Breast Reconstruction With Implant or Tissue Expander Insertion

What is Breast Reconstruction With Implant or Tissue Expander Insertion

Breast reconstruction is surgery to rebuild a breast mound after a breast was removed as part of cancer treatment. Many different procedures can be used in breast reconstruction.

Creating a new breast mound can be done with a flap of tissue from your chest. If you do not have enough skin, fat, and muscle on your chest, your surgeon might take some from another part of your body (flap procedure). To create a fuller breast mound, options include:

• A tissue expander. A tissue expander is an empty implant that is gradually filled with saline over a period of weeks as your skin and muscles expand. This option requires several follow-up visits. When your breast mound reaches the right size, the expander might be removed surgically and replaced with a regular implant.
• A silicone or saline implant placed under the breast flap during your first surgery.

LET YOUR HEALTH CARE PROVIDER KNOW ABOUT:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Previous problems you or members of your family have had with the use of anesthetics.
• Any blood disorders you have.
• Previous surgeries you have had.
• Medical conditions you have.

RISKS AND COMPLICATIONS

Generally, this is a safe procedure. However, problems can occur, and may include:

• Pain.
• Bleeding.
• Infection.
• Scars and bruising.
• Need for further surgeries.
• Loss of feeling in your reconstructed breast or around the donor tissue site.
• Loss of some or all of the flap and breast mound.
• A burst or punctured implant.

BEFORE THE PROCEDURE

• Ask your health care provider about:
• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do nottake these medicines before your procedure if your health care provider instructs you not to.
• Follow your health care provider’s instructions about eating or drinking restrictions.
• Arrange to have someone drive you home.

PROCEDURE

This is what may happen during the procedure:

• An IV will be started in your hand or arm.
• You will be given medicine to make you sleep during the procedure (general anesthesia).
• Your surgeon may mark your breast to plan the incisions.
• Your breast will be cleaned with a germ-killing solution (antiseptic).
• Your surgeon may create a flap of skin, fat, and muscle to make a breast mound.
• Your surgeon may take some tissue from another part of your body to make the mound.
• If you have chosen a tissue expansion, the expander may be inserted.
• If you have chosen an implant, the saline or silicone implant may be put under the skin flap at this time.
• Your blood vessels will be reconnected using very precise instruments and an operating microscope (microsurgery).
• A thin tube may be put in place to drain the incision as you heal.
• The incision will be covered with a bandage and a pressure wrap.

AFTER THE PROCEDURE

• You will stay in a recovery area until the anesthesia wears off.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be checked often until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• After a while, you will be taken to a hospital room. You may need to stay in the hospital for several nights.
• Your IV can be removed when you are able to eat and drink.
• Your drain may be removed before you go home from the hospital. Or you may be sent home with your drain and suction bulb.
• You may need to wear a supportive bra or undergarment as you heal.
• Your health care provider will give you instructions for taking care of yourself at home.

Breast Reconstruction With Implant or Tissue Expander Insertion, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain or tenderness.
• Tiredness.
• Swelling.
• Bruising.
• Scarring.
• Drainage.
• Loss of sensation or changed sensation in the breast and chest area.

Follow these instructions at home:

Incision care

• Keep the area around your incisions clean by gently washing with soap, water, and a gauze pad or washcloth.
• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

If you were sent home with a surgical drain in place, follow your health care provider’s instructions for emptying it.

Activity

• Take short walks every 1–2 hours during the day. Ask for help if needed.
• Do notlift your arms above your head for 4–6 weeks.
• Avoid activities that take a lot of effort.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.

Bathing

• Do nottake baths, swim, or use a hot tub while the drains are in place. After the drains are removed, you may shower if your health care provider approves.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Wear a supportive undergarment or bra as directed by your health care provider.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Join a support group for people who have had breast reconstruction. Talk with a mental health professional if you are having trouble coping with your emotions.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have redness, swelling, or pain in your incision area.
• You have fluid or blood coming from your incision.
• Your incision area feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• Your pain is not going away or it is getting worse.
• You notice unusual lumps or changes in the area where you had surgery.

Get help right away if:

• You feel short of breath.
• Your have an irregular heartbeat.
• You have chest pain.

Summary

• After the procedure, it is common to have some pain and tenderness.
• Keep the area around your incisions clean by gently washing with soap, water, and gauze pad or washcloth.
• Check your incision area every day for signs of infection.
• Contact a health care provider if you have any signs of infection, your pain is not going away, or you notice unusual lumps or changes in the area where you had surgery.