Improve appearance with breast reconstruction

Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or another condition. A new breast can radically improve your self-esteem, self-confidence and quality of life. Although surgery can give you a relatively natural breast, the reconstructed breast will never be the same as the breast that was removed.

Improve appearance with breast reconstruction

Breast reconstruction is an individualized procedure. You should do it for yourself, not to satisfy someone else's desires or to try to fit into any kind of ideal image.

• You cope well with your diagnosis and treatment,
• You have no medical conditions or illnesses that could impair healing,
• You have a positive outlook and realistic expectations of the outcome of breast reconstruction and body image.

Reconstruction typically involves several procedures performed in multiple stages and may:
• Be performed at the same time as the mastectomy, or
• Be delayed until you recover from the mastectomy and any additional cancer treatments.

It is important that you feel ready for the emotional aspect involved in breast reconstruction. It may take some time to accept the results of the reconstruction.

• The reason why you want to have surgery, your expectations and desired result,
• Medical conditions, drug allergies and medical treatments,
• Current use of medication, vitamins, natural medicines, smoking, alcohol and drugs,
• Previous surgeries,
• options available for breast reconstruction surgery,
• The likely results of breast reconstruction and any potential risks or complications,
• The treatment steps proposed by the plastic surgeon, including procedures to establish breast symmetry.

• Assess your general health status and any pre-existing health conditions or risk factors;
• Perform diagnostic tests to determine the underlying cause of gynecomastia, which may include testing your endocrine function;
• Examine your breasts and take detailed measurements of their size and shape, check the quality of the skin, the position of the nipples and areolas;
• Take photos for your medical records;
• Discuss your options and recommend the most appropriate treatment;
• Discuss the likely results of gynecomastia correction and any potential risks or complications;

The decision to undergo breast reconstruction surgery is a personal one. You are the one who must decide whether the benefits will meet your expectations and whether the risks and potential complications are acceptable.

Your plastic surgeon and/or assistants will explain, in detail, the risks associated with the surgery. You will be asked to sign the consent form to ensure that you fully understand the procedure you will undergo and any potential risks or complications.

Possible risks of breast reconstruction include, but are not limited to, bleeding, infection, poor incision healing and the risks of anesthesia. You should also know that:

• Techniques using flaps include the risk of partial or complete loss of donor tissue and loss of sensation at the donor site and the reconstruction site,
• The use of implants carries the risk of breast stiffness (capsular contracture) and implant rupture.

Breast implants do not harm the breast. Scientific research carried out by independent groups has not reported any proven relationship between breast implants and autoimmune and systemic diseases.

The procedure must be carried out in a safe and comfortable place for the doctor and the patient, in a surgical center authorized by the Health Surveillance, with equipment and trained staff for any complications.

Some procedures during return consultations can be carried out in the office, using local anesthesia with sedation. These decisions will be based on the procedure, your preference and the doctor's judgment.

Before surgery, it may be necessary to:

• Perform laboratory tests or medical evaluation;
• Taking certain medications or adjusting your current medications;
• Have a mammogram before surgery and another after surgery to help detect any future changes in breast tissue;
• Stop smoking well in advance of surgery;
• Avoid taking aspirin, anti-inflammatories and natural medicines, as they can increase bleeding.

• What to do on the day of surgery (fasting time, medications, bath),
• The type of anesthesia during breast reconstruction,
• Post-operative care,
• Breast implant registration documents (when necessary).

The procedure must be carried out in a safe and comfortable place for the doctor and the patient, in a surgical center authorized by the Health Surveillance, with equipment and trained staff for any complications.

Be sure to ask someone to accompany you and stay with you for at least the first night after surgery.

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. Options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.

Stage 2 – Flap techniques using the patient's own muscle, fat and skin to create or cover the breast site

Sometimes a mastectomy or radiation treatment can leave insufficient tissue in the chest wall to cover and support the breast implant. The use of breast implants for reconstruction almost always requires one or more flap or tissue expansion techniques.

The TRAM flap uses muscle, fat and skin from the patient's abdomen as donors to reconstruct the breast. The flap can remain with the original blood supply and be tunneled to be positioned in the rib cage or completely separated to form the new breast.

Alternatively, the surgeon may choose DIEP, or SGAP flap techniques, which do not use muscle but rather tissue from the posterior chest or buttock.
The latissimus dorsi flap uses muscle, fat and skin tunneled at the mastectomy site, remaining with its original blood supply.

Occasionally, the flap can reconstruct the breast, but often it provides the muscle and tissue needed to cover and support the breast implant.

Step 3 – Expansion of healthy skin to cover a breast implant

Reconstruction with tissue expansion allows faster recovery than procedures using flaps, however, it is a longer reconstruction process. This procedure requires many visits to the office, for 4 to 6 months, after placing the expander, to inflate it through an internal valve and expand the skin. A second surgical procedure will be necessary to replace the expander, which is not designed to serve as a permanent implant.

