When a woman loses one or both of her breasts to cancer, she often struggles with feelings of loss including a sense of lost femininity, powerlessness, and so on. Breast reconstruction surgery is an option for women who have undergone a mastectomy following breast cancer treatment to regain the look and feel of her lost breast(s). This breast surgery procedure can be done as an integral part of cancer treatment, and may be done immediately after the mastectomy or later.
The reconstruction itself is accomplished by our plastic surgeon using breast implants, autologous (or natural) tissue, or both. Flaps are the method for reconstructing the breast that relies on natural tissue; they consist of fat, skin, blood vessels, and muscle from various parts of the body. The transverse rectus abdominal muscle (TRAM) flap is taken from the abdomen, the deep inferior epigastric perforator (DIEP) and latissimus dori flap are both taken from the back, and the superior gluteal artery perforator (SGAP) from the buttocks.
These flaps can be designed as either pedicle flaps that are attached to their original blood supply, or as free flaps that are disconnected from their blood source at the donor site and reconnected to the recipient site with microsurgery.
Women who have undergone a mastectomy or another breast-conserving surgery, such as a lumpectomy, are candidates for breast reconstruction. However, it is essential that that cancer has been eliminated by mastectomy before breast reconstruction can be planned.
Other important qualifications include:
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.
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.
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.
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.
You should expect to be both tired and sore for approximately 1-2 weeks following breast reconstruction. Dr. Goldberg may prescribe medication to help you control your pain. Stitches are generally removed within 7-10 days following surgery. Extra steps that may be taken to complete the breast reconstruction include: adding the nipple, changing breast shape/size, and operating on the opposite breast to match the newly reconstructed breast. You need to realize that it takes time to readjust — emotionally and physically — to your new breast.
For more information about breast reconstruction surgery, call our office for a consultation at 866-481-5585.
*Individual Results May Vary