What is breast reconstruction with a flap?

Breast reconstruction is a type of surgery. It rebuilds your breast after you've had part or all of a breast removed. It is often done for women who have cancer. It may take more than one surgery to rebuild a breast. But reconstruction is often started during the same surgery that removes the breast. You and your doctor will plan your surgery or surgeries based on your wishes and your health.

To do a tissue flap surgery, the doctor will use skin, fat, and possibly muscle to rebuild your breast. This may come from your back, your belly, or another part of your body. The nipple and the darker area around it (areola) are most often created later.

You will be asleep during the surgery. The doctor will do his or her best to make cuts in places on your body that won't be seen. These cuts are called incisions. Sometimes the doctor uses the same incisions that were used to remove the cancer. The incisions leave scars that fade with time.

After surgery, you will probably go home in 3 to 5 days. Many women can go back to work or their normal routine in 6 to 9 weeks. It depends on the type of work you do.

It's important to know that your breasts will look different after surgery. Your new breast may be more firm, round, or flat than your other breast. It may also not feel the same as the breast that was removed, but over time, you may get some feeling in your new breast. Some women have surgery on the other breast to make their breasts look more alike. If needed, your doctor may take fat cells from another part of your body and inject them into your breast to improve the shape. This is called lipofilling.

What happens before surgery?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
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  Tell your doctors ALL the medicines, vitamins, supplements, and herbal remedies you take. Some of these can increase the risk of bleeding or interact with anesthesia.
• If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
• Your doctor will tell you which medicines to take or stop before your surgery. You may need to stop taking certain medicines a week or more before surgery. So talk to your doctor as soon as you can.
• If you have an advance care plan, let your doctor know. Bring a copy to the hospital. If you don't have one, you may want to prepare one. It lets your doctor and loved ones know your health care wishes. Doctors advise that everyone prepare these papers before any type of surgery or procedure.

What happens on the day of surgery?

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  Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be cancelled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewellery and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery centre

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  Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take 4 to 5 hours.
• You will have bandages on your breast and around your chest and back. You may also have bandages on other places. It depends on where the doctor took tissue to rebuild your breast.

Going home

• Be sure you have someone to drive you home. Anesthesia and pain medicine make it unsafe for you to drive.
• You will be given more specific instructions about recovering from your surgery. They will cover things like diet, wound care, follow-up care, driving, and getting back to your normal routine.