How long will the recovery time be after my breast reconstruction?

The recovery time depends on the type of your breast reconstruction.
Typically, after an implant-based reconstruction with tissue expanders or implants you may go back to your normal, every day activities 2 – 4 weeks after the procedure. Following a breast reconstruction using your back muscle (latissimus dorsi muscle) combined with a tissue expander/implant recovery will take 4 – 6 weeks. After breast reconstruction using skin and fatty tissue from your belly (DIEP flap) your convalescence will take up to 8 weeks. The skin on your abdomen will feel tight in the first weeks and you may have to walk and stand slightly bent over for a while. The skin will stretch over time and you will be able to move without any restrictions. All these times are given as an estimation your personal recovery may be slower or quicker.

What type of postoperative wound care will I need after my breast reconstruction?

In any type of breast reconstruction you will usually have at least one drain for the first couple of days. A home care nurse will look after your wounds and drains once you have been discharged from the hospital. You will also have regular follow up visits in our clinic that will be arranged through our surgeons’ offices. Possible complications during recovery time may include pain, swelling, fluid accumulation (hematoma, seroma), infection and wound healing problems. Our home care nurses will alert our surgeons’ office if they have any of the above concerns. In addition our breast reconstruction nurse will be available to help you in case you have further concerns.

What are the timelines of my breast reconstruction?

Breast reconstruction is a staged process and some minimal time intervals should be respected. Creating the breast mound represents the first step of the reconstruction, which can be done in one or two steps depending on the type of reconstruction you are having performed. Following this operation the tissue needs time to settle in its final position and for the swelling to decrease. The second stage can be scheduled 3 – 6 months after the breast mound reconstruction. At this point, balancing procedures for the healthy breast in a unilateral breast reconstruction can be done as well as refinements to the reconstructed breast or the donor site and also the reconstruction of the nipple areola complex. Between the reconstruction of the nipple and the tattooing of the areola, a healing time of at least 8 weeks should be allowed.

If my muscle has to be used for my breast reconstruction do I have to expect functional impairment?

When your back muscle (latissimus dorsi muscle) is used for your breast reconstruction you might experience a mild weakness in your arm/shoulder especially when performing strenuous and prolonged overhead activities. During activities of daily living, however, you should not experience any impairment or restrictions.

When using your abdominal tissue there is a small risk of development of an abdominal bulge following your breast reconstruction. An abdominal bulge will not result in any functional problems, but might be dissatisfying from a cosmetic point of view. Bulges can be repaired using a permanent mesh that acts as an internal girdle for the lower abdomen.

Can I have my breast reconstruction at the time of my mastectomy?

In many cases it is possible to have a breast reconstruction at the time of the mastectomy (eg. prophylactic mastectomies or when radiation therapy after the mastectomy is unlikely to be necessary). In some cases, however, it may be beneficial to have a delayed breast reconstruction after termination of all additional therapies and a recovery period of around 6-12 months has passed for the radiation changes to improve. Especially radiation therapy can have an unfavorable effect on the cosmetic result and the complication rate of your breast reconstruction. Your plastic surgeon and your breast surgeon can give you specific recommendations about the timing of your breast reconstruction based on your individual case.

Will I need to replace my implants after 10 years?

The implants that are used nowadays are considered to be medical products and are subject to rigorous quality assurance assessments. There is no expiry date and theoretically it is possible to keep your implants during your entire lifetime.

Your body, however, reacts on the implantation of any foreign body (e g. a silicone implant) with the formation of a thin capsule of connective tissue similar to a very fine scar. Over time, this capsule may become firm and tight and can lead to increasing pain and distortion of your breast shape. To resolve this problem the capsule has to be removed surgically and the implants are replaced. It is also possible that the implant wears out or will shift in position in which case replacement is usually recommended.

Will OHIP cover the costs of my breast reconstruction?

Yes, OHIP will cover almost all the treatments directly related to your breast reconstruction including implant or tissue reconstruction, balancing, and nipple areolar reconstruction. There are certain procedures that are NOT OHIP-covered benefits, such as liposuction contouring of the flanks, abdomen, lateral bra rolls, and fat transfer or injection for breast augmentation.

Will my reconstructive breast match the other side?

The goal is to achieve as much symmetry as possible, but your breasts will not look or feel exactly the same.  Depending on your type of reconstruction, there are several procedures that can be done to your other breast to improve symmetry, including a breast lift (mastopexy), breast reduction, or breast augmentation with an implant.  This balancing procedure is often done after your main reconstruction and can be combined with nipple areolar reconstruction.

Can I talk to other patients who have had breast reconstruction, or see some sample patient photos?

There are several websites that show before and after photos for patients who have undergone breast reconstruction, such as this website or:

www.bra-day.com/breast-reconstruction

 It is important to remember that depending on your specific circumstances different options may apply to you.  Willow Breast Cancer Support Canada also has peer support groups (www.willow.org). You may also call your surgeon’s office to speak to one of our patient volunteers.

Can my nipples be saved?

In some specific cases, yes they can be saved.  Possible circumstances include prophylactic (risk reducing) mastectomies, or mastectomies with small tumors that are far enough away from your nipple-areolar complex. In some patients (e.g. patients with large, sagging breasts), it may be favorable for the cosmetic outcome to remove the nipple together with the redundant skin. Your breast and plastic surgeons can review your specific case.

Will my breasts still feel like my own after reconstruction?

The goal is to reconstruct a breast that looks and feels like your own.  However, your breasts will still feel different after your reconstruction, including sensation, shape and firmness.  This varies a lot from patient to patient, and can change over time.

What happens with future screening for breast cancer?

There is no evidence that breast reconstruction increases the risk of breast cancer recurrence or will delay detection of breast cancer recurrence. If you have had bilateral mastectomies, then a major benefit is that you will no longer require any more routine screening or surveillance. If you have had a mastectomy on only one side, then you continue to be screened using mammogram, ultrasound, or MRI on your other breast If you have had a lumpectomy, regular screening mammograms continues, with a new baseline mammogram ordered approximately 6 months after your reconstruction.