Breast Reconstruction after Mastectomy

Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures available today. New medical techniques and devices have made it possible for Dr. Cappuccion to create a breast that can come close in form and appearance to your natural bust, and Dr. Cappuccino is frequently able to perform reconstruction immediately following breast removal (mastectomy). This enables the patient to wake up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all.

If you think this procedure might be the right choice for you, reach out to us at our Mount Airy, Maryland office and set up your in-person consultation today.

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The Best Candidates for Breast Reconstruction

Most mastectomy patients are medically appropriate for reconstruction, which can even be performed at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.

Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the options while they're struggling to cope with a cancer diagnosis. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if the breast is being rebuilt in a more complicated procedure using flaps of skin and underlying tissue. Women with other health conditions, such as obesity, high blood pressure, or smoking may also be advised to wait.

During your consultation, Dr. Cappuccino will work closely with you to determine the best course of action. This is a highly personal and sometimes sensitive decision, and Dr. Cappuccino will call upon his vast experience and high level of training to guide you through the process.

Before & After

Associated Risks and Uncertainties

Virtually any woman who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure.

In general, the usual surgical complications—such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia—can occur. They are, however, relatively uncommon, and their likelihood is reduced even further by Dr. Cappuccino’s extensive experience. 

As with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.

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Implants

If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.

Capsular Contracture

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or scoring of the scar tissue, or perhaps removal or replacement of the implant.

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Planning Your Breast Reconstruction Surgery

You can begin talking about breast reconstruction as soon as you're diagnosed with cancer. Ideally, you'll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction. After evaluating your health, Dr. Cappuccino will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. He’ll take care to describe your options to you, going over the risks and limitations of each.

You’ll be given very specific instructions on how to both prepare for and recover from your surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed. This is an outpatient procedure, and you’ll return home once it’s complete.

The Breast Reconstruction Surgery

Dr. Guy Cappuccino’s high level of training enables him to offer a few different methods by which he can perform a breast reconstruction procedure. He’ll walk you through the options available to you and help you pick out the treatment that will best meet your goals.

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Skin Expansion

The most common technique combines skin expansion and subsequent insertion of an implant. Following mastectomy, Dr. Cappuccino will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. 

After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.

Flap Reconstruction

An alternative approach to implant reconstruction involves the creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.

In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, is tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.

Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in microvascular surgery as well.

Regardless of technique, this surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant.

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Follow-Up Procedures

Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. 

Dr. Cappuccino may recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. But keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.

After Your Breast Reconstruction Surgery

You are likely to feel tired and sore for a week or two after your breast reconstruction. Most of your discomfort can be controlled by medication prescribed by your doctor.

Depending on the extent of your breast reconstruction in Maryland, you'll probably be released from the hospital in two to five days. Many reconstruction options require a surgical drain to remove excess fluids from surgical sites immediately following the operation, but these are removed within the first week or two after surgery. Most stitches are removed in a week to 10 days.

Getting Back to Normal

It may take you up to six weeks to recover from a combined mastectomy and reconstruction or from a flap reconstruction alone. If implants are used without flaps and reconstruction is done apart from the mastectomy, your recovery time may be shorter.

Breast reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Most scars will fade substantially over time, though it may take as long as one to two years.

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Enjoying Your New Look

Chances are your reconstructed breast may feel firmer and look rounder or flatter than your natural breasts. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast, but these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery. If you’re considering this procedure, reach out to Dr. Cappuccino at his Mount Airy, Maryland location and set up your consultation today.

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