Breast Reconstruction
Breast reconstruction after partial or complete removal of breast(s) can be a very physically and emotionally rewarding procedure for many women. It offers the ability to not only create a new breast, but also can dramatically improve a woman’s self-image, self-confidence, and quality of life.
Breast Reconstruction After Mastectomy
Breast reconstruction typically involves several procedures performed in multiple stages. It can begin at the same time as mastectomy or may be delayed until a patient has healed from mastectomy and recovered from any additional cancer treatments that may be necessary. Breast reconstruction is achieved through several reconstructive plastic surgery techniques following mastectomy including:
Expanders and Implants
Flap techniques that use a woman’s own muscle, fat, and skin to create or cover the breast mound
Grafting and other techniques to create a nipple and areola
Breast Expanders and Breast Implants
This procedure can be performed by your breast surgeon in one stage (direct to implant reconstruction) or in two stages (tissue expander first followed by implant). In general, reconstruction with implants following either route has the fewest scars and is the least invasive of all the breast reconstruction surgery options. This type of reconstruction may also involve the use of Alloderm, an acellular dermal matrix used to support the pocket created for the implant or tissue expander.
A tissue expander is a balloon placed at the time of the mastectomy and adds about 1 hour of extra surgery time. This procedure usually entails one day in the hospital. During follow up office appointments, the expander is gradually filled with salt water until you have reached your desired size. When chemotherapy and/or radiation therapy (if necessary) are completed, the expander is removed and the permanent implant placed (UNDER THE MUSCLE). This takes about one hour and is done on an outpatient basis.
After healing from the second surgery, a nipple can be created with skin taken locally from the reconstructed breast. A tattoo is added later in the office for the areola color.
Pre-Pectoral Tissue Expander Breast Reconstruction
Recent advances in technique have allowed for the placement of tissue expanders above the chest muscle (OVER THE MUSCLE), directly under the skin, in some patients. This reduces discomfort after surgery because the muscle is not lifted or cut to accommodate holding the tissue expander, and can avoid deformity of the breast reconstruction when the chest muscle is flexed. Not all patients are candidates for this type of reconstruction.
Flap Reconstruction
Flap techniques use a woman’s own tissue (muscle, fat, and skin) to create or cover the breast mound. Most often, tissue is taken from the back (Latissimus flap) or the abdomen (TRAM flap, DIEP flap). In the case that reconstruction is only needed for one breast, a woman may also wish to have a surgical procedure so that the unaffected breast will more closely match the reconstructed breast. This can be done at the time of mastectomy or later, depending on your preference for symmetry.
TRAM flap reconstruction uses skin, fat, and possibly muscle between the navel and pelvic bone to replace the removed breast. The result is a flatter stomach and a breast mound reconstruction made of your own tissue. This flap may remain attached to the original blood supply and tunneled up to the breast, or it can be completely detached from the abdomen.
Microsurgery is often used to help in the movement of tissue from the abdomen to the chest if the tissue is disconnected from the body during surgery. These flaps are called “free flaps”. Depending on the anatomy of the blood vessels to the tissue, varying portions of the abdominal muscles may also be harvested. If no muscle is taken from the abdomen, this is called a “DIEP” flap or “SIEA” flap. Each technique results in a hip to hip scar near the underwear line that will fade over time.
Latissimus flap reconstruction utilizes skin and muscle from the back which is tunneled just under the skin to the reconstructed breast. The flap stays connected to its donor site, leaving blood supply intact. Because the back has less fatty tissue than the abdomen, an implant is generally necessary to achieve the desired breast size.
DIEP flap Reconstruction:
The Deep Inferior Epigastric Perforator Flap (DIEP flap) is a specialized form of the TRAM flap requiring the use of microsurgery techniques. An incision is made along the lower abdomen. Skin, soft tissue, and blood vessels feeding the tissue are removed. These blood vessels are then matched to supplying vessels at the mastectomy site and reattached under a microscope.
With the DIEP flap, no muscle is removed. This leaves the muscles in place and preserves the abdominal strength. The result in the abdomen is much like a tummy tuck, and the result in the chest is a reconstructed breast that is soft, warm, and more natural feeling. This procedure takes at least 4-5 hours in the operating room, and often requires 3-5 days in the hospital.
“Going Flat” or “Living Flat”
Not offered the possibility of breast reconstruction
Offered only limited options
Age
Denial
Unneccesary
“The most important fact is that every woman, independent of her circumstances, should be offered the entire range of options at the time of the mastectomy in order to be able to make an educated decision. Whether you choose to reconstruct immediately or delay, or not to choose reconstruction at all – it is YOUR decision, and you are entitled to change your mind as your life’s journey continues.” - AIRS.
Implants
Saline: Breast implants filled with sterile salt water.
Silicone: Breast implants filled with silicone gel. The gel feels a bit more like natural breast tissue.
Gummy Bear: Breast (Form-stable) implants filled with silicone that maintain their shape even when the silicone shell is broken.
Round breast implants: Breast implants that have a tendency to make breasts appear fuller than form-stable implants.
Smooth breast implants: Breast implants that have the softest feeling. They can move with the breast implant pocket, which may give more natural movement.
Textured breast implants: Breast implants that develop scar tissue to stick to the implant, making them less likely to move around inside of the breast and become repositioned.
I had breast expanders with reconstruction - Natrelle saline implants - and fat graphting in February 2016.
Any questions on the type of surgery and reconstruction I had, please reach out to Lauren@LivandLet.com