Jamie C. Zampell, MD

Hello,

Swelling can take several months to resolve after flap reconstruction as both the native breast skin and the transferred flaps will take time to heal. Subtle swelling can take up to 6-12 months to completely resolve; the transferred tissue will encourage a new healthy blood supply to your native breast skin but this takes several months to occur. Lumps in the flap may be a separate issue and should be checked by your plastic surgeon. Sometimes small areas of fat necrosis can occur in a flap and can be removed if painful but this would need to be determined by your board certified plastic surgeon. Hope this helps!

Hello,

It is important to understand what was done during your surgery to understand whether this is normal. If you had a true TRAM flap, which does not spare the rectus muscle, there may be some tightness related to the repair of the abdominal wall. If you had a muscle-sparing TRAM or DIEP flap (which mostly preserves the rectus muscle), the tightness may relax over time. Many surgeons intentionally tighten the abdominal muscles if they have spread over time, the purpose being to improve the overall appearance of the abdomen. This is rectus diastasis repair and can lead to tightness. Best to discuss further with your surgeon!

Hello! You are correct that Biocell/textured implants have been linked to ALCL but there is no current recommendation to remove or exchange them in asymptomatic cases.  It may be reasonable to exchange the implants or revise your breast reconstruction if the implants are bottoming out or your do not like the appearance of the reconstruction.  

Options for revision reconstruction include bilateral implant exchange to a smooth implant with capsule revision to address bottoming out and correct your current asymmetry.  If the problem/asymmetry is significant or you prefer to avoid further breast implants, another option is to remove the implants and replace with your own tissue, such as a with a DIEP or other perforator-based flap.  

Yes, immediate reconstruction is a commonly used option to start reconstructing your breast at the time of mastectomy.  An immediate reconstruction can be accomplished using your own tissue (as for a DIEP flap or other flap) or with implants as you inquire about.  Implant-based reconstruction can be accomplished by placing the permanent breast implant at the time of mastectomy (known as "direct-to-implant") or as part of a staged procedure, starting with a tissue expander which is exchanged to a permanent implant a few months later.  

With a "direct-to-implant," the goal is to provide a natural and immediate breast reconstruction completed at the time of mastectomy.  You may still require a second surgery to contour the breasts with fat grafting in order to achieve the best overall result.  Good candidates for this operation generally have little ptosis or sagging, allowing for a more even exchange of breast tissue for an implant. With a staged reconstruction, the surgeon places a tissue expander at the time of mastectomy in order to allow the skin envelope to recover from mastectomy and to create a stable pocket for a future implant.  At a later surgery, the expander is exchanged for a permanent implant and additional contouring performed to achieve the overall final result.

Good candidates for immediate reconstruction are generally in good health or have co-morbid illnesses under control.  Patients undergoing prophylactic (preventative surgery) are generally reasonable candidates for immediate reconstruction since there is not anticipation of additional breast cancer treatment after surgery like chemotherapy or radiation.