FAQS – IMPLANT RECONSTRUCTION

General Questions

Are breast implants safe?

Yes, breast implants are FDA-approved devices and are an important option for breast reconstruction and breast augmentation. Breast implants have been studied and placed worldwide for decades and hundreds of thousands of patients have breast implants placed every year and report no adverse effects. Please visit our implant safety page for more information and additional resources.

What is the difference between subpectoral and prepectoral breast reconstruction?

Breast implants are used in both subpectoral and prepectoral reconstruction. The difference between the two is the location of the breast implant placement above or below the chest muscle

Prepectoral Breast Reconstruction:

• The breast implant is placed above the pectoralis muscle and is supported with a dermal matrix, or internal brassiere
• Tissue expanders are not always required when reconstructing the breast above the muscle

Subpectoral Breast Reconstruction:

• The breast implant is placed below the pectoralis muscle and is supported by the muscle.
• Tissue expander placement is required to expand the muscle, creating a pocket to place a permanent implant in the future

What is pectoral animation?

Pectoral animation is a complication of subpectoral implant placement. It is a deformity that results from the contracting of the pectoralis muscle that results in unflattering contracting and movement of the underlying breast implant.

What is capsular contracture?

A capsule, or scar tissue, forms around all breast implants. This is a natural process of the body. Capsular contracture is when this capsule constricts tightly around the breast implant and can cause distortion of the breast implant, breast tightness/pain, and breast firmness. The cause of capsular contracture is not fully known, but it is thought to be associated with an immune response such as a virus or infection.

What is acellular dermal matrix?

The dermis is the strength layer of our natural body tissue. Acellular dermal matrix is made from cadaver tissue and used as an internal brassiere to support the breast implant and provide additional tissue coverage between the breast implant and the mastectomy skin. Acellular dermal matrix technology is a large contributor that has facilitated prepectoral implant based breast reconstruction.

Why would a tissue expander be placed, rather than an implant?

A tissue expander may be placed following a mastectomy if there is a question regarding the perfusion, or blood supply, to the breast skin and/or nipple areola complex. If there is decreased blood flow to the skin or nipple, putting that skin under tension will only decrease the blood supply, increasing the risk of complications. A tissue expander is beneficial in this case because it allows for the breast pocket to be maintained, without putting unwanted tension on the skin. As the skin heals, the tissue expander can slowly be expanded in the office until the desired breast volume is achieved.

There are a few downsides to placing a tissue expander including that the patient will require more procedures in the future to not only expand the device, but also ultimately to exchange the tissue expander for breast implants. Also, tissue expanders have a less natural look and feel, as compared to breast implants, which some patients find mildly uncomfortable.

Why do I need to have a breast MRI after having breast implants placed?

Maintenance of silicone breast implants includes monitoring the implants with a breast MRI every 3 years to ensure the implants are intact. Implant ruptures can occur without causing any symptoms, and can go unnoticed if implants go unmonitored.

We also offer an annual breast ultrasound in the office to evaluate implant integrity.

Postoperative Care

What is the recovery of breast reconstruction with implants?

Hospital stay: Outpatient – No hospital stay required
Drains: typically two drains are placed to each breast
Mobility: Patients are able to get up and walk around starting the first day after surgery. They may shower 48 hours after surgery
Activity Restrictions: initially activity and arm range of motion restrictions will be placed, that are gradually lifted throughout the first month after surgery. Most normal daily activities can be resumed around 3-4 weeks post op, and depending upon the type of work, patients can return to work at 4 weeks. It is important to note that patients are not to lift/push/pull anything greater than 5-7 lbs for approximately 6 weeks and should avoid more strenuous activity for 2-3 months.

When can I shower?

You may shower 48 hours after surgery (postop day 2, with the water to your back. Showering with the water to your back prevents direct contact of water on the incisions. It is ok if water trickles over your shoulders to the incisions. Just pat the incisions/dressings dry after you shower. Please do not wash/scrub your incision sites. A sterile dressing was placed over your incisions in the operating room and this will stay in place and will be changed during your post op appointment. Please do not remove or change your dressings, unless otherwise specified by our office.

Can I shower with drains?

Yes

How do I care for my drains?

Please strip your drains 5-6 times per day and record the output per drain, per day on your drain log. For specific instruction on how to care for and strip your drains please refer to the drain care page.

