Mastectomy and Implant Reconstruction
Who is a good candidate?
More than 80% of women in the United States who undergo mastectomy and desire a reconstruction make use of implants. This approach may not be appropriate for smokers, uncontrolled diabetics, morbidly obese patients, patients on blood thinners or those who have previous radiation.
While most surgeons use a two-stage approach where a temporary implant is first placed followed by definitive implant placement 3-6 months later, Dr. Schwartz almost exclusively goes “direct-to-implant” placing the definitive implant at the time of the mastectomy. In addition, unlike most surgeons, Dr. Schwartz places his implants above the muscle which minimizes pain and breast deformity, facilitating a quicker recovery with a more aesthetic final result. This approach combined with an expertly performed nipple-sparing mastectomy leaves many patients with results that appear as if they have had a cosmetic breast augmentation. The majority of Dr. Schwartz’s patients are good candidates for nipple-sparing procedures.
Consultation and Procedure
During your consultation, Dr. Schwartz will evaluate your individual case and formulate a treatment plan that is right for you. Thanks to Dr. Schwartz’s access to a private Outpatient Surgery Center, his patients can expect to have their mastectomy and reconstruction scheduled without a delay. Mastectomy and implant-based reconstruction is always covered by health insurance companies and this coverage is guaranteed under federal law.
Dr. Schwartz typically completes a unilateral mastectomy and immediate implant reconstruction in about an hour and bilateral cases in close to two hours under general anesthesia. Typically, one drain is placed into each breast unless a significant lymph node dissection is performed (for more advanced cancers) when 2 drains will be placed. Patients are discharged home on the day of surgery. Dr. Schwartz was one of the first surgeons to document the safety of the outpatient mastectomy and immediate implant-based reconstruction in an Ambulatory Surgery Center, without the need for hospital admission. He further documented increased patient satisfaction and a lower infection rate as well compared to patients undergoing surgery in the hospital. Dressings are placed in the operating room which stay on until the following week when they are removed and a sports bra is put on.
Most patients are good candidates for nipple-sparing mastectomy and have hidden incisions placed in the crease of their breast with no obvious scars seen when standing up. For those patients who are not good candidates for a nipple-sparing approach secondary to oncological concerns or because the nipple is located very far from its ideal location, Dr. Schwartz can immediately reconstruct you a nipple or transplant your own nipples as skin grafts into a more ideal position at the time of mastectomy. Most patients who have significant excess skin and “ptosis” where the nipple is located well below the breast crease will require a “Wise-pattern mastectomy” where the skin is reduced and the nipple repositioned use breast reduction incisions. These patients are often able to still preserve their nipple and appear as if they have had breast reduction surgery. This is performed using a technique that Dr. Schwartz has innovated and published as well. Patients have breast reduction scars- around the areola and then from the areola straight down to the breast crease and then in the breast crease as well (see breast reduction surgery). These are very discreet and aesthetic scars.
Dr. Schwartz has significant experience performing just one-sided mastectomy surgery and reconstructions and getting good symmetry with the opposite healthy breast without operating on it. He has published several innovative papers on strategies on how to accomplish this. Some patients who prefer to have just a mastectomy on one side require a breast reduction on the other side to get good symmetry with their reconstructed breast that has undergone mastectomy. Dr. Schwartz performs all of this surgery in one operation and uses his expertise to get the best result possible with just one surgical procedure.
Recovery and Results
Recovery times after mastectomy and implant reconstruction vary depending on the individual and breast size but are typically two to three weeks and patients can expect to return to their normal activities and exercise within four weeks. Drains are left in place for 10-14 days. Patients are placed in a sports bra at their first post-operative visit and should wear this for three months. Most patients never need additional surgery, but some choose to improve their aesthetic result with fat transfer and or changing out their implants (usually upsizing) 3-6 months after their initial surgery. Results from mastectomy and implant reconstruction are typically very good, with most patients maintaining or even improving their breast appearance.
Your surgical or sports bra will need to be worn for 12 weeks following your mastectomy and reconstruction. You should plan to be off work for 3-4 weeks, depending on the type of work you perform. You also may feel pulling or stretching in your breast area. Although you may need pain medicine for a week or two, you can expect to feel better and stronger each day. For several weeks, you may get tired easily or have less energy than usual. You also may have the feeling that fluid is moving in your breasts. This feeling is normal and will go away over time.
Mastectomy and reconstruction results in significant changes in sensation, with most losing significant nipple sensation permanently. Over time, much of the breast skin will regain normal sensation. Keep in mind that it may take time to get used to your new breasts. You will have swelling at first. But the breasts will soften and appear more natural over time. You are likely to feel well enough to return to work after 2 to 4 weeks, based on your progress. You can usually resume normal physical activities in this time frame as well. You should expect some scarring following mastectomy and implant-based reconstruction; however, these scars will gradually fade over time.