Treatment

Breast Reconstruction

Breast reconstruction is an important part of the treatment plan at the OSUCCC – James, and we have unparalleled expertise in providing this type of care.

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For many people diagnosed with breast cancer, the emotional distress of living with the illness can be heightened by concerns about physical changes that may occur during treatment.

You might worry about what your breasts and chest area will look like following a mastectomy or lumpectomy to remove the cancer. That’s why we believe breast reconstruction can be an important part of breast cancer recovery for many. Our plastic surgery experts, who specialize in reconstructive techniques during and after breast cancer surgery, can help restore the physical breast shape and give you greater confidence as you move forward following breast cancer treatment.

Choosing to have breast reconstructive surgery is a deeply personal choice, so it’s important to work with dedicated breast experts who can best explain your options and walk you through the process of deciding whether it’s right for you.

We want to help you reestablish a sense of wholeness as you navigate life following cancer treatment. If breast reconstruction is one way we can do that, we’re here to offer the best and most expert care possible.

What is breast reconstruction?

Breast reconstruction is surgery to restore the physical appearance of the breasts following a mastectomy or lumpectomy. This includes restoring breast symmetry, addressing any volume loss and assessing the overall breast shape.

These goals are typically accomplished through one of three methods: implant-based reconstruction, tissue-based (flap) reconstruction or a combination of the two. One uses prosthetic implants whereas the other uses tissue, such as fat and skin, from another part of your body to reconstruct the breasts.

When breast reconstruction is coordinated with a multidisciplinary team, there is a relatively low risk of complications and minimal interference with other breast cancer treatments. Breast reconstruction does not increase the risk of breast cancer.

Many people believe breast construction is done for cosmetic purposes, but this is a myth. Reconstructive surgeries for the breast can improve the quality of life of those living with breast cancer.

When does breast reconstruction take place?

By including consultation for reconstruction as part of your overall treatment plan, you’ll have the opportunity to make informed choices about your desired outcomes. Based on these needs, as well as your unique medical history, we’ll recommend one of the following:

Immediate reconstruction, performed at the same time as the mastectomy or lumpectomy
Delayed reconstruction, performed after recovery from the mastectomy or lumpectomy is complete; if radiation is part of the treatment protocol, the surgeon may recommend delayed reconstruction

Breast reconstruction can take place months or even years after your breast cancer surgery, giving you ample time to make decisions.

We offer early reconstruction consultations immediately following a breast cancer diagnosis to allow our surgeons to participate in your care from the outset and create a reconstruction plan that works best for you.

Using living tissue for breast reconstruction

Why should I have my breast reconstructive surgery at the OSUCCC – James?

Having specialized reconstructive plastic surgeons involved early in the process is just one of the many reasons why the OSUCCC – James excels at providing breast reconstructive surgery with exemplary results. Other reasons include:

A multidisciplinary team – Our plastic surgeons collaborate with radiation oncologists, medical oncologists and surgical oncologists from the moment of diagnosis to ensure your reconstruction needs are met as part of your comprehensive recovery plan.
Unparalleled experience – The OSUCCC – James breast reconstruction team performs hundreds of breast reconstruction procedures each year and is nationally recognized as one of the most experienced in the country.
Specialized training in microsurgery – All breast reconstruction specialists at The James have undergone additional specialty training (fellowships) in microsurgery, allowing them to excel in tissue-based reconstruction surgeries.
Surgeries not offered elsewhere – We perform several types of flap surgeries that are offered by only a few centers in the country, giving you more options to choose from that might better suit your goals.

Who is a candidate for breast reconstruction?

Breast reconstruction is available to nearly everyone who undergoes surgical treatment for breast cancer — both from a physical and financial standpoint. (Federal legislation dictates insurance companies must cover breast reconstruction following cancer surgery or surgery performed to reduce the risk of breast cancer. This legislation also covers symmetry procedures on the opposite breast.)

While you might not be a candidate for all types of reconstruction, most people are a candidate for at least some form of breast reconstruction, regardless of age, medical history or cancer.

