If you’ve had a mastectomy or lumpectomy and would like to reconstruct your breasts' shape, appearance, symmetry and size as the final step in your cancer journey, our plastic surgeons have the knowledge and tools to be part of your multi-specialty treatment team.
What's breast reconstruction?
Breast reconstruction is an important part of breast cancer treatment. Although it's not a cosmetic surgery, our surgeons use cosmetic surgery principles and techniques to help you look and feel more like yourself again. This can often involve several procedures performed at separate times and can either begin at the time of your mastectomy or be delayed, depending on your individual circumstances and preferences.
Breast reconstruction options
The type of mastectomy you had, your overall cancer treatments and your body type should be taken into consideration when choosing which option is best for you. Symmetry (balance) is also important in breast reconstruction. If only one of your breasts has been affected, you may also choose to have a breast lift, reduction or augmentation on the opposite breast to improve the balance of size, shape and position of both breasts.
We know there are a lot of decisions to make while dealing with breast cancer, and our trusted specialists will discuss all your options with you so you can make an informed decision during this challenging time. We’ll work with your breast surgeon to guide you through this difficult journey.
Breast reconstruction with implants
Implant reconstruction uses saline or silicone breast implants placed on top of or under your chest muscle to help form a new breast mound. Implant reconstruction typically requires using a tissue expander, which stretches the remaining skin after mastectomy to create room for an implant. After it’s placed, the tissue expander is then gradually filled with saline by your plastic surgeon (over a number of weeks), which slowly stretches the skin. Implants typically need to be replaced after 10 to 20 years.
Breast reconstruction using your own tissue
Some patients prefer to use their own tissue (also known as autologous reconstruction) in breast reconstruction. Tissue, called a flap, is taken from another part of your body and used to form your new breast. This can be done at the time of your mastectomy (called immediate reconstruction), or later as a separate procedure (delayed reconstruction). Sometimes, a breast implant may be added to get the desired breast size. The most commonly used tissue is from the abdomen. Other areas include the thigh or buttocks.
Breast flap reconstruction surgery is complex and more extensive than mastectomy or implant reconstruction. This type of breast reconstruction results in larger incisions that take longer to heal, so they often require a longer recovery period and hospital stay.
Types of Flap
There are several options that are available to reconstruct the breasts. Not every patient is a candidate for flap-based reconstruction.
Our surgeons will discuss the options with you. Based on your desires, physical exam, medical history and surgical history, they'll tailor the reconstruction that’s appropriate for you.
In a TRAM flap procedure, skin, fat, and muscle from your lower abdomen are used to reconstruct your breasts. There are two types of TRAM flaps — a pedicled TRAM flap and a free TRAM flap. The rectus abdominus muscle (also known as your “ab muscle”) is included in this type of flap surgery.
In a pedicled TRAM flap, the muscle and tissue remain attached to their blood supply in your abdomen and are moved to the chest wall to recreate a breast.
In a free TRAM flap, the tissues with its artery and veins are disconnected from their origin blood supply, relocated to the chest wall to recreate a breast mound, and reconnected to recipient arteries and veins in the chest.
This is a more complex surgery and involves microsurgery techniques. Microsurgery is surgery that uses specialized instruments, including an operating microscope to connect intricate structures like blood vessels and nerves. Recovery is typically longer.
In a pedicled TRAM flap, the muscle and tissue remain attached to their blood supply in your abdomen and are moved to the chest wall to recreate a breast.
In a free TRAM flap, the tissues with its artery and veins are disconnected from their origin blood supply, relocated to the chest wall to recreate a breast mound, and reconnected to recipient arteries and veins in the chest.
This is a more complex surgery and involves microsurgery techniques. Microsurgery is surgery that uses specialized instruments, including an operating microscope to connect intricate structures like blood vessels and nerves. Recovery is typically longer.
In a DIEP flap procedure, tissue from your lower abdomen, similar to the TRAM flap, is used to reconstruct the breasts. The main difference is that the blood supply to the tissue is dissected from the abdominal muscle (rectus abdominis), leaving most of your abdominal muscle in place. This is the most commonly used flap for autologous breast reconstruction.
Using a microscope and microsurgery techniques, our surgeons will then connect the blood vessels in the flap to vessels in your chest and rebuild your breast.
Using a microscope and microsurgery techniques, our surgeons will then connect the blood vessels in the flap to vessels in your chest and rebuild your breast.
The SIEA flap reconstruction removes skin, fat and blood vessels from your abdomen. It’s similar to a DIEP flap, but uses blood vessels that aren't as deep within your abdomen. This makes a SIEA flap dissection less extensive. However, the anatomy is not as consistent as the DIEP flap.
Not everyone has appropriate SIEA blood vessels for this surgery, so it’s important to discuss with your surgeon whether you’re a candidate for it.
Not everyone has appropriate SIEA blood vessels for this surgery, so it’s important to discuss with your surgeon whether you’re a candidate for it.
The latissimus dorsi flap uses a portion of skin, fat and the entire latissimus dorsi muscle (the broad, large muscle from your upper back) to reconstruct your breasts.
The tissue is transferred from the upper back region to the chest wall with its blood supply intact. Often times, this is combined with a breast implant to create the desired size.
The tissue is transferred from the upper back region to the chest wall with its blood supply intact. Often times, this is combined with a breast implant to create the desired size.
A gluteal flap is a procedure that takes tissue from your buttocks and transfers it to your chest using microsurgery techniques. It may be an option for women who prefer tissue reconstruction but don't have enough extra tissue in their abdomen or back.
A thigh-based flap uses skin, muscle and fatty tissue from the bottom of the buttocks to the inner thigh to reconstruct your breast. The muscle used from the inner thigh is called the gracilis, and it’s one of four muscles that pull the thigh inward.
However, this muscle can be used for your reconstruction without significant problems in your everyday life. Not everybody is a good candidate for this procedure, however.
However, this muscle can be used for your reconstruction without significant problems in your everyday life. Not everybody is a good candidate for this procedure, however.
Choosing a reconstructive option can be a complex decision. Some patients prefer implant-based while others prefer their own tissue. There are advantages and disadvantages to the different options, and your particular anatomy also plays a huge role.
Talk with our plastic surgeons and together we can tailor a plan personalized to you. Our office staff will be with you every step of the way.
Call (559) 459-4027 today to schedule a consultation.
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