Breast Reconstruction Surgery
Breast Cancer Centre of Hope Breast Cancer Navigator 204-788-8080 Toll-free in Manitoba1-888-660-4866
Types of mastectomies Steps of breast reconstruction Breast reconstruction options Preparing for surgery Getting support along the way
Breast Reconstruction Information Session offered at Breast Cancer Centre of Hope Types of breast reconstruction Your hospital stay Recovery Follow-up care
Breast Reconstruction Information Session Breast Cancer Centre of Hope 204-788-8080 Toll-free in Manitoba 1-888-660-4866
What is a mastectomy?
Non-Skin Sparing Mastectomy Done when: You choose not to have reconstruction Used with implant reconstruction Option to do delayed reconstruction
Non-Skin Sparing Mastectomy Skin and breast tissue are removed S-shaped scar
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
Skin sparing mastectomy Circular scar Breast tissue, nipple and areola are removed Skin pocket
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
3-6 month wait between each step of reconstruction Whole process of reconstruction takes 1-2 years
Immediate Breast Reconstruction Steps: Surgery Mastectomy and Reconstruction Cancer treatments (if needed) Revision surgeries Making a new nipple Tattooing the nipple and areola
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
Two Breasts Reconstructed 6-8 hours May need a surgery to make the breasts look the same
3-5 days Hospital Stay
Cancer Treatment (if needed) May include: Chemotherapy Targeted Therapy Radiation Therapy Anti-hormonal therapy
Revision surgeries may include: Fixing the scars Liposuction
Revision Surgeries May need more than one surgery May need general anesthetic Day surgery
Making A New Nipple Cutting and folding skin Day surgery: 30-45 minutes Heals in 3-6 months Stays numb (no feeling)
Tattooing the Nipple and Areola Use makeup ink Colour gets lighter (fades) over time Tattoo can be touched up if you wish
Types of Reconstruction Tummy Tissue Buttock Tissue Thigh Tissue (not used much) Back Muscle / Implant Tissue Expander / Implant
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
Option 1: Tummy Tissue Reconstruction (DIEP/SIEA)
The flap Skin-sparing Breast Reconstruction Using the Tummy
Skin-sparing Breast Reconstruction Using the Tummy DIEP blood vessels DIEP vessels
Skin-sparing Breast Reconstruction Using the Tummy Breast pocket Removed piece of rib
flap blood vessels flap chest blood vessels
This picture was taken 6 months after her first revision surgery.
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
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
Option 2: Buttock Tissue Reconstruction SGAP/ IGAP
Breast Reconstruction Using the Buttock Tissue
Breast Reconstruction Using the Buttock Tissue The buttock flap is removed
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
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.
Option 3: Thigh Tissue Reconstruction (TUG)
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
Option 4: Back Muscle Reconstruction with Implant (Latissimus Dorsi)
Latissimus Dorsi
Back muscle connected to chest muscle to create a pocket for implant
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
Option 5: Tissue Expander Implant Reconstruction
Tissue Expander
Tissue Expander Skin Pectoralis Major Muscle Pocket created for expander
Permanent Implant Expander removed during day surgery Permanent implant inserted 2 weeks recovery
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
www.breastreconstructionprogram.com 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: 204-788-8080 Toll-free in Manitoba 1-888-660-4866
Preparing for Surgery
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
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
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
Surgical Bra
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
Abdominal Binder
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
Support Vest Back Muscle Reconstruction
Support Shorts Thigh and Buttock Reconstruction
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
Blood pressure, heart rate, temperature Intravenous (I.V.) Medications Contact information
Surgical Markings
Getting Support Along the Way
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
Social Worker WRHA Breast Health Centre 204-258-1004 Toll-free in Manitoba 1-888-501-5219
Peer Support 204-788-8080 Toll-free in Manitoba 1-888-660-4866
Breast Reconstruction Information Session offered at Breast Cancer Centre of Hope Types of breast reconstruction Your hospital stay Recovery Follow-up care
Breast Reconstruction Information Session 204-788-8080 Toll-free in Manitoba 1-888-660-4866
Breast Cancer Centre of Hope Breast Cancer Navigator 204-788-8080 Toll-free in Manitoba 1-888-660-4866