The process of creating a new breast following a mastectomy is called breast reconstruction. If reconstruction is done at the time of the mastectomy, it is referred to as immediate reconstruction. If reconstruction is performed after the mastectomy during a separate operation or series of operation, it is referred to as delayed reconstruction.
Many breast reconstruction options are available for patients who have their breast(s) removed because of cancer. The 2 most common methods involve using either implants or the patient’s own tissue.
Implant reconstruction—-Reconstruction based on implants typically involves placing an implant underneath the pectoral muscle and involves a series of operations:
- A tissue expander is placed underneath the pectoral muscle. The tissue expander allows the patient’s muscle and skin to stretch to accommodate the final implant. Tissue expanders also allow a patient and her plastic surgeon the opportunity to determine her final outcome in breast size and shape.
- The tissue expander is then removed and the final implant is placed in the pocket underneath the muscle created by the tissue expander. (If a patient requires radiation therapy, the final implant will be placed after the radiation therapy is completed.) The final implant may be a saline implant, a silicone implant, or a composite implant, depending on the patient’s desires and medical history.
- After the final implant is placed, if the nipples were removed at the time of the mastectomy, new nipples can be fashioned out of the patient’s own skin or nipples can be tattooed onto the newly created breast.
- Occasionally, a plastic surgeon may be comfortable placing permanent implants at the time of the original surgery. This option is considered on a case-by-case basis and should be discussed with your plastic surgeon.
Tissue-based reconstruction—Tissue-based reconstruction involves using the patient’s own tissue to create the new breast. This technique may give a more natural appearance to the reconstructed breast. Skin, fat, muscle, and tissue, commonly from the patient’s back, abdomen, or buttocks, can be transferred to the mastectomy site. TRAM ( for Trans Rectus Abdominis Muscle) flaps and Latisimus dorsi flaps contain muscle as well as skin, fat and blood vessels. DIEP (for Deep Inferior EPigastric perforator artery) flaps contain skin, fat and blood vessels. DIEP flaps spare a patient’s muscles.
The tissue’s natural blood supply can remain intact or may be reattached to blood vessels in the underarm (axilla) or chest. When the tissue’s blood vessels are reattached to the axillary or chest blood vessels , the transferred tissue is called a “free flap.”
When more volume is needed for the desired new breast size and shape, an implant may be used in addition to the patient’s tissue.
Reconstruction options are based on many factors, including the following:
- The type of surgery required for removal of the breast cancer
- The need for possible chemotherapy and/or radiation after surgery
- Other medical conditions of the patient, such as cardiac disease, lupus, multiple sclerosis
- Previous radiation therapy , chest wall surgery, or medication use (like blood thinners and steroids)
- Cigarette smoking (previous and current)
- The patient’s preference for reconstruction
- To create the reconstructive surgery plan, a consultation with a plastic surgeon is necessary.
As with all surgeries, breast reconstruction surgery does not come without risks, which may include the following:
- Infection, which may lead to removal of the breast implants
- Contracture of implants
- Loss of tissue flaps
- Wound healing problems
- The need for multiple-staged surgeries
Other points to consider are the fact that there will be surgical scars and lack of sensation of reconstructed nipples and skin.
The choice to have breast reconstruction or not is a personal one. It is important that a patient fully considers her options and makes the decision that is right for her.