Breast reconstruction is the surgical creation of a new breast either with a prosthetic device or a person’s own tissue. Breast reconstruction happens after breast removal (mastectomy) due to a cancer diagnosis or genetic abnormalities and/or strong family history of breast cancer. The reconstructed breast ideally has a near-normal appearance, feel, size, and shape. Breast reconstruction is regarded as both physically and emotionally rewarding, as it can help restore a woman’s quality of life, body image, and self-confidence after the loss of a breast. Chicago plastic surgeon Dr. John Kim specializes in breast reconstruction. (Learn more about Dr. Kim’s recent work on the frontline of breast reconstruction education)
There are several different modalities of breast reconstruction that plastic surgeons can perform following mastectomy. The goal of all reconstruction types is to restore the breast to the most natural appearance and feel as possible. Although the reconstructed breast may appear near-normal, it will not look or feel quite like the native breast that was removed. Visible scars may remain on the breast, as well as the donor site (back, abdomen, tummy, or buttocks) if applicable. In most cases, it is only medically necessary to remove one breast because of its cancer diagnosis, which is referred to as a unilateral mastectomy. If only one breast is reconstructed, then it may be advisable to improve the symmetry and positioning of the opposite breast for the most natural look. In this case, Dr. Kim may recommend a breast augmentation, breast lift, or breast reduction on the opposite (contralateral) side.
Breast cancer and breast reconstruction can be very emotional processes for women, and there are several excellent organizations nationwide that work to provide women with meaningful support systems and resources. In the Chicago area, groups like The American Cancer Society, the Susan G. Komen Breast Cancer Foundation, and Bright Pink are among the most committed to assisting women in connecting with others in their same situation and educating themselves about the disease and treatment options.
Together with Dr. Sanjay Gupta of CNN, Dr. Kim discusses post-mastectomy breast reconstruction options.
BRCA 1 and BRCA 2
Abnormalities within the BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two) genes are associated with increased risk of breast cancer. BRCA 1 and 2 are “tumor suppressor” genes that, when functioning correctly, work to ensure normal breast development. Upon mutation, however, these genes no longer suppress tumor formation but in fact increase the likelihood of tumor development and breast cancer. Unfortunately, abnormal copies of the genes are often passed down from mother to daughter, and so a woman may be at higher risk of developing breast cancer if it runs in her family. If you have a family history of breast or ovarian cancer, it is important to consider setting up an appointment with your doctor or a genetic counselor to determine if genetic testing is something you should consider.
Women who have BRCA1 or BRCA2 genetic mutations often consider undergoing a bilateral (both breasts) nipple-sparing mastectomy and reconstruction for cancer prevention purposes. A nipple-sparing mastectomy is breast removal that preserves the nipple and areola (colored region around the nipple). It is then common to undergo breast reconstruction surgery.
Choosing to have Breast Reconstruction in Chicago
Many women choose to have reconstruction after mastectomy because it has been shown to improve their quality of life, body image, and mental health. Some women choose not to reconstruct, however, and instead opt for a flat chest or a prosthetic bra. Choosing the path of reconstruction should be done for you alone and not because of anyone else’s expectations or desires. Breast reconstruction can be especially fulfilling for women who have been able to cope well with their cancer and cancer treatment, those without additional diseases or adverse medical conditions, and women with realistic goals for the end result of rebuilding their breasts.
Typically, breast reconstruction occurs over several months and in more than one stage. It can begin during your mastectomy surgery (immediate reconstruction) or you can wait some time after the breast removal before getting started (delayed reconstruction). There are several different types of breast reconstruction surgery, and Dr. Kim will review all options with you during your initial visit. He will carefully examine your breasts and take detailed notes on your skin quality, nipple location, and breast size and shape, among other things. He will share with you a detailed treatment plan, which will include the important discussion of whether your body is best suited for prosthetic reconstruction with an implant, or autologous reconstruction using your own tissue from another part of your body.
Post-mastectomy breast reconstruction is a very personal, highly individualized process, so Dr. Kim will create a personalized surgical plan to meet your specific needs. He is always more than willing to answer additional questions and engage in further discussion. He has over 10 years of experience with breast cancer patients, so he sincerely understands the emotional upheaval women face after loss of their breast(s). He will serve as your guide, mentor, and friend throughout your treatment.
Breast Reconstruction Recovery
Immediately after surgery, bandages and/or gauze will be applied to your surgical incisions and a support bra will be put in place to decrease swelling and add support for your new breasts. A few small tubes will be temporarily placed underneath the skin to act as drains for excess blood or fluid that your breasts will release during the first few weeks of recovery. You may also have a pain pump put in place.
When you meet with Dr. Kim for the first time after surgery, he will discuss expectations for the recovery period, in terms of activity limitations, medications, further post-op visits, and steps you can take to aid healing and reduce risk of post-operative complications like infection. Following his instructions is of the essence, so as not to endure any pain associated with non-healing surgery incisions.
The healing process will occur over several weeks, during which time swelling and pain will decrease gradually, mirrored by an improvement in breast shape and position. With time, you may experience a return in breast sensation as well as scar improvement. The final outcomes you achieve with your reconstruction experience can help ameliorate the emotional impact of losing your breast(s) and can help you look and feel whole again.
