Before your procedure, you may be given a list of pre-operative instructions to prepare you for your breast reconstruction. These instructions will depend on whether your breast reconstruction is performed at the time of your mastectomy or in a delayed fashion. In most cases, your mastectomy and reconstruction will be performed in a hospital.
On the day of your surgery, your surgeon will walk you through the techniques they will be using, as discussed in your consultation. The first step for most will be the administration of general anesthesia by the anesthesia team so that you do not feel any pain or discomfort throughout the procedure.
If your mastectomy and reconstruction are planned for the same surgery, your breast surgeon will begin with the mastectomy. Once that is completed, your plastic surgeon Dr. Moon, or Dr. Scurci will proceed with Breast Reconstruction.
The type of breast reconstruction agreed upon by you and your plastic surgeon will determine the next steps. In most cases, a tissue expander is inserted by the plastic surgeon immediately following mastectomy. The mastectomy incisions are then carefully closed by your plastic surgeon. The process of tissue expansion occurs over several office visits 1-2 months after placement of the expander to gradually fill the device with saline to expand the skin and prepare it for the next stage of reconstruction.
Tissue expansion is complete once the patient is happy with the volume and shape of the filled tissue expander. A second surgery would then be scheduled to exchange the tissue expander for an implant or to proceed with a flap-based reconstruction depending on your choice of breast reconstruction.
For women who are not candidates for nipple-sparing mastectomy, the final stage of breast reconstruction is nipple and areola reconstruction. This is planned at least 4-6 months from the most recent breast surgery and can often be done as an outpatient procedure under local anesthesia or sedation. Techniques usually involve folding skin to create the shape of a nipple followed by tattooing. Three-dimensional nipple-areola tattooing may be used alone to create the appearance of a realistic nipple with the illusion of projection.
There are many variations to the surgical plan described above, but this is a common treatment timeline.