Nearly 200,000 women are being diagnosed with breast cancer every year. After hearing the words, "You have breast cancer", it is easy to become overwhelmed with treatment options and choices that need to be made.
There are hundreds of questions and frequently more than one right answer. We invite you to explore your options, either before or after your planned mastectomy. Breast reconstruction is a highly individualized procedure. You should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.
Should you choose to pursue reconstruction, the goal of breast reconstruction is to restore one or both breasts to your desired shape, appearance, symmetry and size following mastectomy, lumpectomy or congenital deformities.
Breast reconstruction often involves multiple procedures performed in stages and can either begin at the time of mastectomy or be delayed until a later date.
Breast reconstruction generally falls into two categories: implant-based reconstruction or flap reconstruction. Implant reconstruction relies on breast implants to help form a new breast mound. Flap (or autologous) reconstruction uses the patient's own tissue from another part of the body to form a new breast.
Breast reconstruction consists of rebuilding the breast mound, restoring its shape and size, as well as reconstructing the nipple and areola. The specific technique will depend on your preference, cancer treatment used (use of radiation therapy is especially important), your overall health, your occupation and physical activities, your body type, your smoking status and many other factors.
If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size, shape and position of both breasts. View this procedure in 3D here.
Breast reconstruction surgery is a deeply personal procedure - so it's important that you feel comfortable with your surgeon and his or her experience.
Dr. Majewski is a board-certified plastic and reconstructive surgeon with over 17 years of experience, and has performed hundreds of successful breast reconstruction, augmentation, lift, and reduction procedures throughout his career. His goal for all his patients to help them feel comfortable, confident, and calm throughout their surgery and recovery experience.
The purpose of the consultation is to ensure that you are a candidate for surgery, and to develop a treatment plan that will help you meet your goals. It's also an opportunity for you to ask any questions you may have about the procedure.
Schedule a consultation once you feel you've done sufficient research on the procedure, researched possible surgeons, and you feel confident speaking about your goals and expectations for the surgery.
You may be a candidate for breast reconstruction if:
You are able to cope well with your diagnosis and treatment
You do not have additional medical conditions or other illnesses that may impair healing
You have a positive outlook and realistic goals for restoring your breast and body image
You have realistic expectations
It's worth noting that although breast reconstruction can rebuild your breast(s), the results are highly variable:
A reconstructed breast will not have the same sensation or feel as the breast it replaces
Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy
Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks
CONSULTATION: WHAT TO EXPECT
During your consultation, Dr. Majewski will ask you a number of questions about your health, desires, and lifestyle in order to create a treatment plan that will best satisfy your unique needs. Be honest with your answers, and come prepared with any questions you may have about the surgery, recovery, and the costs involved with the procedure.
Dr. Majewski may ask you questions about the following:
Why you want breast reconstruction surgery, your expectations, and your desired outcome
Medical conditions, drug allergies and previous medical treatments
Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
Results of any recent mammograms or previous biopsies
He will also evaluate your general health status and any pre-existing health conditions or risk factors, examine and measure your breasts, including detailed measurements of their size and shape, skin quality and placement of your nipples and areolas, take photographs, discuss the use of anesthesia during your procedure, discuss your options and recommend a course of treatment, and discuss likely outcomes of breast reconstruction and any risks or potential complications.
There are several surgical techniques that can be used during breast reconstruction, and if implants are involved, many decisions to be made regarding size, shape, and implant type.
Dr. Majewski will discuss your options during your consultation, and will work with you to develop a treatment plan that will help you look and feel your best.
KNOW YOUR RIGHTS
In October of 1998, Congress passed the Women's Health and Cancer Rights Act. The act requires group health plans and health insurers that provide medical benefits covering mastectomy, to also cover the cost of reconstructive breast surgery. The coverage must include all stages of reconstruction of the diseased breast, procedures to restore and achieve symmetry on the opposite breast, and the cost of prostheses and complications of mastectomy.
Dr. Majewski may need to obtain authorization from your insurer for the surgery. This may require a letter and the submission of photographs - so after your consultation, you may have to wait for a period of time before you can schedule your surgery. Once an authorization is obtained, you will be able to schedule your surgery.
About the Breast Reconstruction Procedure
Implant reconstruction (approximately 75% of breast reconstructions in the USA are done this way) can be performed as a one-stage (rarely) or a two-stage procedure.
One-Stage Reconstruction: Direct-to-Implant
In one-stage reconstruction, the breast implant is placed immediately following mastectomy, foregoing the need for a tissue expander. Some patients may still require a second procedure. This scenario is more likely when a skin-sparing mastectomy is performed.
More frequently, since mastectomy removes not only the breast gland, but also a portion of breast skin (usually including nipple/areola complex), there is not enough tissue available to cover a permanent implant. In these cases, a two-stage reconstruction is performed.
