Breast Reconstruction and Patient Rehabilitation

By Sanjay Daluvoy, MD, Specialists in Plastic Surgery

Every October, my world turns (more) pink. Not because of my 4-year-old daughter, but because it’s Breast Cancer Awareness Month. Breast reconstruction is the cornerstone of my practice and an important element in breast cancer treatment. Unfortunately, during this month I see an uptick in women who are diagnosed with breast cancer simply because more women get their screening mammograms. 

When a woman hears the words “breast cancer,” her life is never the same. From the breast surgeon to the radiologist to the oncologist to the plastic surgeon, a woman’s life goes into a whirlwind filled with doctor visits, statistics, and multiple options.

While other physicians work diligently to treat the cancer, the plastic surgeon works to reconstruct the patient’s body and restore normalcy—a new normal. 

The goal of breast reconstruction is to create breast mounds that, in a bra and clothes, give the appearance and curvature of normal breasts.

There are two primary ways to accomplish this goal:

1.  Autologous reconstruction uses the patient’s own tissue (skin, fat, and muscle) from another anatomic site such as
    the abdomen.
2. Implant-based reconstruction consists of one or two stages using tissue expanders and breast implants.

Advances in both options have truly improved the outcomes, experience, and recovery for women. Recently, there has been a growth in “pre-pectoral” implant-based reconstruction. In the right patients, the tissue expanders and implants can be placed “over the muscle,” thus decreasing post-operative pain and discomfort for the patient. 

As much as choosing and executing the right surgical plan, developing an effective recovery plan is important for each patient. Early recovery involves a sound pain-control strategy, early physical activity, and stable emotional comfort. 

By employing a combination of narcotics and muscle relaxants, the physician and patient design a pain control and weaning plan.  In terms of early activity, patients are encouraged to ambulate the night of surgery and perform deep-breathing exercises to improve blood circulation and airflow through the lungs. These are proven ways to accelerate the healing pathways and decrease complications. Range of motion exercises for arms are employed within one to two weeks to help reduce stiffness.      

Emotional support via multi-modal breast care teams and the patient’s family is probably the most important element to help patients get through this challenging period in their lives. 

Breast reconstruction is a physical reconstruction—however, there is a significant psychological rehabilitation component to it that is paramount to its success.