For women who have overcome breast cancer and a mastectomy, replacing the lost breasts is often the first task at hand when it comes to rebuilding. When women make the decision to undergo breast reconstruction, far more options exist than the traditional breast implant, though many women are not aware of their choices. In addition to breast implants, women may have their breasts reconstructed through the use of natural tissue and sometimes a combination of both options.
The surgery may be completed immediately following a mastectomy or later at the patient’s discretion. Health insurance companies also usually cover most or all of the cost of breast reconstruction surgery, which may take place over several procedures.
Who Should Undergo Breast Reconstruction?
Ideal patients for breast reconstruction surgery are those who have undergone a mastectomy or another form of breast conserving surgery, such as a lumpectomy. Patients who have undergone a mastectomy may experience asymmetry and a loss of breast contour, shape or volume. To undergo breast reconstruction, the cancer must have been fully eliminated by the mastectomy and the patient must be mentally prepared for the surgery. If the patient is not ready, the surgery may be delayed until the patient is mentally able to undergo the procedure and experience the effects breast reconstruction can have.
The Surgical Procedure
When the patient is ready to undergo breast reconstruction, she will discuss the available options with her plastic surgeon to decide what procedure is best for her.
If the patient is to undergo the more traditional breast implant reconstruction, the patient is placed under general anesthesia where the first step is to create the breast mound. A tissue expander is then inserted. The tissue expander is gradually filled with saline to stretch the skin in order to place the implant beneath the chest muscle. The breast mound is then restored with the implant, but the nipple itself is often reconstructed later.
Another method for inserting implants in breast reconstruction is the latissimus dorsi flap method. In this procedure, the upper back is used as a donor site. The latissimus dorsi muscle is tunneled from the back to the chest, under the skin. This creates a pocket allowing placement of the implant to create fullness in the reconstructed breast.
If the breast is to be reconstructed without an implant, skin and fat can be grafted from the abdomen, back or buttocks. In this procedure, a blood supply may or may not be attached to the flap.
TRAM, or transverse rectus abdominis muscle, is one of the most commonly performed flap breast reconstruction procedures. In TRAM, skin and fat are grafted from the abdomen, in the area between the waist and pubic bone; the tissue is removed in a procedure similar to a tummy tuck. A single abdominal muscle must also be removed to create the base of the breast mound. The TRAM procedure takes between four and six hours to complete.
DIEP, or deep inferior epigastric artery perforator flap, is similar to the TRAM breast reconstruction technique, but does not involve removal of any abdominal muscle. In addition to the fat and skin graft of the TRAM technique, blood vessels are disconnected from the abdominal muscle and then reconnected to blood vessels in the chest wall.
SGAP flap, or superior gluteal artery perforator, is similar to the DIEP technique, but uses a flap from the buttocks as the donor site. This procedure is often recommended to women who are thin and lack the tissue to use the abdomen as a donor site.
Life After Breast Reconstruction
After breast reconstruction surgery, the patient should expect to be both tired and sore for several weeks. Pain experienced may be managed through a prescription medication. The stitches put in place following the procedure may be removed after seven to ten days. Follow-up procedures may include adding the nipple, changing the shape or size of the breast and operating on the opposite breast to match the newly constructed breast. The patient should also remember that undergoing breast reconstruction can be life-altering for some, and it may take time to adjust to the new breast.