Breast Reconstruction Procedures
There are several types of breast reconstruction surgery; a brief overview is listed below. For more information about the benefits and risks of each type, please click the hyperlinks below.
Tissue Expander/Implant Reconstruction
- A tissue expander is placed in order to allow for gradual stretching of breast skin and tissue, preparing for the placement of a permanent implant
- Tissue expansion and subsequent implant placement mean a much easier recovery than flap-based modalities, but it is a longer total reconstruction process because it involves more surgeries
- It requires many office visits over the 4 to 6 months after expander placement for the purpose of gradual skin expansion via frequent small fills of the expander through a valve
- During the “exchange” surgery, the inflated tissue expander is removed and replaced by a permanent breast implant
- The permanent implant can be saline or silicone-based
- Dr. Kim has written a multitude of original articles of tissue expander/implant breast reconstruction. Here are several examples of his recent work:
- Tissue Expander Breast Reconstruction Using Prehydrated Human Acellular Dermis
- Dual-Plane Tissue Expander Reconstruction with Acellular Dermal Matrix
- Acellular Dermis-Assisted Breast Reconstruction with the use of Crescentric Tissue Expansion: A Functional Cosmetic Analysis of 40 Consecutive Patients
- Patient-Subjective Cosmetic Outcomes Following the Varying Stages of Tissue Expander Breast Reconstruction: The Importance of Completion
Abdominal Flap Reconstruction
- Abdominal flap reconstruction surgery means taking a woman’s own skin, fat, and muscle from a donor site and re-creating the breast mound using this tissue
- When the mastectomy or radiation therapy does not leave enough viable tissue on the chest to cover/support an implant, it is common to use the patient-provided tissue instead
- A TRAM flap employs donor tissue from the patient’s abdomen. The flap can either remain attached to the original blood supply and be tunneled up through the chest wall, or it can be completely detached and relocated to the breast mound
- DIEP or SIEA flap techniques are other flap techniques, but they do not use muscle; they involve transporting tissue to the chest from the abdomen or buttock
- The latissimus dorsi flap option employs tunneling (not detaching) muscle, fat, and skin from the back to the breast mound while leaving the blood supply intact
- Sometimes the latissimus flap alone can create the complete breast mound, but often it supplies just enough donor tissue to support a breast implant requiring additional coverage
- Visit a latissimus flap-related eMedicine article Dr. Kim wrote here.
- The nipple is commonly removed during the mastectomy surgery. Grafting, tattooing, and other innovative techniques are used to create a nipple and areola after all other stages of breast reconstruction are complete.
Expansion Process (FAQs)
When will I have my first tissue expansion?
Typically, 1-2 weeks after tissue expander placement surgery.
Will the expansions hurt?
You will likely have some discomfort in your breast area after expansion. You can ameliorate the effects with Tylenol or Ibuprofen, but please discuss use of these over-the-counter medications with your oncologist.
How often will I need to come to the office for expansions?
Expansions commonly occur every 1 or 2 weeks. However, if you prefer to space them out further due to pain or discomfort, you can certainly do that. You should feel free to discuss your optimal expansion schedule with Dr. Kim and his nurses to come up with a regimen that works best for you.
I have to have chemo, so can I expand during that time or do I have to wait till chemo is over?
You can receive expansions throughout your chemotherapy. If you complete your expansions prior to chemo completion, however, you will have to wait to have your tissue expander/implant exchange surgery until after chemo (and radiation, if applicable) is complete.
I have to have radiation. How will this therapy affect my expansions?
Radiated tissue can be tricky. It is often quite difficult to expand, so we try to expand you as much as possible prior to your first radiation treatment. You will not receive any expansions during radiation. After radiation, if you still need expansions, you will return to the office six weeks after your last radiation session to resume expansions. Depending on your anatomy, it may be the case that your radiated skin cannot handle further expansion, in which case you will likely have to opt for a smaller implant or possibly convert to a flap-based reconstruction. Radiation’s effects on breast reconstruction are often unpredictable, and Dr. Kim adjusts his treatment on a case by case basis.
I need an MRI and a CT scan, and I have expanders in place. Can I have these scans?
You can NOT have an MRI if you have an expander because the expander contains a metal port that is contraindicated for MRI diagnostics. You may, however, safely have a CT scan with an expander in place.
Can I safely travel with an expander in place?
You may travel with expanders. If you are traveling by plane, let us know so we may provide you with a physician’s note informing the airport security employees that your expander contains metal.
How long is the expansion process?
Patients receive 3-6 expansions on average. Every patient is different, however, and the number of expansions often depends on how big or small you desire your final breast volume to be. Typically, when we reach your desired size, we will expand 1-2 more times so as to comfortably accommodate the permanent implant.
Can I exercise while I have an expander?
This is a conversation to be had on a case by case basis with Dr. Kim, as every patient’s restrictions are different.
What signs or symptoms should I be concerned about?
If you experience a fever greater than 101.5 degrees, acute pain, chills, incisional bleeding or discharge, sudden swelling, or redness that spreads all over your breast(s), please call Dr. Kim’s office immediately. Please be prepared to take and email a picture to Dr. Kim or his nurses so they may better assess your condition as quickly as possible.
Schedule your Consultation for Breast Reconstruction Chicago
If you would like to learn more about breast reconstructive surgery or any of the other plastic and reconstructive surgery procedures that Dr. John Kim provides, contacting our Chicago office today.