Breast Reconstruction & Nipple Tattooing

Breast reconstruction is the rebuilding of the breast and nipple after a mastectomy (the surgical removal of a breast) due to cancer or other disease.

Not surprisingly, many women find it difficult to come to terms with the loss of a breast. But new techniques used in breast reconstruction surgery give us the opportunity to remould a breast that matches as closely as possible to your remaining natural breast – or how your natural breasts used to be, if you have had both removed.

It is also possible to create a new nipple and to give it and the areola (the pigmented skin around the nipple) a natural-looking colour with cosmetic tattooing.

Your Procedure

Breast reconstruction might entail the insertion of a breast implant, the use of your own tissue, or a combination of the two. The surgeon will consult with you as to the most appropriate way to reconstruct your breast(s).

The most common procedure offered for breast reconstruction is the Flap reconstruction. This technique is called DIEP flap and it involves the use of donor tissue, generally from the abdomen, to create a breast shape.

If you are having implants, there are a number of different types to choose from and your surgeon will be able to advise which implant is best for you. He can also help you consider the options available in terms of implant shape.

If you choose an implant but do not have the necessary tissue after your breast removal, a technique that involves the insertion of a tissue expander can be used – a temporary implant placed beneath the chest muscle which is progressively expanded over weeks or months to stretch the overlying tissue. Once the new breast has reached an acceptable size, the temporary expander implant may be removed and replaced with a more permanent implant.

Your procedure will be performed under general anaesthetic and will take several hours, with the exact length depending on the surgical method used. Your stay in hospital should be two days to a week, depending on the type of reconstruction you have had.

For more information on breast reconstruction methods please talk to your surgeon. Please note: you will also have access to emotional support via the Mater Hospital's Pastoral Care Team and the Breast Care Nurse.

Side Effects

Breast reconstruction has no effect on the recurrence of disease in the breast, and in most circumstances, it will not interfere with chemotherapy or radiation treatment should cancer recur.

If an implant is used, there is the possibility of an infection developing – usually within the first two weeks following surgery. In some cases, the implant will have to be removed for several months until the infection clears.

Capsular contracture of implants can occur if the scar or capsule around the implant begins to tighten. This squeezing of the implant can cause the breast to feel hard. This can be treated in several ways, including the removal of the scar tissue or removal or replacement of the implant.

After your operation

Your post-surgical situation will depend on which type of reconstruction surgery you have had.

• If you have undergone DIEP Flap surgery, you may initially be admitted to the Intensive Care Unit for overnight monitoring, before moving onto a plastic surgery ward, where you and your wounds will continue to be regularly monitored. You will initially be on a drip to help you maintain your fluid intake.
• You may have drains from your breast(s) and abdomen (if you have had DIEP Flap surgery) to help remove any excess fluid and aid the healing process. These are generally removed prior to your discharge from hospital.
• Some pain or discomfort at your wound site and/or drain site can be expected. You may have a PCA pump (Patient Controlled Analgesia), which allows you to control your pain relief through a drip. Additional oral pain medication is also advisable.
• To help with the prevention of blood clots forming in your legs, you will have been measured for TED stockings and compression sleeves (SCDs) prior to your operation. These are worn to the operating theatre and post-operatively. You are able to stop wearing the SCDs once you are comfortably mobile. The TED stockings are to be worn until you are discharged from hospital. A small dose of blood thinning medication once or twice a day may also be advised.
• The garment for which you were measured up at your initial consultation will be put on you in theatre once your operation is complete. This must be worn continuously for six weeks to help keep the breasts supported.
• You may require assistance in the shower, or a sponge bath, depending on your needs.
• You may need a catheter in your bladder, particularly after DIEP Flap surgery. This will be removed after a few days, depending on how mobile you are.
• You will be visited by a physiotherapist who will give you exercises to perform. You will also be encouraged to sit out of bed and begin walking when possible.
• Your surgeon will visit you each day while you are in hospital and the nurses will be on hand to help you with any concerns.

At home

• You may notice some redness, swelling and bruising around the wound, which is normal.
• You may have some pain around the wound sites, which is normal and will eventually settle. This can be managed with oral pain medication.
• You will have dressings over your wound site. These should be left on until the two to three week post-op review. These dressings are waterproof, so there is no need to cover them to have a shower. However, if the dressings lift before the post-op review, please contact one of the clinic nurses.
• You must continue to wear your garment for six weeks.
• Avoid heavy lifting, strenuous exercise and unnecessary strain on your wounds for six weeks after surgery.
• Make sure you remain mobile at home, going for short walks, etc.
• Avoid driving for two weeks after surgery, and if necessary, only drive short distances until six weeks after surgery.
• Post-operative lethargy is often experienced and can last for a month or more after your operation.
• You should eat a nutritious diet high in vitamin C and drink plenty of water to help promote wound healing.
• A post-op review will generally be carried out two to three weeks after your surgery.

Problem signs

Surgery is not without its risks. You should be aware of any signs that something might be wrong. The symptoms below are potentially serious and would require you to contact the clinic, your GP or your closest emergency department:

• Signs of infection, such as a high temperature, heavy discharge from your wound site, an increase in redness around your wound site, or a dramatic increase in pain that is not relieved by oral pain medication.
• Increased swelling around your wound.
• Nausea or vomiting which does not settle.

Nipple Tattooing

A natural-looking colour can be restored to surgically sculpted nipples and the surrounding areola using cosmetic tattooing. Like a conventional tattoo, this process involves the depositing of pigment beneath the surface of the skin with needles. This pigment is a safe, non-reactive substance that has been specifically designed for implanting in human skin. All treatments are performed under sterile conditions by qualified professionals.

Colours can be selected or created to match your natural skin tone as closely as possible. You may require more than one visit and ongoing touch-ups may be necessary if over time the tattooed pigment fades.