovery from this last stage is extremely short.
|