For example, you might not be a candidate for certain flap surgeries that use tissue from your stomach if you’ve had prior abdominal surgery but might still be a candidate for tissue flaps from other parts of the body or implant-based reconstruction.

Types of breast reconstructive surgery

What type of breast reconstructive surgery you’ll have depends on a variety of factors, including one’s body, cancer type, medical history, personal goals and need for other therapies.

That’s why it takes a multidisciplinary team of cancer and plastic surgery experts all familiar with your case to determine what might work best for you.

Dr scrubbing into surgery

Our expert breast reconstruction team is skilled in numerous procedures, including:

Implant-based reconstruction using breast implants or tissue expanders followed by an exchange for a permanent breast implant
Tissue-based (flap) breast reconstruction
- DIEP (deep inferior epigastric artery perforator)
- GAP (gluteal artery perforator)
- LAP (lumbar artery perforator)
- PAP (profunda artery perforator)
- TUG (transverse upper gracilis)
- SIEA (superficial inferior epigastric artery)
- LD (latissimus dorsi) with or without a breast implant for added volume
Oncoplastic breast reconstruction (used after a lumpectomy)
Nipple-areolar reconstruction

Surgery can also happen on the opposite breast as a balancing procedure, if needed, to achieve breast symmetry.

Preparing for breast reconstructive surgery

Once you and your doctors have made the decision to move forward with breast reconstruction and chosen what type, you’ll begin preparing for the surgery. This may include:

Stopping smoking
Avoiding certain medications, like aspirin, that increase bleeding
Arranging rides to and from the hospital
Not eating or drinking the night before surgery for general anesthesia

You can also work with one of our team members to ensure you understand your insurance coverage as it relates to reconstructive surgery and any out-of-pocket costs.

What happens during breast reconstructive surgery?

You’ll be under general anesthesia for the surgery, meaning you’ll be asleep and won’t feel any pain. What occurs during reconstructive surgery depends on the type of surgery you have.

Breast reconstruction surgery

Reconstruction after mastectomy

With a mastectomy, a surgical oncologist removes the entire breast, leaving behind most or all of the skin envelope. In these cases, the breast can be reconstructed using either tissue-based (flap) or implant-based techniques, or a combination of both.

Flap procedures usually take several hours to do, but since it’s your own tissue it typically does not require any maintenance in the future. If you’re having a flap surgery:

Tissue will be removed from another part of your body.
The new breast is created using this tissue.
Incisions in both the flap origin site and the chest area will be closed using stitches or other methods.
You’ll wake up in a recovery room.

Implant-based surgeries can be quicker but typically require long-term follow-up and replacement in the future. If you’re having implant surgery:

Sometimes the implant is placed in one reconstructive surgery (direct-to-implant), and sometimes a tissue expander is placed at the initial surgery and the implant replaces the tissue expander at a second surgery.
If a tissue expander is used, a saline solution is injected into the expander in the office over several weeks or months to stretch the tissue until the desired volume is obtained. Then, the second surgery occurs to insert the implant and remove the expander.
When an implant is placed in one surgery, no tissue expander is needed.

Reconstruction after lumpectomy

With a lumpectomy, a surgical oncologist removes the area of breast cancer but preserves the surrounding breast tissue.

In some cases, after lumpectomy, a reconstructive surgeon can rearrange the remaining breast tissue to reshape the breast. This typically involves some reduction in the size of the breast and lifting of the breast. Usually, a balancing procedure is also performed to the opposite breast to maintain symmetry.

Recovery from breast reconstructive surgery

Recovery time can vary depending on the type of surgery you had, when you had it and your overall health. Often, this surgery can be done on an outpatient basis, meaning you can go home the same day or after only one night in the hospital. Tissue-based (flap) surgeries typically require a hospital stay of one to three nights.

You may be sent home with drains still in place and will have to return to the clinic to have them removed. You’ll feel sore and fatigued for a week to two weeks following implant surgery, and this could continue longer for flap surgeries, since you have surgical sites in two places.

Most people who have breast reconstruction will be able to return to normal activity in six to eight weeks, but it could take up to a year for scars to fade. Loss of sensation can be associated with some surgeries.