Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy. It can be performed in coordination with the general surgeon at the time of mastectomy or lumpectomy, or at a later time.
Although breast reconstruction can rebuild your breast, the results are highly variable. A reconstructed breast will not have the same sensation and feel as the breast it replaces. Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back or abdomen.
Most breast reconstruction requires two-staged operations. The most common and least invasive with less recovery time is breast reconstruction with placement of a tissue expander under the chest (pectoralis) muscle. An acellular dermal graft is used to cover the bottom portion of the expander under the skin. The expander is then filled every two weeks in the office for usually three sessions. In some instances, an immediate implant may be placed at the initial surgery. The second phase operation is then performed whereby the expander is replaced by a permanent implant and a nipple is made. Tattooing of the nipple and areola may also be done in our office.
Flap techniques: When a patient has insufficient tissue to cover or support an implant, a flap would be required. This repositions a woman’s own muscle, fat and skin to create or cover the breast mound. Flap procedures are more involved, longer procedures that require longer hospitalization.
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 can reconstruct to a complete breast mound, but often provides he muscle and tissue necessary to cover and support the breast implant.
A TRAM flap uses donor muscle, fat and skin from a women’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.
Tissue Re-arrangement: When a lumpectomy is performed, there may be enough breast tissue to rearrange to try to avoid a depression and make the radiation area less noticeable.
Opposite Breast: If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.
Fat grafting to refine the reconstructed breasts may be recommended. This is a nice method to smooth transition zones, tissue irregularities and even soften and improve radiation damage.