Revision of Breast Reconstruction- Improving Reconstructive Results

Who is a good candidate?

Patients who have undergone their cancer surgeries and reconstructions who are unhappy with aesthetic outcomes are good candidates for revisional surgery.  Patients should not be undergoing active cancer treatment (chemotherapy or radiotherapy) and should be at least 6 weeks from their last chemotherapy session and 6 months from their last radiation treatment.  Patients who have undergone either mastectomy or lumpectomy are candidates for revision of their breast reconstructions.

Consultation and Procedure

During your consultation, Dr. Schwartz will evaluate your individual case and formulate a treatment plan that is right for you.  He will give you several different options to address your reconstructive concerns, highlighting the pros and cons of each.  Thanks to Dr. Schwartz’s access to a private Outpatient Surgery Center, his patients can expect to have their revisional surgery without delay, with decreased cost and lower infection rate than the hospital.  Revision of breast reconstruction after breast cancer surgery is always covered by health insurance companies and this coverage is guaranteed under federal law.

Almost all revisions can be performed as outpatient surgeries.  They may involve removal and replacement of implants, fat transfer, conversion from an under the muscle implant to an above the muscle implants, placement of implants back into  a patient who has lost them secondary to complications, flap surgery to replace damaged, radiated tissues after lumpectomy or mastectomy, flap reconstruction to replace poor implant reconstructions, oncoplastic surgeries to retailor and reduce the skin envelope and reshape the breast, etc.  There are countless different types of revisions, all of which Dr. Schwartz has significant experience performing.  The lengths of these surgeries vary from an hour to four or five hours depending upon the complexity of the problem and the extent of surgery required to fix it.  Dr. Schwartz always makes certain to minimize scars by either using existing scars or placing them in hidden areas.

Most patients will have drains placed in the breast that will stay in for 10-14 days.  If they have tissue taken from the back, they will have a drain placed there that typically stays in for 14 days. Patients will be bandaged up after surgery and will keep this on until there follow up in approximately one week.

Recovery and Results

Recovery times after revisions of your breast reconstruction   vary depending on the nature of the revision performed and whether unilateral or bilateral surgery is performed.  Typically, patients can return to normal activities within three weeks and exercise without restrictions within 4-6 weeks. Drains are left in place for 10-14 days in the breast and 14-21 days in the back, if back tissue is used.  Patients are placed in a sports bra at their first post-operative visit and should wear this for two to three months.   Most patients do not require additional surgery, but some choose to improve their aesthetic result additional revision 3-6 months after their initial surgery.  Results after revision of breast reconstruction are usually excellent, with most patients noting a significant improvement in their breast appearance immediately after surgery.

You should plan to be off work for at least 3-4 weeks, depending on the type of work you perform.   You 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.  You may also feel a tight sensation in your back where the tissues were taken to reconstruct your breast.  This will loosen up and return to normal over time.

Revising your breast reconstruction may result in significant changes in sensation of your breast skin and nipple.  Over time, many will regain normal sensation.  Keep in mind that it may take time to get used to your newly revised 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 revision of your reconstruction; however, these scars will gradually fade over time.