These FAQs cover breast reconstruction with tissue expanders, breast implants, the Latissimus Dorsi (LD) Flap and the TRAM Flap.
Q: What are my options for breast reconstruction?
A: There are three commonly used techniques for reconstructing your breast.
A breast implant may be used to reconstruct your breast. In most cases, a tissue expander (a device similar to an implant) is placed at the time of mastectomy. Then the expander is enlarged by injecting a fluid during weekly clinic visits. As the expander stretches out the remaining skin on the breast, a pocket is created to allow for placement of a breast implant at a second surgery.
Your own tissue is a second option, using tissue from your back (latissimus dorsi flap). This tissue is used to cover a breast implant and often eliminates the need for tissue expansion but still requires the use of an implant.
The third option is the use of the tissue from your abdomen (TRAM flap) and usually does not require an implant.
There are other options available but they are used only in unusual circumstances.
Q: Which option is best for me?
A: Each option has its advantages and disadvantages. Not all women will be candidates for each reconstruction.
The best option will depend on your wishes and expectations, your overall health, breast and body shape, and if you have any risk factors for reconstruction such as smoking, obesity or radiation treatment.
The choice of reconstruction will be decided by both you and your plastic surgeon after an examination and careful review of your health history.
Q: Is breast reconstruction covered by insurance?
A: Yes, in most cases all procedures associated with breast reconstruction are covered as required by federal law. This includes any treatment on the opposite breast to achieve symmetry. We strongly recommend that you check with your insurance company prior to surgery and determine your specific coverage.
Q: How many surgeries are necessary?
A: The use of a tissue expander is a two-stage process and will require a second surgery four to six months later to exchange it for a breast implant.
Breasts can be reconstructed in one stage by using a latissimus dorsi flap to cover an implant or by using a TRAM flap.
After your breast is reconstructed, most patients desire nipple reconstruction. This minor procedure is usually done four to six months later.
At that time, minor revisions may be done to your reconstructed breast. After the nipple is reconstructed, the areola (pigmented skin around the nipple) may be reproduced with a tattoo.
Some patients desire surgery on the opposite breast to have better symmetry with the reconstructed breast. This may involve a breast enlargement, reduction, or lift. If breast implants are used, you may need another surgery to replace them at some time.
Q: Where will the procedure be done?
A: Most breast reconstruction procedures are done in one of our hospitals. However, secondary procedures can frequently be performed in a surgery center or a hospital.
Q: What kind of anesthesia will I have?
A: General anesthesia is used and you are completely asleep during the procedure. If a TRAM flap is being done, an epidural may also be used to provide pain relief after surgery. However, in many second stage procedures, the surgery can be done using “twilight” or sedation anesthesia, which allows for faster recovery.
Q: How long does the procedure take?
A: Placement of a tissue expander or breast implant takes about one hour. Reconstruction with a latissimus flap or TRAM flap takes three to five hours. More time may be needed if both breasts are being reconstructed.
Q: Will I need a blood transfusion?
A: It is very unlikely you will need a blood transfusion for such cases.
Q: How long will I stay in the hospital?
A: After reconstruction with only an expander or implant, most women are able to go home the next day. Women with a latissimus flap spend two to three days in the hospital, while those with a TRAM flap reconstruction spend three to four days.
Q: Will I have any drains after surgery?
A: Drains are small soft plastic tubes that exit the skin to help drain any fluid that can build up under your skin after surgery. The drains are usually removed five to ten days after surgery.
Q: How long before I can return to work?
A: This depends on the type of work you do.
Women who perform mostly desk work will be able to return sooner than those who require heavy activity at work.
After reconstruction with only an expander or implant, most women are able to return to work in one to two weeks.
Women with a latissimus flap reconstruction may return to work in two to three weeks, while those with a TRAM flap reconstruction may need four to six weeks before returning to work.
Q: Will I need any therapy after surgery?
A: For most women, no therapy is needed. However, just be sure to move your arms in a full range of motion in a slow and gentle manner after surgery to prevent stiffness.
Q: What can I do to minimize scars after surgery?
A: Silicone gel sheets have been shown to improve scar appearance after surgery.
Q: Will my reconstructed breast match my remaining breast?
A: This depends on your breast size and shape. It is common to have additional procedures, such as a breast reduction, lift or enlargement, to give your breasts a more similar appearance.
Q: Are there any other sources of information available?
A: Many patients utilize the Internet to find information about surgery they are considering. Unfortunately, the Web at times contains information that may not be completely trustworthy. However, there are a few Web sites sponsored by professional organizations and the National Library of Medicine that we recommend: