How Is Breast Reconstruction Conducted?
Direct-to-Implant Breast Reconstruction
In many cases, an immediate, single stage, reconstruction can now be performed with breast implants during breast augmentation. This is a wonderful and simple option, with often excellent results. Not everyone, however, is a good candidate for this option. Dr. Goldberg can help counsel you on whether this is a good option for you.
Tissue Expansion
In other cases, implant reconstruction is performed in two stages. A tissue expander is a deflated implant that can be placed at the time of the mastectomy. The tissue expander, a tool designed to stimulate skin growth, is placed under the skin and gradually filled with saline to stretch the skin for the implant beneath the chest muscle. These expansions can be done in the office with a needle directly into the expander. The breast skin is usually insensate, so there is no pain. The breast mound is usually restored when the implant is inserted, and the nipple is usually reconstructed later.
Latissimus Dorsi Flap Breast Reconstruction
During the latissimus dorsi flap procedure, muscle from the back is tunneled under the skin to the front of the chest. The placement of the muscle creates a pocket in which the implant will sit.
Autologous (Free Flap) Breast Reconstruction
Approaches that rely on autologous methods, like the TRAM flap, are complex procedures that can take between 4-6 hours to conduct. During the TRAM flap, tissue is removed from the lower abdomen as in the tummy tuck procedure. One abdominal muscle is removed to form the base of breast mound, and the tissue — skin, fat, and/or blood vessels — is then used to reconstruct the breast.
Another type of flap is the DIEP, or deep inferior epigastric perforator. This is a type of free flap surgery, meaning that tissue and blood vessels will be cut and reattached to tissue and blood vessels in the new location on the chest. The DIEP flap, like the TRAM flap, comes from the abdomen. The difference between the TRAM and DIEP techniques is in the types of tissues being transferred. While the TRAM flap repurposes muscle, skin, and fat, the DIEP approach only utilizes the skin and fat. In cases where muscle transfer will not be necessary, a DIEP flap reconstruction may be recommended. One of the benefits of the DIEP technique is that most patients recover more quickly, as no muscle is harvested.
Revision Reconstruction
Corrective breast reconstruction, also known as a revisionary procedure, is a specialized surgery performed to refine or correct the outcome of a previous breast reconstruction, addressing both aesthetic concerns and functional issues that may arise over time. Many patients pursue revision reconstruction to enhance breast shape, size, or symmetry, especially if the initial reconstruction has changed due to factors like scar tissue, radiation therapy, aging, or implant-related complications.
In some cases, revision may involve replacing old implants with newer ones, switching from implants to natural tissue reconstruction (or vice versa), or reshaping the breast mound to achieve a more natural and balanced contour. Dr. Goldberg may also revise the nipple and areola, improve the definition of the inframammary fold, or perform fat grafting to enhance softness and projection. Every breast reconstruction journey is unique, and the revision process is carefully tailored to a patient’s anatomy, goals, and prior surgical history. The ultimate goal of revision breast reconstruction is not only to enhance the cosmetic result, but also to restore a sense of comfort and wholeness. For the right patient, revision surgery can help women feel more confident in their appearance and at ease in their own bodies after breast cancer treatment or previous surgery.
