Breast Reconstruction, A Process

Many of our patients express concern about what to expect after breast reconstruction. In my discussions with patients prior to mastectomy and reconstruction, I always find it challenging to help patients anticipate what things will look like. In practice, we find before and after pictures to be a useful tool to address this question, but breast reconstruction is definitely a process; this means that what you look like right after surgery is most likely not how your final reconstruction will look. Regardless, most patients, in anticipation of the process they are about to experience, would like to know more about this intial post-op period.

One of our patients recently chronicled this process, and has given us permission to share her pictures here. We hope that you will find this helpful in anticipating what to expect as the process of reconstruction progresses for you. Remember that all patients are different, and this is just one patient’s experience. If you have any questions about what you see here, please feel free to email me at [email protected]

A Pictorial of Implant Reconstruction after Mastectomy

If you are planning to have immediate reconstruction with implants, expect that your initial reconstruction will be slightly smaller in size than your natural breasts. Most patients with breast cancer will also have the nipple-areola complex removed which will leave a scar starting at the middle of your breast angling out towards your armpit (such as what is seen in this picture). Incisions are generally covered by steri-strips after surgery. These will remain on for usually around 10 days. Bruising after surgery is normal.

This patient had bilateral non-nipple sparing mastectomy with immediate tissue expander reconstruction.

Once the steri-strips have been removed, you may see bunching along the incision. This is normal and will resolve with time. Some pink discoloration of the skin is also normal and is a sign of healing. You may also notice a small scab along the incision. We will monitor this at your follow up appointments.

Close up of right breast mastectomy incision one week post-op.

Most patient will be managing drains for 7-10 days after surgery. When you are in the hospital, your nurse will teach you how to empty your drains, record the output, and strip them. Once drains are under 30 ml/24 hours, we will remove them in the office. Drains usually come out under the arm; most patients will have two per side.

Left: two drains as they appear under the arm. Right: securing drains after surgery, ace wrap for comfort.

Expansions usually begin 2-4 weeks after surgery once you are healed. They can occur during chemotherapy, but not during radiation. This patient had chemotherapy, but no radiation. Her expansions were delayed slightly to allow her time to heal. Delayed healing, as is shown in this picture, can occur after mastectomy due to inadequate blood supply to the skin. If this happens, we will continue to watch the area. We may remove the scab in the office and reclose the area with sutures if necessary.

At one month post-op, this patient still has a small scab on her left breast.

After healing is complete, expansions begin. Once expansions and any other needed treatments are completed, we will proceed with your second stage surgery. At this surgery, we will exchange to silicone or saline implants depending on your preference and will make small adjustments to improve symmetry and shape. The second stage surgery is an outpatient surgery done under sedation that usually takes about 1.5 hours. Most patients feel good enough after surgery to go back to their normal daily activities within a few days.

After exchange, you will notice your reconstruction feels much softer and appears more natural. Between two and three months after exchange, we will proceed with nipple-areola complex reconstruction. Some patients elect not to have nipple reconstruction and just have tattoo. This is sometimes also recommended if you have had radiation therapy and your skin is very tight on the radiated side. Tattoo occurs in the office with Jeff. After tattoo, we ask that you do not swim for 1-2 weeks; there are no other restrictions.

Tattoo planning will occur in the office during the tattoo session. If you have particular desires for the appearance of your tattoo (such as color or size/shape), please come prepared with that information. Pictures can be helpful if you’d like to bring pre-op pictures or other pictures that show your desired outcome.

Left: 3D tattoo planning; Right: one 3D tattoo completed. This patient did not have nipple reconstruction.

This patient completed her reconstruction, with the final procedure being her 3D nipple tattoo, approximately 5 months after her mastectomy and first stage reconstruction with tissue expanders. As you can see, the appearance of the reconstruction significantly changed over time. See below for her final pictures compared to her pre-op.

Left: before mastectomy; Right: completed implant reconstruction with 3D tattoo.

We hope this helps you! If you have any questions about this process, feel free to check out our website and our frequently asked questions section. And if you find you still have questions, please let us know!

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