Breast Enhancement Surgery | Breast Enlargement Surgeon| Common Questions & Answers on Breast Reconstruction Surgery

General Questions
Questions on Breast Implants
Questions on Latissimus Flaps
Questions on TRAM Flaps
Questions on DIEP Flaps

How long does the breast reconstruction process take?
The entire process of breast reconstruction can take from 6 months up to 1 year. There are several reasons why the process can take so long. After the first stage of breast mound reconstruction, you have to wait for at least 3 months afterwards before performing the next step, the equalization stage, followed a few months later by a nipple reconstruction. For the tattoo pigments to be uniform in appearance, an additional month or two of waiting is required after the nipple reconstruction to allow the scars to fade. Waiting between each stage allows for optimal healing to occur and swelling to settle down. Rushing through this process will likely lead to asymmetry or a poor aesthetic result. Patience will pay off in the long run.

Is there any problem if I had my mastectomy months or years ago?
It does not matter how long ago your mastectomy was, you can still have breast reconstruction. Either a tissue expander and implant method or using your own tissues such as a TRAM flap or DIEP flap can be done months to years after a mastectomy.

How is a nipple reconstruction done?
There are many ways that a nipple can be created. The most common methods used include a C-V flap, which only uses the tissues already on your breast mound, or skate flaps, which often require a small skin graft from elsewhere (usually lower belly) to be used. Either method can result in a nipple reconstruction that is adequate in size to match your other nipple.

Do I have to complete all 3 steps for breast reconstruction or can I stop after the first step?
Many patients complete all 3 steps involved in breast reconstruction. However, some patients choose not to complete the nipple reconstruction or have anything done for equalization on their other natural breast, such as a breast lift. In most cases, this comes down to your personal decision.

How long should I wait after chemotherapy or radiation before starting reconstruction?
At least 2 months after chemotherapy is finished so that you can regain full healing capability and minimize infection risk. As for radiation, you need to wait at least 6 months after finishing radiation therapy before proceeding with breast reconstruction. Performing breast reconstruction too soon after radiation will put you at higher risk of wound healing complications.

Questions on Breast Implants for Breast Augmentation or Breast Reconstruction

Are breast implants safe?
There have been numerous scientific studies done on patients that had saline filled or silicone filled breast implants. The largest and best performed studies to date have not shown that either saline or silicone filled breast implants are associated with any harm to your health. In addition, the current silicone breast implants are different from the original silicone implants. Many patients prefer the natural breast-like feel of a silicone implant. However, the decision to use saline or silicone implants is up to you.

Are breast implants permanent?
Breast implants can be permanent. If they do not get infected, deflate or have other mechanical complications, than they do not need to be replaced.

What is capsular contracture?
Anytime a foreign material is inserted in the body, a scar lining forms around the foreign material, in this case the breast implant. In a minority of cases, the lining can get firm and start to contract. This can happen over the course of months and years after the implant is put in. In severe cases, the implant can look distorted and feel much harder, sometimes causing pain. Treatment for capsular contracture is an operation to remove the scar lining around the implant (capsule) and possibly replace the implant. This is an outpatient same-day surgery. Patients who have had radiation for the treatment of breast cancer are very susceptible to this complication.

What happens if I should develop capsular contraction?
Most times capsular contraction is mild and not a problem. The implant will feel more firm than it was when initially placed months to years ago. If however, the implant begins to feel hard or has moved from the initial location, an outpatient surgery may be required. Often times, the surgery involves removing the scar tissue from within (capsulectomy or capsulotomy) and usually, replacing the implant. Recurrence is uncommon.

What happens when breast implants deflate or leak?
Saline implant deflation is usually gradual and not related to a traumatic event like an accident or falling. Rather, most patients notice a gradual deflation and softening of the implant. Since saline is salt water, no bodily harm is inflicted on you. But, you do need an outpatient surgery to replace the defective implant. Most manufacturers cover their product for 10 years.

With silicone implants, the rupture is often unnoticed and therefore, it is recommended that you have an MRI scan every 3 years to screen for a ruptured implant. This is for your safety. The new silicone implants have a very low rupture rate (< 5%).

What happens if I get an implant infection?
In the rare event that your implant or tissue expander gets infected and does not respond to antibiotics, the only way to cure it is to remove it. Once the infection has resolved, then the operation can be performed again, usually two or three months after removal. This is a rare complication affecting less than 1% of patients.

Will my lymphedema (arm swelling) get worse after implant reconstruction?
Tissue expanders or implants rarely worsen the arm swelling. Although some swelling may occur in the chest skin and remain for several weeks after the operation, the arm swelling is almost always transient and not permanent.

Should I have saline or silicone breast implants?
This really comes down to a matter of personal preference. There is no scientific evidence that silicone implants are harmful, but this is a subject of continued scrutiny.

How much time off from work will I need after having breast implant surgery?
For most people, two weeks off from work are more than plenty. Especially if your job or home situation does not require heavy lifting, you can go back to work in a week. Starting to drive depends on when you stop taking the pain medicines.

Can I have breast implants for reconstruction if I had radiation?
Generally the answer is no. Although it can be attempted and sometimes a satisfactory result obtained, the complications are high and end result is often aesthetically unpleasing and not durable.

Questions on Latissimus dorsi Flap for Breast Reconstruction

What happens to my back and arm strength after the muscle is transferred?
The latissimus is a large muscle, but there are other muscles that can help compensate for the loss. Unless you do an athletic activity that requires full arm strength like energetic cross-country skiing, competitive tennis or competitive swimming, most patients are able to return to their normal activities after full recovery.

