What percentage of women with breast cancer decide to have a breast reconstruction following mastectomy?

Recent studies show that approximately 15 percent of these women undergo breast reconstruction. This low percentage is explained by the lack of information, and sometimes misguidance of patients receiving treatment for breast cancer. However, today, more and more women are seeking breast reconstruction because it is easier to find reliable information.

Is it possible to know in advance how will the reconstructed breast look like after surgery?

Generally, your breast reconstructive surgeon may show you the clinical photographs before and after reconstruction in patients with similar physical characteristics(anonymous). However, remember that these images can give only a rough idea of the reconstruction results as each patient is physically different, treatment protocol for the specific cancer may be different as well as tissues and the healing process.

Is it necessary to have surgery for the opposite breast?

The goal of reconstructive surgery is to achieve the best result not only for the reconstructed breast but the whole female figure. Therefore, it is often advisable to reduce the other breast, heighten the nipple and areola (mastopexy) to get a more youthful appearance) or even increase the size of other breast. In our hands, this procedure is usually done at the same time with the reconstruction to avoid subjecting the patient to further surgery in the future.

What are the common risks in case of breast implant, tissue expansion, and latissimus dorsi muscle and DIEP flap reconstruction?

Risks common to all three techniques are: altered skin sensations, abnormal scarring which may require subsequent surgical correction, asymmetry between breasts, and skin necrosis.

In procedures involving prostheses (breast implants), it is more difficult to obtain symmetrical breasts, because changes in patients’ weight over time may cause variations in terms of size, shape and position between the breast tissue and implant.
In the technique of tissue expansion possible complication is extrusion of the implant (expander or silicone implants) due to wound breakdown or infection. Complete implant extrusion through the skin requires implant removal. Intolerance may also be material.

In the reconstruction with the latissimus dorsi, there may be a delayed healing and, by sacrificing the latissimus dorsi muscle there could be difficulties to practice certain types of sports or physical exercises such as tennis or climbing. In addition, necrosis of the flap can be total or partial. However, the most common complication lies in the formation and accumulation of fluid (seroma) on the donor site (back), which can become infected and / or cause delayed healing in the overlying skin, so it must be drained as often as necessary by needle aspiration over a longer period of time.

As for the DIEP, specific risks are potential changes in abdominal tenderness, and abnormal scarring in the abdomen. The most serious risk, although rare, and in our hands less than 1 percent , is a partial or total loss of the flap-reconstructed breast.
In addition, the three techniques require reconstructive surgery of the areola and nipple. And in this case, the specific risks of this intervention are abnormal disruption of the scar, nipple necrosis and altered pigmentation of the areola.

When can we reconstruct the areola and the nipple?

The reconstruction of the areola and nipple (nipple areola complex), and any other change or improvement in the size or shape of the reconstructed breast, should be performed when the reconstructed breast tissue has stabilized at its new location. Therefore, the exact timing of these procedures depends on the evolution and recovery of each patient. Normally this can be done between four and six months after breast reconstruction. The procedure is performed as an outpatient procedure under local anesthesia.

Can you improve the scar appearance?

The final result depends on the skin quality, however, the use of silicone dressings, when applied to the scars, may improve the final appearance by what is known as acupressure. Similarly, there are cosmetics, oils and creams that can support this process. In addition, there may be a role for laser techniques to improve the final aesthetics. In summary, compression, cosmetic and laser-employed according to the progress of each case; provide a very good aesthetic result in the vast majority of cases and help scars to permanently stabilize within a year.

What is the likehood for cancer recurrence in the reconstructed breast?

Relapse or recurrence of cancer depends on the type of tumor, its size and the number of nodes involved. Therefore, the reconstruction does not interfere on the type of treatment and trends over time and cannot delay the detection of recurrence.

Is a mammogram necessary in the reconstructed breast?

It is not necessary since there is no breast gland tissue left following mastectomy.

When can I start with sunbathing?

Approximately two months after reconstruction but only with extreme sun protection. Without the sun protection, it is advisable to wait for a year.

When can I use the bra after DIEP?

The second day after surgery. During the first few weeks you have to use a sports type of bra day and night. Then, for a limited time, you can start using other models, but no rims or seams as these may injure the reconstructed breast. Finally, after 3-4 months, you can choose and wear the lingerie of your choice.

How many days is prudent to wait before travelling?

Three or four weeks for longer trips. However, for short distances , you can travel after a week following your surgery.

How many days should I avoid driving or lifting heavy objects?

Two to three weeks.

Can I use the bathtub or shower for the first few days after surgery?

We recommend quick shower keeping the wounds dry.

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