A Guide To Double Mastectomy Breast Reconstruction Surgery

A mastectomy is a medically necessary and often life-saving procedure, but it can also be incredibly traumatic. Removing breast tissue can severely diminish self-esteem and harm mental health as a result. Breast reconstruction can help.

Breast reconstruction surgery will not recreate the exact look of your natural breasts, but it can restore your figure and improve your self-image. There are several types of breast reconstruction, including implants, fat grafting, and flap reconstruction. A qualified plastic surgeon can help you determine what’s suitable for you and your goals.

Below, we will provide a brief guide to breast reconstruction surgery after a double mastectomy.

Preparation For Breast Reconstruction

The first step to breast reconstruction is to book a consultation with a qualified surgeon. During your consultation, you will discuss your medical history and desired outcome. Your surgeon can make recommendations from there on the best treatment path for your individual needs. You will also undergo a medical evaluation – including a physical and routine bloodwork – to ensure you’re healthy enough to undergo surgery.

Your practitioner and surgeon will give you instructions on preparing in the days before surgery. You may need to refrain from eating or drinking for a set period, adjust your medications, and cease the use of alcohol and tobacco.

Your plastic surgeon with often work with a oncological breast surgeon who will be performing the mastectomy. Commonly, the first stage of breast reconstruction is done at the same time as mastectomy. Single sided or bilateral mastectomies are commonly performed today. Bilateral mastectomy is often performed for prophylactic reasons such as a genetic predisposition to develop breast cancer. The one advantage to bilateral mastectomies is a higher likelihood of achieving breast symmetry afterward.

Types Of Breast Reconstruction

Implants

Breast implant placement is the most common type of breast reconstruction, although they are not the only option (more on this below). The procedure typically has two stages.

First, your surgeon places a tissue expander device underneath the skin. During follow-up visits, the expander is slowly filled with saline to expand the tissue and make room for the implant. Second, once the chest tissue has relaxed and healed, your surgeon removes the expander and replaces it with a silicone or saline implant.

However, every patient is different. Some patients may not need a tissue expander before placing the implants.

Autologous/Flap Reconstruction

Autologous reconstruction – also called flap reconstruction – harvests skin, fat, and sometimes muscle from another part of the body and uses it to form a breast mound. There are numerous types of flap procedures, such as:

• Transverse Rectus Abdominus (TRAM): Creates a breast mound with rectus muscles and skin from the lower belly
• Latissimus Dorsi Flap: Uses tissue from the latissimus muscle and skin, located on your back, to create a breast mound
• Endoscopic Latissimus Dorsi Flap: A newer version of the Lattissimus Dorsi Flap procedure that helps reduce incision size, postoperative pain, and scarring
• Deep Inferior Epigastric Perforator (DIEP) and other free flaps: The DIEP flap is a free flap from the lower abdomen. This requires microsurgery to reconnect blood vessels. There are other flaps that can be harvested from other areas of the body for breast reconstruction.
• Fat Grafting: Fat grafting is not a flap. However, it is autologous tissue. Fat is removed from other parts of the body, purified, and then used to construct a new breast. This can be used in conjunction with any of the above surgeries or by itself to create a breast mound. When building a breast from fat grafting alone, it takes multiple surgeries over time to achieve adequate volume. We call this ‘serial’ fat grafting.

These are just a few of the more common flap procedures. During your initial consultation, your surgeon will recommend what is right for you based on factors like your body type, medical history, and personal preferences.

Nipple Reconstruction

After a mastectomy, nipple reconstruction may be a vital part of breast reconstruction. Your surgeon uses skin from the breast to form a nipple, which may then be tattooed to create an areola. However, not every patient needs nipple reconstruction, depending on the type of mastectomy they underwent. A nipple-sparing mastectomy leaves the nipple and areola in place.

Recovery From Breast Reconstruction

Recovery times will vary greatly depending on individual health and the type of reconstruction you underwent. The best way to know what to expect is to talk to your surgeon.

For the initial weeks after surgery, expect some soreness and swelling. Your surgeon will provide you with medication to manage your pain.

Most patients can resume regular activities after six weeks. You will need to refrain from strenuous activities and overhead lifting during this time. You will regularly follow up with your surgeon and your medical team during your recovery, who will provide you with a more detailed recovery timeline.

While most patients can resume daily activities within a few months, it may take a year or more to fully recover and see your final results.

Are There Risks Associated With Breast Reconstruction?

Every medical procedure carries some risks, but working with a reputable surgeon and following aftercare instructions can mitigate your chance of serious complications.

Implants can sometimes rupture or shift after placement, which may require follow-up surgery to treat. Other potential risks include:

• Pain
• Infection
• Bleeding
• Capsular contracture (scar tissue that forms into a hard, sometimes painful shape)
• Changes in breast sensation (to be expected and not a complication)

Contact your surgeon right away if you notice any unusual pain or discharge following your breast reconstruction surgery. Many complications can be successfully treated with prompt medical care.

Will Breast Reconstruction Impact Future Cancer Screenings?

In most cases, you will not have mammograms after surgery as no breast tissue remains. Instead, your surgeon will perform a thorough physical exam.

Your oncological breast surgeon may order a breast MRI instead of a mammogram for surveillance.

Double Mastectomy Breast Reconstruction: The The Bottom Line

Breast reconstruction can be incredibly beneficial after a double mastectomy. While a surgeon cannot replicate your original breasts exactly, they can work with you to ensure you are satisfied with your final results. Breast reconstruction often results in a substantial improvement in mental health and self-esteem.

Ready to get started? Leif Rogers, MD, is an Ivy League-educated, board-certified plastic surgeon and a standing member of the American Society of Plastic Surgeons. If you’re considering breast reconstruction, get in touch with his team to schedule a consultation.