The diagnosis of breast cancer and the prospect of surgical removal of the breast can be a very emotionally traumatic event for most women. Breasts are important to many women both physically and emotionally, and the loss of a breast can be very difficult. Many women experience a loss of femininity or lack of completeness after mastectomy. Fortunately, new techniques and technology have advanced the field of breast reconstruction such that plastic and reconstructive surgeons are able to create a new breast that very closely matches the opposite natural breast. There are a variety of surgical options that can be performed either at the time of mastectomy or at a later date. These options include tissue expansion and implant placement as well as use of the body's own tissue to reconstruct the breast (flap reconstruction), or a combination of both. Most patients will require two to three surgical procedures to recreate the final breast appearance. Usually the second or third procedures are often very minor.
Flap reconstruction involves using the women's own body tissues to reconstruct the breast.
The most common flap is a TRAM (transverse rectus abdominis muscle) flap that uses the skin and fat of the lower abdomen with the attached rectus muscle providing blood supply to reconstruct the breast. The procedure has the added advantage of removing excess tissue from the abdomen essentially resulting in a tummy tuck. This form of breast reconstruction avoids the need for any implant materials and in most cases will give the most natural appearing breasts.
Latissimus Dorsi Flap
Another common flap used is the latissimus dorsi flap. This flap uses skin and muscle from the back. Because it does not have as much bulk an implant is often also used.
The disadvantages of the flap reconstruction are that these are more complicated and longer operations, and require a longer postoperative recovery period. The primary advantage, especially for a TRAM flap, is the more natural appearance of the breast as well as the avoidance of any implant materials.
Tissue expansion involves the placement of an expandable balloon underneath the skin and muscle at the time of mastectomy or later. The implant then is gradually inflated with sterile saline solution over the course of several months to stretch out the skin and muscle. The implants are inflated in the office and take only ten minutes. Once the implant has reached the desired size then it is removed and replaced with a permanent implant.
The advantage of the tissue expander followed by implant is that it is a simpler operation with less initial postoperative recovery time required. The disadvantage is that it requires repeat office visits for expansion of the implant over the course of several months.
Immediate Implant Placement
Some times with skin sparing mastectomy and a small opposite breast an implant can be placed immediately without the need for tissue expansion, but this is not very common.
Following reconstruction of the breast mound and adequate healing of the tissues the nipple and areola can be reconstructed as minor procedure using local skin on the newly reconstructed breast as well as skin from another distant inconspicuous site. Finally, tattooing of the skin may be performed to darken the nipple-areolar complex to match the opposite side.
The best form of reconstruction will depend on individual patient characteristics and patient desires.