Breast reconstruction is an important consideration for women undergoing breast cancer treatment. Due to the many options available, breast cancer treatment decisions may seem overwhelming at times. For many women, reconstruction is an integral part of the recovery process. Regaining your health and restoring your body image is possible with a lot of care, patience and courage. Our goal is to help you understand your options since there are several reconstructive techniques that can be used following a mastectomy.
Federal law requires that breast reconstruction, including aesthetic changes to the unaffected breast, be covered by insurance. It is very important that all women understand that they are entitled to breast reconstruction and have different options for reconstruction. If only one breast is affected, it alone may be reconstructed. A breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry between both breasts. It is important to consider all of the reconstruction options before making a decision.
Breast Expanders & Implants
A tissue expander followed by a breast implant is typically the simplest and quickest form of breast reconstruction. In this procedure, a tissue expander is placed under the skin, either at the time of the mastectomy or after healing from the mastectomy is complete. Saline solution is then added every few weeks to the expander, stretching the skin as it expands. When the skin has been sufficiently stretched, the tissue expander is removed at a second surgery and replaced by a permanent silicone or saline breast implant. This second procedure also can include nipple reconstruction and surgery to the unaffected breast to improve symmetry.
A latissimus flap is a breast reconstruction procedure that uses muscle and skin from the upper back to create a new breast mound after a mastectomy. An ellipse of skin and the latissimus dorsi muscle is tunneled from the upper back to the mastectomy site to create a reconstructed breast. A tissue expander is then placed under the flap, and saline is added weekly to the expander, stretching the skin as it expands. When the skin has been sufficiently stretched, the tissue expander is removed at a second surgery and replaced with a permanent silicone or saline breast implant. This second procedure also can include nipple reconstruction and surgery to the unaffected breast to improve symmetry. The advantages of this procedure include less visible scaring on the breast, more protection after radiation, and more soft tissue padding over the implant.
The Transverse Rectus Abdominus Myocutaneous Flap (TRAM flap) is a more involved method of breast reconstruction that utilizes extra skin and soft tissue (fat) from the lower abdomen, along with one of the rectus abdominus muscles, to create a breast mound. Since this is living tissue, an adequate blood supply must be maintained. The blood supply is contained within the rectus abdominus muscle. A synthetic mesh is placed over the area where the muscle was removed. This strengthens the abdominal wall and minimizes the chance of bulges.
Nipple reconstruction can be performed at a second procedure along with any surgery to the unaffected breast to improve symmetry.
Patients wishing to have this procedure must stop smoking six weeks prior to and six weeks following the surgery. Failure to comply may result in the death of the flap since it is living tissue.
Microvascular Breast Reconstruction
Microvascular breast reconstruction involves use of your own tissue in breast reconstruction, most frequently from the lower abdomen, as is the case with the muscle sparing free TRAM flap or the DIEP flap [Deep Inferior Epigastric Artery Perforator Flap]. These methods involve microsurgery to connect the tissue and provide the needed blood supply to survive. Dr. Chalekson will attempt to remove much smaller amounts or no muscle to decrease the potential for abdominal weakness, hernia or abdominal bulging after surgery. This method of surgery is typically a longer surgery and more complex.
Free Muscle Sparing TRAM A free muscle sparing flap is constructed with abdominal skin, fat and s small portion of the rectus muscle. The flap is disconnected from its own blood supply and reconnected to the arteries in the chest.
Free Deep Inferior Epigastric Perforator Flap (DIEP) The DIEP flap is constructed with abdominal skin and fat. The flap is disconnected from its own blood supply and then reconnected to the blood supply in the chest using the deep inferior epigastric artery, vein and its perforators. Not only does the skin and fat removed at the time of surgery reconstruct a natural appearing breast, but it also provides for a "tummy tuck" effect.