Reconstruction

Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition. The creation of a new breast can help you regain your self-image, self-confidence and quality of life. Breast reconstruction is a highly individualized procedure and is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy. Breast reconstruction can involve several procedures performed in multiple stages. It can begin at the same time as mastectomy, or be delayed until you heal from mastectomy and recover from any additional cancer treatments such as radiation or chemotherapy. There are many factors that go into the type of reconstruction that can be offered including the stage of your cancer, size of your natural breasts, the amount of tissue available for a flap procedure, the appetite for the patient to undergo multiple procedures, the recovery periods, etc. With whichever method is used, breast reconstruction is broken up into two main techniques, flap surgery where one uses their own muscle and tissue to provide the volume for reconstruction or through an expansion with breast implants.

Procedure: A TRAM flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.

Alternatively, it is possible to choose a perforator flap such as a DIEP or SGAP flap which do not transfer any muscle but only the subcutaneous tissue from the abdomen or buttock.

 A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact. Occasionally, the flap has insufficient volume reconstruct a complete breast mound, and is often necessary to add a breast implant to provide the sufficient shape. 

Reconstruction with tissue expansion allows a quicker recovery than flap procedures, but it is a more lengthy reconstruction process. It requires multiple office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin and muscle. A second surgical procedure is needed to replace the expander with a permanent implant (saline or silicone). Finally, a third surgery involves creating a new nipple and areola through a variety of techniques.

Results:  Recovery depends greatly on which reconstruction method was used but typically, a flap reconstruction take up to 8 weeks for a full recovery, whereas the implant reconstruction can take up to 3 weeks.