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What is breast reconstruction?

In addition to restoring the breasts after a lumpectomy or mastectomy, breast reconstruction procedures are also used to address congenital deformities such as Poland syndrome or tuberous breast deformity, or to address inverted nipples and enlarged areolas (the pigmented area around the nipple).

There are several types of breast reconstruction approaches. Breast implants can be used or the surgeon may reconstruct the breast using blood vessels, fat and skin from the abdomen—a procedure called called autologous or DIEP flap reconstruction.

With implants, doctors sometimes use a woman’s own body fat to surgically reshape one or both breasts for a more natural look and feel in a procedure called fat grafting. If your natural breasts show signs of sagging, your doctor may also recommend a breast lift. Your doctor can also address concerns about the way your breasts look—for example, making adjustments to the areolas, if their shape or asymmetrical size bothers you.

The most common form of breast reconstruction is a two-stage implant reconstruction. In the first stage, a tissue expander is placed in your breast. This is a temporary device used to expand the skin and muscles to create space for an implant. The device is inflatable; the doctor gradually inflates it over many weeks to stretch the skin and muscles. In the second stage, the tissue expander is removed and the patient either receives permanent implants or undergoes the flap reconstruction procedure.

Is breast reconstruction done at the same time as a mastectomy or later?

Usually breast reconstruction is done immediately following a mastectomy while you’re still under anesthesia. In some cases, reconstruction is performed at a later date if a woman prefers that. Your surgeon will review your options and help you make the decision that is right for you.

Federal law requires that breast reconstruction be covered by insurance policies for all patients at any time after the cancer is removed.

What is breast reconstruction for Poland syndrome?

Poland syndrome is a congenital disorder in which people are born with missing or underdeveloped chest muscles on one side of the body, making that side appear concave. It is sometimes identified at birth, but often doesn’t become apparent until puberty. Breast reconstruction for Poland syndrome typically involves a custom-made implant that helps to reshape the chest on the affected side of the body to create a more symmetric appearance. If the nipple is affected, a procedure to alter its appearance may be incorporated into the surgery as well. Sometimes Poland syndrome also affects the hand and fingers; if so, a patient may benefit from plastic and reconstructive hand surgery, another specialty at Yale Medicine.

How can tuberous breast deformity be addressed with breast reconstruction?

Tuberous breast deformity is a congenital condition that shows up when breast development begins during puberty. Tuberous breasts are cylindrical rather than rounded and do not grow symmetrically. Sometimes, one breast does not develop at all or one or both breasts may have an areola that is too wide. Treatment is customized to each patient’s needs. (Note: Some health plans don’t consider this procedure medically necessary for people with tuberous breast deformity, so insurance coverage varies.)

What are the risks of having breast reconstruction?

Like any procedure, there are risks, including:

  • Infection
  • Loss of breast sensation
  • Scarring
  • Misalignment, requiring revision surgery
  • Leakage or rupture
  • Capsular contracture (scar tissue around the implant)
  • Wrinkling
  • Stretch marks
  • Pain and discomfort

Are breast implants safe?

Discuss all risks with your plastic surgeon if you are considering breast reconstruction or augmentation.

Breast implants have improved greatly over the years and do not increase your risk of developing breast cancer, in most cases. However, the Food and Drug Administration has noted an association between breast implants and a rare form of cancer called anaplastic large cell lymphoma (ALCL). Nine deaths caused by this cancer have been linked to receiving breast implants—most frequently the textured variety.

For most women, the main risk with breast implants is capsular contraction, which happens when too much scar tissue forms around the implant. If this happens, breast implants become firm and cause tenderness, and they may look misshapen or change position. In this case, a patient may need to undergo surgery to remove the implants.

Although implants are durable and designed to last a lifetime, there is a one percent risk of rupture. In a saline implant, this results in a quick deflation of the breast. Saline is then absorbed into the body naturally without risks. But, silicone implants can undergo a “silent” rupture, which means they can leak. The gel can remain in the implant or leak into the pocket area where the implant was placed. In either case, surgery would be needed to remove and replace the implants. The FDA recommends periodic monitoring of silicone implants using an MRI to detect signs of wear that indicate a need for replacement. If you suspect that your implants have ruptured, get medical attention immediately.

What happens during surgery when breast implants are placed?

During surgery, your doctor will make an incision to create a “pocket” in which to insert the implant, typically at the bottom of the breast or around the areola. Other potential incision sites include the underarm and naval, but this isn’t always a possibility. Your surgeon will recommend the ideal placement for your incision.

Breast implants can be placed either above or underneath the pectoral muscles. There are advantages to each. Locating them underneath the muscle may cause more post-surgery discomfort and require a longer recovery time, but implants placed there often feel more natural to the touch than implants placed above the pectoral muscles.

What kind of breast implants are used during breast reconstruction?

There are several types of breast implants. These include:

  • Saline breast implants: Silicone shells filled with sterile salt water.
  • Silicone breast implants: Silicone shells filled with a soft gel.
  • Cohesive gel silicone implants: Silicone shells filled with a thicker gel.

Breast implants also come with a smooth or textured surface. The benefit of textured-surface implants is there’s a lower incidence of capsular contracture. Smooth-surfaced implants, however, are more rarely associated with ALCL, which is a very uncommon form of cancer.

What distinguishes Yale Medicine in breast reconstruction?

At Yale Medicine, our plastic and reconstructive surgeons are known for their expertise in treating the most complicated breast reconstruction cases.

“Breast reconstruction can take so many different forms. You want to be at a regional center that offers all of the cutting-edge options, so that then you can choose the best one given your diagnosis, overall health and desires,” says Dr. Alperovich. “We strive to offer you the support you need in order to make a safe surgical plan that will restore your body and help you heal."