Breast Reconstruction

Breast reconstruction is a surgical procedure designed to restore the size, shape and appearance of the breast after a mastectomy (removal of the breast due to cancer). The decision to undergo reconstructive surgery is extremely personal and there are several techniques designed to meet the individual goals and physical needs of each patient.

If you’re interested in reconstructive surgery, it is ideally discussed with your breast surgeon and Dr. Robinson, and planned prior to the mastectomy. The best time to undergo reconstructive breast surgery is at the same time as the mastectomy. At that time, the chest wall is normal and the skin maintains it’s elasticity allowing an implant or expander to be placed with minimal tension on the incision.

However, some patients delay breast reconstruction for various personal and emotional reasons. In addition, if radiation in the chest is needed post-mastectomy, it is usually advised to delay reconstruction until after radiation treatment has completed.

Procedures

There are three general options for breast reconstruction. One method is to use a breast implant alone. Another is to place a tissue expander at the time of mastectomy and replace it with an implant at a later date. The final is to use your own tissue. It is important for you to understand your options. Dr. Robinson will discuss these options and help you make a decision appropriate for your needs.

Using Breast Implants for Breast Reconstruction

A saline or silicone gel implant is used to mold a new breast shape. If your skin and chest wall tissues are tight and flat, this may be done in multiple stages, wherein a tissue expander is placed beneath the skin and chest muscle. This expander is sequentially filled with saline, which over time creates a new cavity. Once the cavity reaches the correct size, the tissue expander is replaced with a standard implant.

Most patients who choose to have a breast implant reconstruction undergo this sequence of procedures. Some patients may be candidates for immediate implant placement after mastectomy.

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Tissue Flap Breast Reconstruction

The basic idea of a tissue flap is to take your own skin, fat, and sometimes muscle from one area of the body and use them to reconstruct a new breast. There are four primary methods for a tissue flap procedure:

• A TRAM (transverse rectus abdominis muscle) flap uses the lower abdomen, between the waist and pubic bone as a donor site. In terms of the tissue removed, The TRAM flap procedure is very similar to a tummy tuck. There is typically enough skin, fat, and blood vessels to reconstruct a breast. One abdominal rectus muscle (one side of the “six-pack”) must be removed, however, to form the base of the breast mound.
• A latissimus dorsi flap uses the upper back as the donor site. The latissimus dorsi muscle from the back is tunneled under the skin to the front of the chest. This creates a convenient pocket which can be filled with an implant to add fullness to the reconstructed breast.
• A DIEP (deep inferior epigastric artery perforator) flap is similar to a TRAM flap except that it doesn’t involve the sacrifice of an abdominal muscle. Instead, blood vessels are carefully dissected out of the abdominal muscle and then reconnected to new blood vessels in the chest wall with the use of a microscope.
• An SGAP (superior gluteal artery perforator) flap is similar to the DIEP flap. It is an ideal option for women who are thin or for some other reason cannot spare tissue from the lower abdomen. Instead, the buttocks are used as the donor site.

Nipple and areola reconstruction is an optional secondary surgery associated with breast reconstruction. If the patient chooses, nipple and areola reconstruction can be done two to three months following breast reconstruction to allow time for healing. Like the tissue flaps, donor skin from your body is typically used to reconstruct the nipple and areola.

Ultimately, the areola is tattooed using permanent makeup to make it look very similar to the intact breast. This last step is very crucial and completes the sequence of breast reconstruction.


How long is the recovery after breast reconstruction?

Recovery time will vary depending on the procedure you choose. With implants, you are likely to feel fatigue and soreness for one to two weeks after your breast reconstruction. If you choose a tissue flap, recovery will typically take longer. You can return to most normal activities in as little as three to four weeks with an implant, or six to eight weeks after a tissue flap procedure.

It is normal to have decreased sensation around the breast after your operation. Some of this numbness may resolve with time. Tissue may not completely heal for up to a year. Scars will start out as pink or red, but will certainly fade with time.

Fountain View Professional Center 10110 Donald S. Powers Drive, Suite 201A Munster, IN 46321 (219) 513-2100	Vale Park Medical Center 401 Wall Street Valparaiso, IN 46383 (866) 613-2100

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