How soon can I drive after surgery?

Once you no longer have drains, you no longer are taking pain medication, and you feel confident in your ability, you can return to driving. In the immediate post operative period you are at an increased risk for blood clots and precautions should be taken to avoid this. If you are driving longer than 2 hours, wear TED stockings and take breaks from sitting. You should only wear a lap belt, however if you must wear one that crosses your chest, be sure to place padding between you and the belt.

What wound care do I need to do?

In most cases after surgery you are not required to do any wound care, unless otherwise specified by our office. A sterile dressing will be placed over your incisions that should remain intact and will be changed in the office during your post operative visit.

What bra should I wear post op?

A special surgical bra will be placed post operatively in the operating room that is soft and breathable, allowing for optimal healing after your breast surgery. In the initial post operative period it is important that your breasts are supported, and the surgical bra is to be worn both during the day and at night.

How long do I wear the post op bra?

This is very individual and is based on the size of the breasts and your specific post operative recovery. Typically, at your one month post op appointment, pending no recovery complications, you will receive information regarding approved bras that you may purchase. After having a mastectomy, most patients have some degree of sensation change to the breasts. This decrease in breast sensation increases the risk of bras rubbing and causing skin irritation. It is important that you wear a bra that is soft, without underwire, and that does not have thick seams, to reduce the risk of skin irritation and breakdown. Our office has spent a lot of time finding bras that are safe and comfortable and you will be given this information when it safe for you to transition from the initial surgical bra.

When can I wear an underwire bra?

We do not recommend wearing an underwire bra. The wire tends to rub in areas that no longer have sensation or have decreased sensation, causing chafing or blistering. If you choose to wear an underwire for a short period of time, check your skin frequently for any breaks in the skin. If you are going to wear an underwire bra (for example for an event), you should wait at least 3 months after your initial surgery or 2 months after your symmetry procedure.

When can I wear deodorant?

Do not wear deodorant on the day of surgery. You may start wearing deodorant after you have been discharged home, unless you had a sentinel node biopsy, in which case you will need to wait until 1 week after surgery. There are no restrictions on the type of deodorant you may use.

When do I stop iron, selenium, and zinc after surgery?

You may stop iron 2-4 weeks after surgery if your energy levels have returned to normal (or you may stop if you are experiencing gastrointestinal issues with the iron). You may stop the zinc and selenium 2 weeks after surgery if you do not have wound healing complications.

When can I start Tamoxifen after surgery?

You can restart Tamoxifen 1 week after surgery.

When do I start range of motion exercises?

You will begin simple range of motion exercises after all drains have been removed, typically at the 2-3 week appointment. If at 4 weeks you have not been able to restore full range of motion, you will receive a prescription for physical therapy.

When can I exercise?

You can begin walking as soon as you return home. At 4-6 weeks, we allow you to gradually increase your activity. Most patients can resume light exercise including the stationary bicycle at 4-6 weeks post operatively. More strenuous exercise can typically be resumed at approximately 2-3 months post op. Please discuss with our office before resuming any exercise to ensure it is safe for you to do so in your specific situation.

When can I sleep on my stomach or side?

Please discuss with our office before transitioning to sleeping in a new position. All patients are required to sleep on their back for a minimum of 4-6 weeks post operatively. Typically, at 3 months post op, as long as there are no delays in your recovery, you can sleep on your stomach.

Can I massage my breasts?

Breasts can be lightly massaged at 2-3 months post operatively. Please avoid applying direct heat or cold to the breasts, this can result in burns or damage to the breast due to decreased breast sensation after mastectomy.

When can I resume sexual activity?

Intimacy can be resumed 6 weeks post operatively, as long as there are no recovery complications or delays in healing. Please avoid direct pressure to the breasts until at least 3 months post operatively.

When can I travel?

Implant reconstruction patients may travel the day after surgery. There are no restrictions with flying and you can fly with drains. Remember no lifting/pushing/pulling until you have been cleared. If you are flying or driving longer than 2 hours, wear TED stockings and take breaks from sitting. You should only wear a lap belt, however if you must wear one that crosses your chest, be sure to put some sort of padding between you and the belt. You may only drive yourself when you are no longer taking pain medication and 1 week after your last drains have been removed, generally this is two to three weeks postoperatively and is patient dependent.