Stage 4 – Breast implant placement surgery

Breast implants can be a complement or alternative to flap techniques. Silicone implants are available for reconstruction.
The surgeon will help you decide which alternative is best for you. Reconstruction with implants often requires tissue expansion

Stage 5 – Grafts and other specialized techniques to create the nipple and areola

Breast reconstruction is completed through a variety of techniques to reconstruct the nipple and areola

After surgery using flaps and/or insertion of an implant, gauze and tape will be applied to the incisions. An elastic bandage or bra will minimize swelling and support the reconstructed breast. A drain may be temporarily placed under the skin to drain any excess blood or fluid.

You will receive specific instructions, including: How to care for your breast after surgery, medications you should take orally to help reduce your risk of infection, specific concerns to look for at the surgery site or in your general health, and what it will be like follow-up with the plastic surgeon.

• Where will I remain in recovery after surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will dressings be necessary after surgery? When will they be removed?
• Will there be drains? For how long?
• When can I take a shower?
• When will I be able to resume normal activities and exercise?
• When will my return appointment be?

Recovery will take place over several weeks, with swelling decreasing and the shape and position of the breast improving. Follow your plastic surgeon's recommendations and attend your return appointments as scheduled.

The final results of post-mastectomy reconstruction can help minimize the physical and emotional impact of the mastectomy. Over time, some sensitivity in the breast may return, and the scars tend to improve, although they will never disappear completely. There are some limitations, but most women think they are small compared to the improvement in their quality of life. Careful monitoring of breast health through self-examination, mammography and other diagnostic techniques is essential for your long-term health.

If you experience shortness of breath, chest pains, or an abnormal heartbeat, seek medical attention immediately. If any of these complications occur, you may need hospitalization and additional treatment. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve the best results with a single surgical procedure, requiring a new surgery.

Following your doctor's recommendations is essential for the success of the surgery. It is important that surgical incisions are not subjected to excessive force, abrasion, or movement during the healing time.

The cost may include:

• Surgeon's fees;
• Hospital and surgical center costs;
• Anesthetist's fees;
• Prescribed medications;
• Post-operative meshes;
• Medical exams.

When choosing a plastic surgeon for gynecomastia surgery, remember that the surgeon's experience and your good relationship with him or her are just as important as the final cost of the surgery.

• Areola: Pigmented skin around the nipple.
• Breast augmentation: Also known as breast augmentation, breast augmentation through surgery.
• Breast lift: Also known as mastopexy, surgery to lift the breasts.
• Breast reduction: Reducing the size of the breast and lifting the breast by surgery.
• Capsular contracture: Complication of breast implant surgery that occurs when scar tissue, which normally forms around the implant, leaves it hard and deformed.
• DIEP flap: Flap that uses the perforator of the inferior epigastric artery, taking tissue from the abdomen without the need for muscle.
• Donor site: Area of ​​the body where the surgeon uses skin, muscle and fat to reconstruct the breast – commonly located in less exposed areas of the body, such as the back, abdomen or buttocks.
• Flap techniques: Surgical techniques used to reposition the patient's own skin, muscle and fat to reconstruct or cover her breast.
• General anesthesia: Drugs and/or gases used during surgery to relieve pain and reduce consciousness.
• Grafting: Surgical technique to recreate the nipple and areola.
• Hematoma: Accumulation of blood beneath the skin.
• Intravenous sedation: Sedatives given by injection into a vein to help you relax.
• Latissimus dorsi flap technique: Surgical technique that uses fat, muscle and skin from the woman's back in the reconstructed breast, remaining with the original blood supply.
• Local anesthesia: Drug injected directly into the incision site during surgery to relieve pain.
• Mastectomy: Removal of the entire breast, most often to cure cancer.
• SGAP Flap: Superior gluteal artery perforator flap that takes gluteal tissue.
• Tissue expansion: Surgical technique to expand healthy tissue and provide coverage for a breast implant.
• TRAM flap: Also known as the transverse rectus abdominis muscle. Musculocutaneous flap that uses fat, muscle and skin from the patient's own abdomen to reconstruct the breast.
• Transaxillary incision: Incision made in the armpit area.

• Are you a specialist by the Brazilian Society of Plastic Surgery?
• Have you been trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Is the installation of the procedure room in your office authorized by the Health Surveillance of your city?
• Am I a good candidate for this procedure?
• What is expected of me so that the best results are obtained?
• Where and how will the procedure be performed?
• What is the shape, size and texture of the surface? What incision and placement site is recommended for me?
• How long can I expect to recover and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications treated?
• Will breastfeeding be harmed?
• How will the surgery evolve over time? After pregnancy? After breastfeeding?
• What will my breasts look like if I choose to remove/replace the implants in the future?