Q&A: Breast Reconstruction

Q: I’m 43 years old and had breast cancer. Did a radical mastectomy and axillary lymph node removal, plus chemotherapy. In the meantime, I have gain a lot of weight, my tummy is quite prominent, and the other breast is big and droopy. I would like to go for breast reconstruction and also to tackle the other two issues- tummy and breast. What are my options? How long will it take to recover?

Ans: Thanks for dropping a question. Your situation is quite common and actually being a bit overweight and having a bit bigger tummy can be actually an advantage in your case. One of the reconstruction methods uses the abdomen skin and fat to reconstruct the breast. It can be done using one of your abdominal muscles to transfer skin and fat to the mastectomy site, called TRAM flap. Or the same volume can be transferred to the chest using microsurgery techniques, sparing de abdominal muscle- the DIEP flap. Both are intended to mould the abdominal tissues in the chest to create a breast, and you’ll gain a tummy tuck, improving your abdominal contour significantly. This is usually the first step of the reconstruction. As it is a lengthy procedure, we need to stage it into different surgeries. The first is the actual breast reconstruction.
The second stage, in a situation like yours, is directed to reduce and lift the healthy breast to achieve symmetry. It is a more straightforward surgery. Sometimes we also need to work on the reconstructed breast to improve the result: doing some liposuction and\or fat graft to enhance the shape, improving scars, reconstructing the nipple and areola. In terms of recovery, the first stage has a longer downtime, as it is a quite extensive procedure and you’ll have some limitations in the post-operative period. It varies from patient to patient, depending on other associated illness, physical condition, age and family support. Taking the necessary precautions,you’ll be back to your routine in two to three weeks. Although avoiding exercise, lifting weights and strenuous activities for a variable and more prolonged period.
The second stage is usually planned after 4 to 6 months after the initial reconstruction, to allow the new breast to take shape and the tissues and scars to settle down. The recovery is much faster, and usually, after a week, you’ll be back to your normal life with some small limitations.

Sometimes we defer the nipple-areola reconstruction to a 3rd stage, and that is an outpatient procedure, done under local anaesthesia.

Overall the process can take up to 9-12 months, depending on the patient condition, availability to take time out of work and personal options and choices. Breast reconstruction is an essential part of breast cancer treatment. It allows you to recover your body image, your self-esteem, your life quality and is a significant step to overcome and win the battle against cancer.

As a piece of final advice, would recommend you to and discuss and weigh your options with your medical team, family and friends, support groups, make up your mind and go for it if that is your wish.

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Dr Francisco de Melo is a board certified Plastic Surgeon with more than 20 years of experience in plastic, reconstructive and cosmetic surgery in Portugal and the UAE. Before moving to Dubai in 2012,  was a Consultant Plastic Surgeon and  Head of Surgery Department in the Military Hospital of Lisbon in Portugal.

Mobile : +971585887265