“Every woman diagnosed with breast cancer should meet with a plastic surgeon at the time of diagnosis. Early planning is key for an optimal aesthetic outcome.”
Common name – Breast Reconstruction.
Technical name/also known as – Lumpectomy Reconstruction, Implant based Reconstruction, Flap Reconstruction.
Benefits of a Breast Reconstruction
For women diagnosed with breast cancer, a consultation with a plastic surgeon early after diagnosis is imperative, even—and especially—if a woman is considering a lumpectomy. For most patients, breast reconstruction is performed immediately, meaning, at the same time as mastectomy or lumpectomy. While this adds an additional decision to be made during what is an overwhelming time, the importance of a consultation with a plastic surgeon is essential.
Immediate breast reconstruction has been shown not only to be a safe option but more importantly, has been shown to benefit overall well-being of the woman treated.
How it is done
There are essentially three types of reconstruction: reconstructing a breast after lumpectomy (breast conservation), reconstructing a breast after mastectomy with an implant, or reconstructing a breast after mastectomy with a flap (or your own body’s tissue). If a woman chooses, the unaffected breast may also be changed for symmetry. Sometimes, breast disease is present in both breasts at the time of diagnosis.
Lumpectomy reconstruction: for cancer that is not encompassing the entire breast, a plastic surgeon can work with a breast surgical oncologist to optimally remove the cancer while rearranging the remainder of the breast tissue. Called aesthetic oncology or oncoplastic surgery, plastic surgeons often rely on cosmetic breast techniques such as breast lift or breast reduction to conceal that a tumor was removed. A symmetrizing operation is done on the unaffected breast to make the breasts look more even.
Mastectomy reconstruction with an implant: for cancer in many areas of the breast, for women with the breast cancer gene (BRCA+), or for women who opt to remove their breast as treatment, implant reconstruction after mastectomy can be performed. This may be done with a tissue expander, or adjustable implant, that allows the reconstructed breast to be gradually enlarged once healing is completed. For some, an implant can be placed directly. A biologic material called acellular dermal matrix (ADM) provides shape and support of the lower portion of the breast as well as additional coverage over the implant. At a later date, the adjustable implant or expander is removed and a more permanent implant placed. If a woman has a bilateral (double) mastectomy, the operation is performed on both sides. If not, a symmetrizing operation on the other breast may be performed at a later time. If the nipple is not saved during the original surgery, reconstruction of the nipple and areola can be performed at a time later in the reconstructive process. Other surgeries are often required to achieve a better cosmetic result.
Mastectomy with flap reconstruction: For some women undergoing mastectomy, using her own tissue may be a choice. This may use skin, fat, and muscle from the abdomen or back, though other sites may also be considered. This operation involves a second surgical site (a donor site) and involves the longest recovery. The blood supply to the flap may remain attached to the body (pedicled) or attached after removal to a new blood supply (free, or by microsurgery). Reconstruction of the nipple and areola are not usually performed at the time of mastectomy, but later in the reconstructive process. If you choose a flap based reconstruction, Dr. DeLuca-Pytell can refer you to a surgeon in the area.
With immediate reconstruction, there is no point where a woman is without a breast, though the nipple may be absent. Evidence shows that immediate reconstruction is psychologically beneficial. As breasts are associated with beauty and femininity, breast reconstruction is chosen by most women undergoing breast cancer treatment. Federal law covers mastectomy reconstruction as reconstructive (not cosmetic) procedures as well as procedures to improve symmetry with the unaffected breast.
Recovery from mastectomy reconstruction is difficult. Multiple drains and adherence to strict activity restrictions are imperative. Risks of complication are highest in my practice among those choosing implant-based mastectomy reconstruction. Mastectomy reconstruction from beginning to end is a long process—up to a year for some. It is not unusual for women to require additional procedures after the initial breast reconstruction operation. Ancillary procedures to improve symmetry or shape may be needed. Nipples which remain after nipple-sparing mastectomy or which have been reconstructed will not have sensitivity. For symmetry, it is often necessary to operate on both breasts even if only one is affected by cancer.
Who pays for this
This operation is usually covered by insurance, though precertification may be required. Insurance plans vary, so out-of-pocket cost may be required.
My Post-Operative Bra Suggestions
Please click this link for suggested bras to be worn after surgery.
What to expect
Length of operation
2-4 hours (depending on procedure and extent of operation).
General anesthesia, you will be asleep the whole time.
