Breast Reconstruction Surgery

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1 Breast Reconstruction Surgery

2 Breast Cancer Centre of Hope Breast Cancer Navigator Toll-free in Manitoba

3

4 Types of mastectomies Steps of breast reconstruction Breast reconstruction options Preparing for surgery Getting support along the way

5 Breast Reconstruction Information Session offered at Breast Cancer Centre of Hope Types of breast reconstruction Your hospital stay Recovery Follow-up care

6 Breast Reconstruction Information Session Breast Cancer Centre of Hope Toll-free in Manitoba

7 What is a mastectomy?

8

9 Non-Skin Sparing Mastectomy Done when: You choose not to have reconstruction Used with implant reconstruction Option to do delayed reconstruction

10 Non-Skin Sparing Mastectomy Skin and breast tissue are removed S-shaped scar

11 Delayed Reconstruction Advantages o Cancer treatment done first o Time to consider your options o Wear a breast prosthesis while you decide Disadvantages o You will be without a breast o Bigger and more noticeable scars o 1-2 year wait to have reconstruction

12 Skin sparing mastectomy Circular scar Breast tissue, nipple and areola are removed Skin pocket

13 Immediate Reconstruction Advantages o One surgery o Reconstruction begins right away o Less scarring Disadvantages o Delay in starting your cancer treatmentsmay need a longer time to heal o Radiation can cause some breast shrinkage

14 3-6 month wait between each step of reconstruction Whole process of reconstruction takes 1-2 years

15 Immediate Breast Reconstruction Steps: Surgery Mastectomy and Reconstruction Cancer treatments (if needed) Revision surgeries Making a new nipple Tattooing the nipple and areola

16 One Breast Reconstructed 4-5 hours New breast will be swollen and bruised The new breast is made larger as it will shrink with healing and/or radiation Your breast will be made to look the same after you are healed and finished treatment if it is needed

17 Two Breasts Reconstructed 6-8 hours May need a surgery to make the breasts look the same

18 3-5 days Hospital Stay

19 Cancer Treatment (if needed) May include: Chemotherapy Targeted Therapy Radiation Therapy Anti-hormonal therapy

20 Revision surgeries may include: Fixing the scars Liposuction

21 Revision Surgeries May need more than one surgery May need general anesthetic Day surgery

22 Making A New Nipple Cutting and folding skin Day surgery: minutes Heals in 3-6 months Stays numb (no feeling)

23 Tattooing the Nipple and Areola Use makeup ink Colour gets lighter (fades) over time Tattoo can be touched up if you wish

24 Types of Reconstruction Tummy Tissue Buttock Tissue Thigh Tissue (not used much) Back Muscle / Implant Tissue Expander / Implant

25 Sometimes using your own tissue is not recommended Being overweight History of certain abdominal operations Diabetes Heart problems Lung problems Clotting problems Chronic back pain Previous tummy tuck/ liposuction Smoking

26 Option 1: Tummy Tissue Reconstruction (DIEP/SIEA)

27 The flap Skin-sparing Breast Reconstruction Using the Tummy

28 Skin-sparing Breast Reconstruction Using the Tummy DIEP blood vessels DIEP vessels

29 Skin-sparing Breast Reconstruction Using the Tummy Breast pocket Removed piece of rib

30 flap blood vessels flap chest blood vessels

31

32

33 This picture was taken 6 months after her first revision surgery.

34

35 Risks and Complications 1-2% risk of total failure 4-5% risk of requiring a second operation 1% risk of abdominal bulge or hernia Infection/bleeding/bruising Blood clots

36 Signs and symptoms of a blood clot Pain, swelling or a hot spot in calf Shortness of breath Restlessness/sense of panic If you have these symptoms go to the emergency department

37 Option 2: Buttock Tissue Reconstruction SGAP/ IGAP

38 Breast Reconstruction Using the Buttock Tissue

39 Breast Reconstruction Using the Buttock Tissue The buttock flap is removed

40 The Buttock Incision is Sewn Closed Takes 4-6 weeks for the incision to heal before you can sit May need revisions to the buttocks to make them the same shape and size

41 Buttock Flap Moved up to Chest into the Skin Pocket The blood vessels will be sewn together A piece of buttock skin will close the centre of the new breast.

42 Option 3: Thigh Tissue Reconstruction (TUG)

43 Breast Reconstruction Using the Thigh Tissue The incision is made from the front of the thigh and goes around to the inner thigh to the back side A piece of thigh skin will close the centre of the new breast Recovery: Keep your knees together at all times and no sitting Takes 4-6 weeks for the incisions to heal before you can sit

44 Option 4: Back Muscle Reconstruction with Implant (Latissimus Dorsi)

45 Latissimus Dorsi

46 Back muscle connected to chest muscle to create a pocket for implant

47 Muscle and piece of skin taken from the back Skin will be used to close the centre of the new breast Large scar wraps around the back near the bra line Fades with time

48 Option 5: Tissue Expander Implant Reconstruction

49 Tissue Expander

50 Tissue Expander Skin Pectoralis Major Muscle Pocket created for expander

51

52 Permanent Implant Expander removed during day surgery Permanent implant inserted 2 weeks recovery

53 Risks and Considerations of Implant Reconstruction 30-40% risk of complications May include infection or hardening of the tissue (capsular contraction) Will eventually need replacing Radiation increases the risk of damage to the implant Works best when two breasts are reconstructed Works best for smaller to medium sized breasts

54 Reconstruction techniques may change over time and vary between plastic surgeons. Contact the Breast Cancer Navigator at Breast Cancer Centre of Hope for more information: Toll-free in Manitoba

55 Preparing for Surgery

56 things to avoid Avoid smoking for 6 weeks before and after surgery Try to avoid caffeine before surgery to avoid withdrawal headaches and avoid 3 weeks after surgery

57 Special Bra and Undergarments Prescription given by plastic surgeon Can claim under private insurance and/or income tax Buy two of each type of undergarment needed Given a list of where to buy undergarments Bring the undergarments with you to the hospital

58 Special Bra and Undergarments Supports the new breast/breasts and area where the tissue was taken from for your reconstruction Helps with healing and to reduce swelling

59 Surgical Bra

60 Surgical Bra No seams or underwire Closes in the front Fits well around your body and below your breasts Wear the bra 24 hours per day for approximately 3 months after surgery Can take it off to shower

61 Abdominal Binder

62 Abdominal Binder Try it on Must fit low down on the tummy and around the top of the buttocks Supportive but not too tight Adjustable with Velcro Wear the binder 24 hours per day for approximately 4 weeks after surgery Can take it off to shower

63 Support Vest Back Muscle Reconstruction

64 Support Shorts Thigh and Buttock Reconstruction

65 What to Bring to the Hospital Toothbrush Comb Slippers/Housecoat Loose pants Button or front zip top Bra and binder or garments required Health card/insurance card Medication list and allergy lists

66 Blood pressure, heart rate, temperature Intravenous (I.V.) Medications Contact information

67 Surgical Markings

68 Getting Support Along the Way

69 Social Worker Adjustment to illness Decision making Financial resources Community resources Groups Expressing your fears, worries, feelings Communicating with your family Navigating the health care system

70 Social Worker WRHA Breast Health Centre Toll-free in Manitoba

71

72 Peer Support Toll-free in Manitoba

73 Breast Reconstruction Information Session offered at Breast Cancer Centre of Hope Types of breast reconstruction Your hospital stay Recovery Follow-up care

74 Breast Reconstruction Information Session Toll-free in Manitoba

75 Breast Cancer Centre of Hope Breast Cancer Navigator Toll-free in Manitoba

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