Vanderbilt Breast Center

Plastic Surgery & Reconstruction


 

Types of Plastic and Reconstructive Surgery

If you have had a mastectomy, you have the option to undergo breast reconstruction. Two major types are implant and natural tissue reconstruction. If you choose implant reconstruction, a silicone gel (an artificial material that feels like a natural breast) or saline (salt water) fills a silicone pouch that is typically inserted through your mastectomy scar. Natural tissue reconstruction typically uses either abdominal tissue or tissue from the back. Breast reconstruction can involve one or two stages. The number of stages usually depends on your breast size. Placing a tissue-expanding device that resembles an empty balloon with a front-wall valve is part of the first stage. In the second stage, the tissue expander is replaced with an implant.

Silicone Gel v. Saline
Deciding between saline and silicone implants can be discussed between you and your doctor. Many plastic surgeons believe that silicone-filled implants look and feel more natural than saline implants, but if silicone gel leaks, it’s harder to detect because your breast tends to look and feel the same. When a saline device fails, the reconstructed breast typically goes flat.

Nipple Reconstruction
Once you’ve undergone breast reconstruction, you have the choice to have additional surgeries to make your breasts look as natural as possible. You may choose to have nipple and areola reconstruction. To create a nipple, your surgeon takes a small flap of skin from the breast and molds it into a cone shape. You also have the option to apply removable, adhesive nipples that are semi-erect with a lifelike color and texture. If you’re interested in reconstructing your areola, this procedure involves taking skin from a different area of your body and sewing it into the new nipple on your reconstructed breast. You could also tattoo the area a darker color around the reconstructed nipple. If you choose to undergo any of the nipple reconstruction procedures, it has to be at least three months after your breast reconstruction, and please be aware that you will not have much if any feeling when it’s touched.

Other Breast Surgeries
Breast lifts, augmentations and reductions can also be performed once you have undergone breast reconstruction in order to balance your breast sizes and shapes. To learn more about these surgical procedures, please visit Vanderbilt Cosmetic Plastic Surgery.


 

What to Expect

You can expect your first surgery to take about one to two hours in order to place the tissue-expanding device. Please note that the side of your chest will be mostly flat at the end of your surgery. Tissue expander placement does not add any additional time to the one day hospital stay that is associated with mastectomy. If the expander is placed at a later time, it is usually an outpatient operation. Tissue expansion will usually begin 7 to 21 days after your first surgery. You will be asked to visit your doctor every one to two weeks after your surgery in order for he or she to inject saline through the overlying skin into the valve located on the front wall of the tissue expander. These injections will gradually inflate the expander. Basically, the tissue expander develops the breast mound. You might experience some soreness, tightness or discomfort for a few days after each inflation appointment.

Once your breast has reached the appropriate size, you will undergo your second operation to receive the actual implants. The implants are placed under a layer of muscle to be sure your new breast has the most natural shape and feel. This surgery typically lasts one to two hours and does not require an overnight stay in the hospital. You are likely to feel tired and sore for one to two weeks. Normal sensation to the breast cannot be restored, but some feeling may return in time. The scars you have after surgery typically fade over one to two years, and it is important to realize that your reconstructed breast will not match your natural breast’s appearance.

Post-Surgery Instructions 

  • Someone will need to drive you home after the surgery as well as help you at home for one to two days.
  • You will need plenty of rest after the procedure.
  • Increase fluid intake and eat more raw fruit to help with constipation.
  • Take pain medication as prescribed, and DO NOT take aspirin or any products containing aspirin unless approved by your surgeon.
  • Smoking delays healing and puts you at risk for complications.
  • Do not drink alcohol when taking medications.
  • Start walking as soon as you’re able to help reduce swelling and the chance of blood clots.
  • Do not drive while you’re taking pain medication.
  • Do not drive until your arms have full range of motion.
  • Discuss your time off from work with your surgeon.
  • Overhead lifting, strenuous sports and sexual activity are discouraged for three to six weeks after surgery.
  • You may shower 48 hours after you have removed the drainage tubes.
  • Exposing your scars to the sun should be avoided for at least 12 months.
  • Use sunblock with SPF 30 or greater if the sun is unavoidable.
  • Steri-strips should be left on.
  • Keep incisions clean and inspect daily for infection.
  • Do not soak in the bathtub while sutures or drains are in place.
  • If surgical drain was used, it will be removed one to two weeks later when output is less than 30 cc for two days.
  • Stitches are usually removed in seven to 10 days.

What We Offer

The Vanderbilt Breast Center offers several types of plastic surgery operations that can be done to reconstruct your breast after a mastectomy. These include: expander/implant reconstruction as well as your-own-tissue reconstructions. The tissue reconstructions include the TRAM flap (abdominal tissue) or tissue from the back, buttock or inner thigh. The Vanderbilt Department of Plastic Surgery also performs the Deep Inferior Epigastric (DIEP) Reconstruction.

Non-surgical Options
If you’re interested in non-surgical options for breast reconstruction, Pretty in Pink Boutique, adjacent to the Breast Center, offers prosthetics and provides a personal fitting with a registered nurse.

 

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