Breast Reconstruction

CONSIDERATIONS

The surgical planning for a breast reconstruction typically begins at the same time as the planning for the mastectomy. Considerations include how soon the patient will have the procedure and what type of reconstruction technique is best suited for the case.

The surgical plan also will determine whether to use implants or tissue grafts, whether (or how) to incorporate nipple and areola reconstruction, and other procedures specific to the patient’s circumstance that need to be employed. The general goal is to help the patient regain a normal appearance of the breasts as part of the final phase of breast cancer treatment.

SURGICAL TECHNIQUE

Surgical techniques vary, and today, patients are getting more options that can match their personal preferences. It is important to find a highly specialized plastic surgeon to perform breast reconstruction and one who will work with the cancer surgeon to achieve a natural result.

RECONSTRUCTION WITH IMPLANTS

Breast implants are a common method used with a reconstruction procedure. Reconstruction with implants usually occurs in a multi-stage treatment session. The doctor places a tissue expander between the chest muscle and the skin during the mastectomy. This expander will be gradually filled with a saline solution to expand the skin and eventually replace it with an implant. Sometimes, the saline-filled expander is retained instead of an implant.

AUTOLOGOUS RECONSTRUCTION

Flap procedures harvest skin and muscle tissue from donor sites and transfer them to the breast. The surgeon may choose between one of the following common techniques:

• TRAM flap involves grafting skin and muscle tissues on the lower part of the abdomen.
• DIEP and SIEA flap graft tissue from the lower part of the abdomen, but harvests only the skin and fat tissues instead of muscles.
• Latissimus Dorsi flap uses skin and muscle tissues from the upper back.
• GAP flap uses skin, fat, and muscle tissues from the buttocks area.
• TUG flap harvests skin, fat, and muscle tissues from the inner thighs near the buttocks area.

NIPPLE/AREOLA RESTORATION

Nipple and areola reconstruction occur after the surgical breast removal process when the breast. Skin and muscle tissues are grafted and formed to recreate the nipple, while the areola is achieved by tattooing. This occurs when the breast reconstruction has fully healed.

DURING/AFTER SURGERY

Breast reconstruction uses general anesthesia, and the patient is often required to stay in a hospital if done simultaneously with the mastectomy. Patients who have flap surgeries sometimes stay up to 5 days for monitoring. There will be discomfort and pain within the first week, and the patient may feel disoriented with the newly formed chest. Temporary drain tubes and bandages assist in healing. It can be unnerving to go through a major body change; however, patients find it gratifying and relieving that they once again look and feel normal as they start their new journey towards becoming a cancer survivor.