Breast Reconstruction Surgery

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Breast Cancer Centre of Hope

Breast Cancer Navigator 204-788-8080

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• Types of mastectomies

• Steps of breast reconstruction • Breast reconstruction options • Preparing for surgery

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Breast Reconstruction Information Session offered at Breast Cancer Centre of Hope

•Types of breast reconstruction •Your hospital stay

•Recovery

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Breast Reconstruction Information Session

204-788-8080 Toll-free in Manitoba

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Done when:

• You choose not to have reconstruction

• Used with implant reconstruction

• Option to do delayed reconstruction

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•Skin and breast tissue are removed

•S-shaped scar

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Delayed Reconstruction

Advantages

o Cancer treatment done first

o Time to consider your options

o Wear a breast

prosthesis while you decide

Disadvantages

o You will be without a breast

o Bigger and more noticeable scars o 1-2 year wait to

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• Circular scar

• Breast tissue, nipple and areola are

removed

• Skin “pocket”

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Immediate Reconstruction

Advantages

o One surgery

o Reconstruction begins right away o Less scarring

Disadvantages

o Delay in starting your cancer

treatments-may need a longer time to heal

o Radiation can cause some breast

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• 3-6 month wait between each step of reconstruction

• Whole process of reconstruction takes 1-2 years

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Immediate Breast Reconstruction Steps:

• Surgery – Mastectomy and Reconstruction • Cancer treatments (if needed)

• Revision surgeries • Making a new nipple

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One Breast Reconstructed

• 4-5 hours

• New breast will be swollen and bruised • The new breast is made larger as it will

shrink with healing and/or radiation

• Your breast will be made to look the same after you are healed and finished

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Two Breasts Reconstructed

• 6-8 hours

• May need a surgery to make the breasts look the same

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Hospital Stay

• 3-5 days

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Cancer Treatment (if needed)

May include: • Chemotherapy • Targeted Therapy • Radiation Therapy • Anti-hormonal therapy

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Revision surgeries may include:

• Fixing the scars • Liposuction

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Revision Surgeries

• May need more than one surgery • May need general anesthetic

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Making A New Nipple

• Cutting and folding skin • Day surgery: 30-45

minutes

• Heals in 3-6 months

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Tattooing the Nipple and Areola

• Use makeup ink

• Colour gets lighter (fades) over time • Tattoo can be

touched up if you wish

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• Tummy Tissue • Buttock Tissue

• Thigh Tissue (not used much) • Back Muscle / Implant

• Tissue Expander / Implant

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Sometimes using your own tissue is not recommended

• Being overweight

• History of certain abdominal operations • Diabetes

• Heart problems • Lung problems • Clotting problems • Chronic back pain

• Previous tummy tuck/ liposuction • Smoking

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Option 1:

Tummy Tissue Reconstruction

(DIEP/SIEA)

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The flap

Skin-sparing Breast Reconstruction Using the Tummy

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DIEP vessels

DIEP blood vessels

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Removed piece of rib Breast pocket

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flap blood vessels

chest blood vessels flap

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This picture was taken 6 months after her first revision surgery.

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Risks and Complications

• 1-2% risk of total failure

• 4-5% risk of requiring a second operation • 1% risk of abdominal bulge or hernia

• Infection/bleeding/bruising • Blood clots

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Signs and symptoms of a blood clot

• Pain, swelling or a hot spot in calf • Shortness of breath

• Restlessness/sense of panic

If you have these symptoms go to the emergency department

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Option 2:

Buttock Tissue Reconstruction

SGAP/ IGAP

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The buttock flap is removed

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The Buttock Incision is Sewn Closed

• Takes 4-6 weeks for the incision to heal before you can sit

• May need revisions to the buttocks to make them the same shape and size

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Buttock Flap Moved up to Chest into the Skin Pocket

• The blood vessels will be sewn together

• A piece of buttock skin will close the centre of the new breast.

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Option 3:

Thigh Tissue Reconstruction

(TUG)

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Breast Reconstruction Using the Thigh Tissue

• The incision is made from the front of the thigh and goes around to the inner thigh to the back side

• A piece of thigh skin will close the centre of the new breast

• Recovery:

– Keep your knees together at all times and no sitting – Takes 4-6 weeks for the

incisions to heal before you can sit

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Option 4:

Back Muscle Reconstruction

with Implant

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• Back muscle

connected to chest muscle to create a pocket for implant

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• Muscle and piece of skin taken from the back

– Skin will be used to close the centre of the new breast

• Large scar wraps

around the back near the bra line

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Option 5:

Tissue Expander Implant

Reconstruction

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Pectoralis Major Muscle Skin

Pocket created for expander

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Permanent Implant

• Expander removed during day surgery • Permanent implant inserted

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Risks and Considerations of Implant Reconstruction

• 30-40% risk of complications

– May include infection or hardening of the tissue (capsular contraction)

• Will eventually need replacing

• Radiation increases the risk of damage to the implant

• Works best when two breasts are reconstructed • Works best for smaller to medium sized breasts

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www.breastreconstructionprogram.com

Reconstruction techniques may change over time and vary between plastic surgeons. Contact the Breast Cancer Navigator at

Breast Cancer Centre of Hope for more information:

204-788-8080

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things to avoid

• Avoid smoking for 6 weeks before and after surgery • Try to avoid caffeine before surgery to avoid

withdrawal headaches and avoid 3 weeks after surgery

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Special Bra and Undergarments

• Prescription given by plastic surgeon

– Can claim under private insurance and/or income tax

• Buy two of each type of undergarment needed • Given a list of where to buy undergarments

• Bring the undergarments with you to the hospital

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Special Bra and Undergarments

• Supports the new breast/breasts and area

where the tissue was taken from for your reconstruction

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Surgical Bra

• No seams or underwire

• Closes in the front

• Fits well around your body and below your breasts

• Wear the bra 24 hours per day for

approximately 3 months after surgery • Can take it off to shower

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Abdominal Binder

• Try it on

• Must fit low down on the tummy and around the top of the buttocks

• Supportive but not too tight • Adjustable with Velcro

• Wear the binder 24 hours per day for approximately 4 weeks after surgery

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Support Vest

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Support Shorts

Thigh and Buttock Reconstruction

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What to Bring to the Hospital

• Toothbrush • Comb

• Slippers/Housecoat • Loose pants

• Button or front zip top

• Bra and binder or garments required

• Health card/Insurance card • Medication list and allergy

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• Blood pressure, heart rate, temperature

• Intravenous (I.V.) • Medications

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Social Worker

• Adjustment to illness • Decision making • Financial resources • Community resources • Groups

• Expressing your fears, worries, feelings • Communicating with your family

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Social Worker

WRHA Breast Health Centre 204-258-1004

Toll-free in Manitoba 1-888-501-5219

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Peer Support 204-788-8080

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Breast Reconstruction Information Session offered at Breast Cancer Centre of Hope

•Types of breast reconstruction •Your hospital stay

•Recovery

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Breast Reconstruction Information Session

204-788-8080

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Breast Cancer Navigator 204-788-8080