Implant & Non-implant Reconstruction After a Mastectomy

Implant and Non-Implant Breast Reconstruction

You may need to have (or choose to have) a bilateral mastectomy (removal of both breasts) because of a cancer diagnosis or because you have a very high risk of future cancer due to genetic test results or family history. Where possible, both breasts are reconstructed in the same way, improving the chances they both match. There may be limitations in the size of your new breasts, depending on the form of reconstruction chosen and the availability of your own tissues, but you can alter the size of your breasts if you choose.

Some women may only need to have a single mastectomy. We will then discuss with you whether you are happy with your other breast and plan to provide two breasts that match each other. Using tissue flaps can help with this as breasts formed from your own tissue will change as you change while implants will not. This can be from a change in weight or from the effects of time and gravity.

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Breast Augmentation Using an Implant

In this procedure an implant will make the remaining breast fuller or firmer. The incision for this kind of surgery will be made under the breast, around the areola, under the arm or through the belly button. This is called transumbilical breast augmentation and the implants are moved up to the breast, where the surgeon will place the implant under or over the chest muscle, depending on your anatomy.

Generally, you can resume normal activities in about 3-4 weeks. It can take about 6-8 weeks for swelling to get better and the breast to appear more normal.

Short-term risks: soreness, bruising, heaviness in the chest, tingling, burning, sharp pain for a few weeks, nipple sensitivity, infection.
Long-term risks: small risk of loss of feeling in the nipple and areola, implant will need to be replaced at some point.

Breast Reduction

Reducing the size of breasts is a more complicated procedure than breast augmentation, and the recovery is longer. It can take six to eight weeks before you can resume everyday activities and take months or up to a year for the breast to get back to normal.

During breast reduction surgery your RPS surgeon will make an incision to match the needs of your reduction so that the breast volume and available skin are in balance. This incision typically passes from the areola to the base of your breast. Excess fat from the inside and skin from the outside of your breast will be removed.

When the skin is closed the result is a smaller breast. In some cases a smaller incision around the areola can be made if only a small amount of tissue has to be removed. Normally the nipple can stay attached to the skin, but in some cases, if the breast is large, your surgeon may have to remove the nipple and reposition it at the end of the surgery.

Short-term risks: bruising, soreness, and swelling for several weeks, temporary loss of sensation in the nipples (it usually does come back), pain that is constant or comes and goes.
Long-term risks: possible pain and/or shooting sensations for several months to a year, damage to or loss of blood supply to the nipple, especially if it is removed and repositioned, loss of the ability to breastfeed.

Recovery and Rehabilitation

After a breast augmentation or reduction it’s common to experience some pain, bruising and swelling. You may also lose nipple sensation for a short period of time but it is possible that nipple sensation can be decreased or sometimes increased permanently following surgery. In most cases you can get back to everyday activities within three to four weeks (augmentation) or six to eight weeks (reduction).

After your breast reconstruction we will provide you with an elastic dressing or surgical bra. This will help support your breast during the healing process. Dressings will be changed or removed over time. If needed, we will insert a plastic tube into your breast to help drain any excess fluid.

You may need to take time off work to rest, how much time will depend on the scope of your procedure. We recommend no heavy lifting and to avoid strenuous exercise, sports, and swimming.

Your RPS team will work with you to prescribe pain relief as needed.

Notify the RPS team immediately if you experience any of the following symptoms:

nausea, vomiting or diarrhoea
fever/high temperature – 38°C or higher
shortness of breath
breast leakage after day one of recovery – blood or fluid
increasing pain in either breast
increasing redness around incision site
heavy bleeding from incisions site.

More information

What else you should know

Will I require additional surgery on my existing breast?

In some circumstances you may need to undergo surgery on the existing breast to achieve a symmetrical result.

It’s challenging to exactly match a reconstructed breast with an existing one, over time adjustments may need to be made.
If the reconstructed breast is enlarged, reduced, or is lifted, the existing breast may need to be adjusted to match.

These types of procedures can be undertaken at the same time as a mastectomy. In other cases your doctor may advise you to wait until the reconstructed breast has healed. Health plans that cover mastectomy should also cover reconstructive procedures.

Are there any risks associated with implants?

Allegations have been made that implants are linked to the development of connective-tissue diseases such as rheumatoid arthritis, lupus erythematosus, scleroderma and similar auto-immune conditions. Some research suggests small increased risks, but medical studies have not shown that implants increase the risk of these conditions. Women with or without implants can develop these problems.

In rare cases, women with implants have experienced general symptoms such as unusual tiredness, joint pain, aching, greater amount of flus and colds, hair loss, rash, headaches, swollen lymph glands, poor memory, weak muscles, nausea, fever and irritable bowel syndrome. The relationship between autoimmune disorders have been suggested, however not proven.

In the past, textured implants were used by many surgeons. These have been associated with an increased risk of a rare type of lymphoma- Breast Implant-Associated Anaplastic Large Cell Lymphoma. These are no longer used in clinical practice. If you are worried about any current implants you have, feel free to to make an appointment to discuss your concerns.

Dr Findlay is a leading expert in cutting edge techniques to grow new tissue for breast reconstruction after mastectomy. Feel free to make an appointment to discuss this option if it is of interest to you.

How will my surgeon manage my post-operative care?

Your surgeon will give you specific advice regarding your individual post-operative recovery. They will advise:

where you will go after your surgery
what medication you will be given or prescribed
what bandages and dressings you will need and when they’ll be removed
if you require stitches, when they’ll be removed
when you can get back to normal activity and exercise
when to book your follow-up care.

Will I have scarring?

With any invasive surgery, scars are inevitable. Our RPS surgeons will go above and beyond to keep minimise your scarring and make them as inconspicuous as possible.

If possible, our surgeons will place the scars in areas where they are easily hidden, along natural skin lines and creases. Scars will fade over time. Your surgeon should be advised if you are prone to scarring.