After mastectomy, breast reconstruction uses plastic surgery techniques to restore a breast to near-normal shape and appearance. The procedure can be done at different stages in cancer removal, depending on what best suits your circumstances.

Immediate breast reconstruction is performed on the same day as your mastectomy and may include breast implants or an autologous DIEP flap. Many patients will experience significant psychological benefits because they do not have to wait months for their follow-up procedure to see the surgery results.

What is Immediate Breast Reconstruction?

Breast reconstruction at the same time as mastectomy surgery is called immediate reconstruction. When the oncology surgeon removes the breast, your plastic surgeon reconstructs it with tissue from another location on your body or an implant. Nearly all the work is done during one operation, and you wake up with a rebuilt breast.

Immediate reconstruction may not be possible if you need additional treatments such as radiation or chemotherapy; your surgeon might recommend waiting until after these treatments are finished before starting reconstruction. Alternatively, they may suggest doing part of the reconstruction immediately and finishing the reconstruction after chemotherapy or radiation. However, if you have a mastectomy to reduce the high risk of breast cancer, reconstruction is always done immediately.

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You might be a candidate for immediate breast reconstruction surgery if you:

  • Have a smaller tumor
  • Have a non-invasive tumor that is not directly beneath the nipple or areola will
  • Carry the BRCA gene and are undergoing a preventative mastectomy
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What to Expect Before and During Surgery

Dr. Rancati will evaluate your medical status and history during your consultation to determine which surgical method will be your best option.

Unless there is a specific cancer-related reason to remove the nipple and areola, most women choose a nipple-sparing mastectomy in which the mastectomy surgeon removes the entire contents of the breast through an incision in the natural fold under the breast.

This surgical technique preserves all of the breast skin, the nipple, and the areolar complex so the implant can be placed immediately. This eliminates the need for tissue expansion and a second reconstructive procedure to create a new nipple-areolar complex.

In preparing for breast reconstruction surgery, you may be asked to:

  • Get lab testing or additional medical evaluation
  • Take certain medications
  • Adjust your current medications
  • Stop smoking
  • Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements that increase the risk of bleeding

Immediate breast reconstruction surgery is generally performed in a hospital setting using general anesthesia and may include a short hospital stay. However, Dr. Rancati may perform follow-up procedures on an outpatient basis, and local anesthesia with sedation may be used instead.

Once the mastectomy is complete, the reconstruction will be performed immediately. Dr. Rancati uses a permanent implant that he can adjust after the operation filled with saline inside a silicone shell; silicone breast implants are not generally used for immediate breast reconstruction.

The implant is placed over the chest muscle and filled about three-quarters of the way with sterile saline. By partially filling the implant, the skin heals smoothly without tension and reduces the chance of complications. The implant connects to a port under the skin, allowing it to fill with more saline at The Ariel Center following the procedure. For the most part, just one or two inflations are needed to achieve a uniform appearance, after which the port is removed.

Recovery, results, and when to expect them

After the procedure, an elastic bandage or support bra will minimize swelling while supporting the reconstructed breast. Additionally, a small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.

You will be given specific post-op and recovery instructions that may include:

  • How to care for your surgical site(s) following surgery
  • Medications to apply or take orally to aid healing and reduce the risk of infection
  • Specific concerns to look for at the surgical site or in your general health
  • When to follow up with your plastic surgeon
  • When you can bathe or shower
  • When you can resume regular activities
  • When to return for follow-up care
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Healing continues for several weeks while swelling decreases and the breast’s shape and position improve. 

The final results of immediate breast reconstruction surgery can reduce mastectomy's physical and emotional impact. Some breast skin sensations may return, and scar lines will improve, although they will never disappear completely.

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Any Risks or Side Effects

While immediate breast reconstruction can rebuild your breast, keep in mind that the results are highly variable and have some risks and side effects.

These include:

  • Visible incision lines will always be present on the breast from reconstruction or mastectomy
  • For immediate breast reconstruction using fat transfer, specific surgical techniques will leave incision lines at the donor site
  • It can be harder to detect mastectomy skin problems
  • More extended hospitalization and recovery time compared to having just a mastectomy alone

If you experience shortness of breath, chest pains, or unusual heartbeats, seek medical attention immediately; you may require hospitalization and additional treatment.

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