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FAQ's

What is breast reconstruction?

Breast reconstruction is surgical procedure performed to recreate a breast that has been removed due to a mastectomy secondary to cancer, trauma or due to a congenital defect. This can be achieved in a variety of ways:

  1. Placing an implant under the skin and muscle.
  2. Moving tissues from another part of the body to the chest area.
  3. A combination of the above.

The ultimate goal is to create symmetry and to closely match the remaining natural breast.
Typically, multiple procedures are required to complete the transformation.

Why should I have breast reconstruction?

Women choose reconstruction for many reasons:

  1. To make their breasts look balanced when they are wearing a bra.
  2. To regain their shape.
  3. To avoid having to wear an external prosthesis in their bra.

When can these procedures be performed? (Immediate vs. Delayed)

Dr. Van Laeken works in partnership with several general surgeons and can coordinate the reconstruction at the time of the mastectomy. This is referred to as immediate reconstruction. The benefits of immediate reconstruction are as follows:

  1. Recovery from the mastectomy and breast reconstruction can occur simultaneously without women needing to take additional time off work.
  2. Only one anesthetic will be required as compared to two.
  3. In the case of an autologous tissue flap, the patient will wake up from the mastectomy with a reconstructed breast mound which often helps reduce the stress and loss associated with the removal of a breast.
  4. Chest tissues are not damaged by radiation therapy or scarring. This translates to a better final result.

Alternatively, delayed reconstruction is performed after the mastectomy and the patient has completed any required adjuvant therapy such as chemotherapy or radiation. This can be performed months to years later. Delayed reconstruction may also apply to women who may have had a mastectomy many years ago and were not informed about reconstructive techniques. Some women may find that making decisions related to the treatment of breast cancer enough to deal with at one time. Women who are undecided about reconstruction at the time of mastectomy may prefer to delay the surgery until they are more emotionally and physically prepared.

Am I a candidate for breast reconstruction?

Most women in good general and mental health following a mastectomy are considered candidates. Also, patients seeking a prophylactic mastectomy due to their high risk status would also be considered in addition to patients with congenital defects.

In advanced cancer, patients need to consider the toll of additional surgery on their bodies and whether or not the procedures will interfere with their quality of life.

Women with existing health issues such as diabetes, heart disease or lung disease are considered higher risk. Smokers are encouraged to quit for 3 months prior to reconstruction as wound healing may be compromised and infection may be more likely.

Are there costs associated with reconstruction?

No, MSP (Medical Services Plan) covers breast reconstruction.

This includes:

  1. First and second stage reconstructive surgical procedures
  2. Hospital stay
  3. Home care nursing if required
  4. Post operative follow up care from your surgeon
  5. Most balancing procedures: (Surgery for the unaffected breast to match the newly reconstructed breast, i.e. breast lift) must be approved by MSP.

How long will I be in hospital for after my mastectomy?

The length of time in hospital will depend on the immediate reconstructive procedure chosen. The following are some general guidelines.

  • Tram procedures: 3- 5 days in hospital
  • Tissue expander procedures: 1-2 days in hospital
  • Latissimus Dorsi procedures: 2 days in hospital

Can breast reconstruction be completed in one surgery?

Breast reconstruction occurs in stages and cannot be completed in one surgery. Typically, from start to finish the entire process can take up to one year to complete.

Below is a list of general guidelines for various procedures.

Immediate Reconstruction

Tissue Transfer (Tram, Latissimus Dorsi Flap) - 2 procedures

  1. Mastectomy and tissue transfer to create breast mound. (hospital stay 3-5 days)
  2. Nipple and areola reconstruction (daycare procedure)
  3. Tattoo of nipple and areola (done as outpatient procedure)

Tissue expander and implant - 3 procedures

  1. Mastectomy and insertion of tissue expander (in hospital 1-3 days)
    1. Follow up appointments required for tissue expansion at your surgeon’s office every 2 weeks for approximately, 3-4 months.
  2. Removal of tissue expander and insertion of breast implant (daycare procedure)
  3. Nipple and areola reconstruction (daycare procedure)
  4. Tattoo of nipple and areola (outpatient procedure)

Delayed Reconstruction

Tissue Transfer (Tram, Latissimus Dorsi Flap) - 3 procedures

  1. Mastectomy (in hospital 1-3 days)
  2. Tissue transfer and creation of breast mound/balancing procedure if required for unaffected side. (hospitalized 2-5 days)
  3. Nipple and areola reconstruction (daycare procedure)
  4. Tattoo of nipple and areola (done as outpatient procedure)

Tissue Expander and implant - 4 procedures

  1. Mastectomy (in hospital 1-3 days)
  2. Insertion of tissue expander (in hospital 1 day or daycare procedure)
    1. Follow up appointments required for tissue expansion at your surgeon’s office every 2 weeks for approximately, 3-4 months.
  3. Removal of tissue expander and insertion of breast implant (daycare procedure)
  4. Nipple and areola reconstruction (daycare procedure)
  5. Tattoo of nipple and areola (done as outpatient procedure)

What if I need chemotherapy or radiation, will that impact my reconstruction?

In many cases the oncologist will recommend either chemotherapy and/or radiation depending on the size and spread of the cancer following the mastectomy. Our priority is to treat the cancer first and then address the reconstruction.

If you proceeded with an immediate reconstruction and now are learning that you require adjuvant therapy, then the plastic surgeon works in partnership with the cancer agency. This may often mean delaying expansions or exchanges when referring to the tissue expander procedure. For patients commencing chemotherapy, it is important to remember that fills of the tissue expander will need to be arranged a day or two before your chemotherapy cycle commences. This typically is done every 3 weeks when your risk for infection is low. Your treatment regime will be tailored with your safety in mind.

Radiation will also delay the timeline for surgery, until the skin has recovered. The radiation cycles are typically 5 weeks in duration but this can vary from case to case. This can often add months to the reconstructive process. It is also important to recognize that subsequent treatments with radiation can affect wound healing and may potentially impact your overall result.

Are there potential complications associated with these procedures?

As with any surgery, risks are associated. Please visit each individual procedure for a list of potential complications.

How will I know which procedure is best for me?

Dr. Van Laeken will review your history and examine you. Based on her findings and your consultation she will recommend which procedure would be most appropriate for you.

If I decide to go ahead with Reconstruction, how long will it take before I can have surgery?

Dr. Van Laeken works in partnership with several General Surgeons and both offices act to coordinate your combined procedure. Wait times are approximately 6-8 weeks.

Should I bring anything to my consultation?

Please bring a list of your medications to your appointment.

Why should I have breast reconstruction?

Women choose reconstruction for many reasons:

  1. To make their breasts look balanced when they are wearing a bra.
  2. To regain their shape.
  3. To avoid having to wear an external prosthesis in their bra.