Two-Stage Reconstruction: Expander/Implant
Usually, two-stage reconstruction is offered. The first stage includes placement of a tissue expander that - after successful process of tissue expansion - is replaced with a permanent implant. A tissue expander is a temporary implant with a built-in port that can be inserted after mastectomy (either immediately, i.e. during the same surgical procedure or after a period of weeks, months or even years after mastectomy - there is really no time frame within which the reconstruction process has to begin).
A few weeks after the tissue expander is inserted (usually 3 weeks or so, when the incisions are healed) the process of tissue expansion begins. The patient will be asked to return to the office for a visit every other week, during which the tissue expander will be accessed and saline will be added to increase its volume. The overlying tissue will be gradually stretched until the desired volume is achieved. Depending on the size of tissue expander, initial fill volume, patient's comfort level etc., the process may take 2-4 months.
After the expander is fully inflated, the second procedure will be performed - replacement of a tissue expander with permanent breast implant. Currently, silicone gel-filled breast implants are used for that purpose (since several nationwide studies proved efficacy and safety of the silicone implants, they have largely replaced saline-filled devices. They provide a much more natural look and "feel" than the saline implants).
ARE IMPLANTS SAFE?
Concerned about the safety of breast implants? Listen to these board certified plastic surgeons share their personal and professional opinions on the safety of breast implants.
Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. In these cases, breast reconstruction usually requires a flap technique.
A TRAM flap uses donor muscle, fat and skin from a woman's lower abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.
Alternatively, Dr. Majewski may choose the DIEP flap or SIEP flap techniques, which do not use abdominal muscle but transfer only skin and fat to the chest from the abdomen. If there is insufficient tissue on the lower abdomen, other donor sites such as the buttocks or thighs may be selected (SGAP flap, TUG flap, PAP flap).
OTHER BREAST REVISION TECHNIQUES
For women who are not candidates for nipple-sparing mastectomy, breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola. Techniques usually involve folding skin to create the shape of a nipple followed by tattooing. Three-dimensional nipple-areolar tattooing may be used alone to create the appearance of a realistic nipple with the illusion of projection.
Breast reconstruction outcomes can often be enhanced with staged revision procedures that improve symmetry, use liposuction with fat grafting, and improve the appearance of the donor site.
Following your breast reconstruction surgery for flap techniques and/or the insertion of a breast implant, gauze or bandages may be applied to your incisions.
An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.
Dr. Majewski and his team will provide you with specific instructions for breast reconstruction recovery that may include:
How to care for your breasts following breast reconstruction surgery
Medications to apply or take orally to aid healing and reduce the risk of infection
When you can shower
Specific concerns to look for at the surgical site or in your general health
When to follow up with your plastic surgeon
Be sure to ask Dr. Majewski specific questions about what you can expect during your individual recovery period.
Where will I be taken after my surgery is complete?
What medication will I be given or prescribed after surgery?
Will I have dressings/bandages after surgery? When will they be removed?
Are stitches removed? When?
When can I resume normal activity and exercise?
When do I return for follow-up care?
The amount of time you need to recover from breast reconstruction will depend on your natural healing rate as well as the extent of surgery performed. You will be able to get up and walk around the same day of surgery, although you should have a trusted adult with you during the first 24 hours (at least). While you may be permitted to shower a few days after surgery, you will probably need help getting dressed, as you will not have full range of motion in your chest and shoulders at first.
Avoid raising your arms above your head, or lifting or carrying anything more than a few pounds for several days to weeks after surgery. If something feels uncomfortable, don't do it. This is not the time to be a superhero! You'll regain strength over time, but you might find everyday actions - such as closing the trunk of an SUV or opening a jar - will be difficult in the weeks after surgery. Learn to ask for help in these types of situations, and plan ahead so that you're never alone in the days following your procedure. You should be fairly self-sufficient within 4-6 days.
Most patients feel ready to drive and return to a desk job within 1 week, after they are no longer taking prescription pain medication. Dr. Majewski will likely have you wait a minimum of 3 to 4 weeks before resuming exercise other than walking; this helps to ensure your incisions heal properly. It is absolutely essential to follow all post-operative instructions after surgery in order to ensure proper healing.
While a breast reconstruction typically yields larger breasts right away, the final results may take a few weeks as the swelling subsides and the skin stretches. Some patients may need to wear a bandeau to help shape their breasts. Incision lines may take several months, even a couple of years, to fade. Dr. Majewski will provide you with a scar gel to minimize the appearance of your scars.
If you receive breast implants that are placed partially beneath the pectoral muscle—the preferred method in most cases—your breasts may seem to sit high on the chest at first. This is normal, and your implants will settle into their optimal position over the next several weeks, with final results after a couple of months.
The final results of breast reconstruction following mastectomy can help lessen the physical and emotional impact of mastectomy.
There are trade-offs, but most women feel these are small compared to the large improvement in their quality of life and the ability to look and feel whole.
Careful monitoring of breast health through self-exam and other diagnostic techniques is essential to your long-term health.
Ready to Schedule Your Consultation?
You can use our online scheduler to set up your appointment with Dr. Majewski at any time!