Why do I need an implant as well as the flap?
Your back often does not have enough fat to create a breast mound with and in most cases, the latissimus is being used to provide some skin and muscle coverage over damaged, irradiated chest skin. Therefore, there is no bulk to create the breast mound with. The implant is required to provide projection to simulate a natural appearing breast mound.

Will my lymphedema (arm swelling) get worse after the latissimus flap?
There is some risk that your arm swelling could get worse and remain worse after a latissimus dorsi flap for breast reconstruction. Although most patients have a mild degree of worsening that can be controlled with a compressive garment, this is an important point to discuss with your physician if you are contemplating a latissimus flap for breast reconstruction - especially if you had axillary lymph node dissection and radiation.

Will I have drains and for how long?
Like the DIEP and TRAM flap, drains will be placed for a short time in the chest, usually a few days to a week. The back requires drains for a longer time and the drains are usually left in for 2 weeks or until the volume of each drain has dropped to less than 30cc per 24 hour period.

How much time off from work will I need after a latissimus flap?
The latissimus flap requires around 2-3 weeks off before returning to work, provided that heavy lifting is not involved. You will be in the hospital for 1 night. For work that involves exertional activity, 6 weeks without heavy lifting is recommended.

Questions on TRAM Flap for Breast Reconstruction

How much pain is there after a TRAM flap?
Most of the pain from a TRAM flap is from the belly and not from the chest. You will be given narcotics afterwards to make you feel comfortable. Most patients are off their narcotic medicines within 1-2 weeks after the surgery, but this varies from patient to patient.

What happens if I get a hernia after the operation?
This is an unusual complication but can occur. If you should develop a bulge in the abdomen, usually noted around 6-12 weeks after the surgery, then the only treatment of this condition is additional surgery. A hernia operation is done as an outpatient surgery by a general surgeon and may require additional time off from work.

Will my lymphedema (arm swelling) get worse after a TRAM flap?
Like the DIEP flap, the arm swelling is usually transiently worsened and often resolves to the same pre-operative level after a few weeks.

Will I have drains and for how long?
Like the DIEP flap, you will have drains in your chest and in your abdomen. The drains in the chest are often removed by the time you are ready to leave the hospital or shortly thereafter. The drains in the belly stay for around two weeks after the surgery. You will need to wear an abdominal binder or similar compressive garment for at least three weeks after the surgery.

How much time off from work will I need after a TRAM flap?
That depends on the activity level of your work. If you have a desk job, patients can return as early as 4-6 weeks. Because of the risk of hernia (1-4%), it is recommended that no lifting be done for at least 6 weeks after the surgery. Most patients take 6 weeks off so that they are completely able to perform their duties without restrictions.

Questions on DIEP Flap for Breast Reconstruction

What is so special about the DIEP?
The DIEP flap allows a breast reconstruction to be performed without cutting your abdominal (belly) rectus muscles. Only skin and fat from the belly are used and thus, the breast reconstruction preserves your abdominal muscles. Since there are only 2 rectus muscles, cutting one may have a slight impact but, taking both can be significant.

Why don't more surgeons offer the DIEP flap for breast reconstruction?
The operation is very complex and without substantial experience in microsurgery, can lead to a very high failure rate. There are only a few surgeons in the country that perform the DIEP flap procedure routinely.

Why should I do a tissue based reconstruction over an implant method?
Sometimes the method of breast reconstruction is based on patient preference - in other words you have a choice. In other situations, your anatomy and breast cancer treatment may dictate which method of breast reconstruction is feasible. If you have had radiation or problems with implants in the past, then the tissue method (either latissimus or TRAM or DIEP) is the preferred method of breast reconstruction.

Why should I have a DIEP rather than a TRAM flap?
The benefit of a DIEP is that your muscles in the abdomen (belly) are preserved. The pain is much less and activity levels after the surgery are often better after a DIEP. Otherwise, the outward appearance and scars that result are identical between a TRAM and a DIEP and resemble those from a tummy tuck.

How much pain is there after a DIEP flap?
It is difficult to compare two surgical procedures in terms of pain, but there is uniform consensus based on published data that the DIEP is associated with much less post-operative narcotic usage than a TRAM flap. We have had numerous patients who either do not take any narcotics after the surgery (motrin or similar) or stop taking the narcotic pain pills within a few days after the surgery.

Will my lymphedema (arm swelling) get worse after a DIEP flap?
Dr. Isik uses the blood vessels under the rib cage (internal mammary vessels) and not the blood vessels in the armpit to provide the flap's new blood supply, therefore the risk of worsening of the lymphedema (arm swelling) is much less likely. Although there are no guarantees in any medical procedure, the risk of this happening is very low. You may have a transient worsening after the surgery, but this often resolves completely within a few weeks.

Will I have drains and for how long?
You will have drains in your chest and in your abdomen. The drains in the chest are removed within a week. The drains in the belly stay in for around two weeks after the surgery. You will need to wear an abdominal binder or similar compressive garment for three weeks after the surgery.

How much time off from work will I need after a DIEP flap?
That depends on the activity level of your work. If you have a desk job, patients can return to work as early as 2-3 weeks. Because of the risk of hernia (less than 0.3%), it is recommended that no lifting be done for 6 weeks after the surgery.