In or out patient
Lumpectomy reconstruction: outpatient
Implant-based reconstruction: outpatient recommended
Time until final appearance
6 months to 1 year.
Length of results
Should be long lasting, but breasts can increase or decrease in size with weight changes. Pregnancy or other hormonal changes can also increase breast size.
Temporary swelling, bruising, and some pain. Drains are used for implant based reconstruction, and these may stay for a long time.
Risks of procedure
All surgery carries risk. I recommend patients carefully weigh the benefits of having surgery against the potential risks which may arise. Risks include pain, bleeding, infection, damage to nearby structures, need for other procedures, recurrence of skin laxity, dissatisfaction with appearance, asymmetry, seroma, sensory changes including permanent loss of sensation, temporary or permanent changes in facial movement, wound healing delays requiring wound care, deep vein thrombosis, and pulmonary embolus. A complete list of risks will be discussed with you before surgery.
“This is one of the most gratifying yet challenging procedures I perform. I get to know a lot about my patients, their lives, and their families since the treatments are ongoing. I still stay in touch with many of my patients long after their surgeries have been completed.”
– Dr. Danielle DeLuca-Pytell
While we are under social distancing and shelter at-home instructions, I am offering virtual consultations for new patients interested in meeting with me.
You can do this from a computer (via an invitation) or a smartphone (via an invitation and the Google Meet app).
There are four parts to the consultation:
1. Arrange a consultation by phone or email,
2. Download the new patient forms. Click here.
After you fill them out, you can either fax or email them to me.
3. Once the consultation is arranged, a meeting invite will be sent to you with the link for the consultation. At our prearranged time, follow the link to our secure and private consultation.
There, you and I will have time to talk about your goals, medical history, and all about the procedure.
While the examination is limited to observation in two dimensions, I should be able to determine whether or not you are a candidate for surgery.
4. If you are indeed a surgical candidate, you will be contacted by Andrea, my patient coordinator, to get a surgical quote (or if insurance-based, your expected out of pocket costs), and an opportunity to hold a surgical date.
You will also be given a follow-up visit to confirm with your exam that you are a candidate and preoperative visit time for us to prepare you for surgery.
I hope to virtually see you soon!
Your Next Step!
Call or email us to schedule an appointment and find out if you are a suitable candidate for this procedure.
Our phone number
Give our office a call Monday to Thursday, 9am to 5pm, Friday 9am to 3pm.
Our email address
Please also email us anytime with questions you have.
Quick Contact Form
Before and After Gallery
When you come into the office for your appointment, you will be able to see more ‘before and after’ photos of this procedure including different options.
If healing proceeds as expected:
Rest at home (princess treatment) 2 weeks (no housework or exercise). Outsource housework a while you rest. Walk around the house, but do not work out. Rest with your head up and sleep with your neck extended (to avoid creasing) for the first two weeks.
Return to gentle exercise and household chores at two weeks, but no heavy lifting or strenuous activity for six weeks. May cover scars with makeup once scabs are gone. May resume work if it is sedentary. May color hair at three weeks after surgery.
Return to full activity 6 weeks after surgery.
Returning to Work
This depends on the type of work that you do. Many women can return to sedentary work at three to four weeks, though not everyone is ready to return to work by then. Surgery affects different people differently. If your work is more strenuous, six weeks off work may be needed.
Time until final appearance
6 months to one year.
Length of results
Should be long-lasting, but breasts can increase or decrease in size with weight changes. Pregnancy or other hormonal changes can also increase breast size.
Smoking and Surgery
For the first two weeks or so, sleep with your back elevated to help with swelling and make it easier to get up. A surgical bra will be provided, and a bra sheet will be given in the office with a list of light support bras to be worn until you can be fit for a regular bra again, usually three months after surgery. It will take time for the breast size and shape to settle.
If you smoke, it is imperative that you quit six weeks both before and after surgery. To better understand why, please click this link:
if you color your hair, do so right before surgery as you will not be able to color your hair until three weeks following the procedure. Plan to bring a scarf with you to the hospital on the day of the procedure as well as dark glasses to camouflage your temporarily swollen appearance on leaving the hospital.
See what her patients have to say about their surgical experience.
Follow the link to read some of the many letters received by Dr. Danielle DeLuca-Pytell.
When you visit the office for your appointment, we will talk about the side effects and risks of this procedure.
You will have the chance to ask any questions you might have.
Don’t forget: it is your body! There is no such thing as a bad or silly question!