I am an active smoker. I know I should quit for my health, but what are the risks of smoking with breast reconstruction?
Active smokers have a marked impaired ability to heal and an increased risk of poor healing with the mastectomy and the breast reconstruction. With implant surgery, smokers are at higher risk of implant infection, mastectomy flap necrosis, bleeding after surgery requiring reoperation, and either early or late reconstructive failure. With abdominal DIEP flap breast reconstruction surgery, smokers are at higher risk of infection, breast skin healing problems, and delayed healing of the abdomen. In summary, smoking increases the risk of total breast reconstruction failure, wound healing problems, and infection. Nicotine replacement therapies (patches, e-cigarettes, gum) also have a poor effect on wound healing and are not better than smoking. It is encouraged to be off of all nicotine products for at least six weeks prior to surgery and six weeks after surgery to reduce these risks.
I am going to need radiation therapy after my mastectomy. How will this affect my decision for breast reconstruction?
Patients planning to undergo radiation therapy after mastectomy present a complicated reconstructive scenario. If breast implant reconstruction is performed and then radiation is given, there is a higher rate of aggressive scarring around the implant, which can cause pain and deformity. This is called "capsular contracture." There is also a higher rate of implant-based infection, which can lead to removal of the implant and breast reconstruction failure. If a woman wants abdominal DIEP flap breast reconstruction, performing it prior to radiation therapy can lead to unpredictable shrinkage of the reconstruction. For most women who are known to need radiation therapy after mastectomy, we generally recommend either placing a temporary breast-shaped device to hold the shape of the breast as a "babysitter" of the skin or delaying the breast reconstruction until after the radiation therapy is completed. If a "babysitter" device (tissue expander) is placed during radiation, the patient completes a DIEP flap breast reconstruction six months later to create a soft, healthy breast that will have optimal healing and a long-lasting, natural result. In some select patients—especially thin women with smaller breasts—initial reconstruction might be considered prior to radiation but needs to be discussed with both the surgical oncologist and plastic surgeon.
I have had previous mastectomy and radiation therapy and now want to have breast reconstruction. What is my best option?
In general, previously radiated tissue has impaired healing with surgical procedures and doesn't stretch well because of scarring. Implant-based reconstruction after radiation has a higher rate of delayed healing, infection, and reconstructive failure. Because of the tight radiated skin, it is very difficult to get an adequately sized, long-lasting breast implant reconstruction. Abdominal tissue DIEP flap breast reconstruction in a previously radiated area generally involves replacing much of the radiated tissue with healthy, non-radiated skin and fat. Because new, non-radiated skin is used to replace the radiated skin on the chest, a soft, healthy breast can be created at the time of surgery. Timing is generally six months after completing radiation.
I'm planning a DIEP flap breast reconstruction. Where will my abdominal incision be placed? If it's higher than desired, can it be revised in the future?
The location of the DIEP flap breast reconstruction abdominal incision varies between patients based on the location of the perforators needed for the breast reconstruction. High perforators (generally above the umbilicus) result in a high scar, whereas lower perforators can allow for the planning of a lower scar. In general, the scar is slightly higher than the location of a true "tummy tuck" scar. In some cases, the scar can be lowered as a secondary procedure at the time of the breast reconstruction revision surgery.
