Breast Reconstruction

Reconstruction of the breast after mastectomy is possible through a combination of plastic surgery techniques and can dramatically improve a woman’s self-image and quality of life. The results of breast reconstruction can be relatively natural in appearance, though the reconstructed breast my never look or feel exactly the same as the breast a woman had prior to mastectomy.

Breast reconstruction can be performed months or even years after a woman has already undergone mastectomy. This is known as delayed reconstruction. But in many cases the process of breast reconstruction can be started at the time of mastectomy. This is known as immediate reconstruction.

Whether a woman has immediate or delayed reconstruction, it is important to understand that the entire process from start to finish can take a year or longer to complete. This is because breast reconstruction is usually performed in stages.

The process of breast reconstruction begins with the creation of the breast mound. The three main types of breast reconstructive procedures include tissue expansion, TRAM Flap, and Latissimus Flap reconstruction.

Tissue expansion involves the placement of a tissue expander device under the pectoralis muscle of the chest. Over a period of several months, the expander is filled with sterile saline during visits at the office. Once the expansion is completed, the expander is removed and a breast implant is placed.

TRAM Flap (Transverse Rectus Abdominus Myocutaneous Flap) is an autologous form of breast reconstruction that involves the use of a woman’s abdominal skin and fat to reconstruct the breast. The skin and fat used come from the lower abdominal region, similar to the area removed in a tummy tuck procedure. Generally, so long as a woman has sufficient tissue in the area, the entire breast can be reconstructed without the use of a prosthetic implant. The main difference between TRAM Flap surgery and a tummy tuck procedure is that the rectus abdominus muscle is taken as part of the TRAM Flap and serves as the blood supply that nourishes the tissue.

Latissumus Flap surgery involves the use of the Latissimus Dorsi Muscle with an overlying paddle of skin, which is tunneled under the axillary region and brought onto the front of the chest. Occasionally the flap can reconstruct the entire breast mound. But in most cases, either a tissue expander or a breast implant is placed under the flap to reconstruct a complete breast mound.

In stages after the breast mound has been reconstructed, the nipple and areolar complex are created through use of small skin flaps and/or skin grafting techniques. Once healed, these are later tattooed to give the proper color. Additionally, some women will have surgery performed on the opposite breast to provide symmetry, such as breast reduction, breast lift, or breast augmentation.