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Breast Reconstruction*

Breast Reconstruction with DIEP Flap

There are a variety of surgical techniques for breast reconstruction.  Most mastectomy patients are medically appropriate for breast reconstruction, either immediately following breast removal or at a later time.  The best candidates, however, are women whose cancer, as far as can be determined, seems to be eliminated by mastectomy.  There are legitimate reasons to delay breast reconstruction.  Some women may be advised by their surgeon or oncologist to wait until other forms of necessary cancer treatment are completed.  Other patients may require more complex breast reconstruction procedures.  Women who smoke or who have other health conditions such as obesity or high blood pressure may be advised to postpone surgery.  In any case, being informed of your options concerning breast reconstruction can help you prepare for a mastectomy with a more positive outlook on the future.

Breast reconstruction has no known effect on altering the natural history of breast cancer or interfering with other forms of breast cancer treatment such as chemotherapy or radiation. However, breast reconstruction techniques and results may be impacted by the administration of other forms of breast cancer treatment.

The DIEP flap technique of breast reconstruction involves the use of lower abdominal skin and fatty tissue with as little as possible of the abdominal muscle.  This tissue is transferred to the chest wall region in order to reconstruct a breast mound.  The blood vessels providing circulation to the tissue are re-connected to the blood vessels on the chest to re-establish flow of blood to the tissue in the new position. This vascular connection usually requires microsurgical techniques.  Following the reconstruction of the breast mound, the lower abdominal incisions are closed.  This is a modification of TRAM (Transverse Rectus AbdominisMyocutaneous) abdominal muscle flap breast reconstruction, but attempts to preserve the “six-pack” rectus abdominis muscle function.  In some cases, your plastic surgeon may recommend that a breast implant be inserted underneath the flap to give the breast mound additional projection.

Tissue flap techniques of breast reconstruction are useful in the following situations:

  • Inadequate chest wall tissue for breast reconstruction with implants or expanders
  • Past history of radiation to chest wall after mastectomy
  • Patients with concerns about breast implants.
  • Failure of earlier breast reconstruction

Contraindications to DIEP flap breast reconstruction procedure exist:

  • A patient who is medically or psychologically unsuitable for breast reconstruction
  • A past history of abdominal surgery which has impaired DIEP flap blood supply

Breast Reconstruction with Latissimus Muscle Flap

There are a variety of surgical techniques for breast reconstruction.  Most mastectomy patients are medically appropriate for breast reconstruction, either immediately following breast removal or at a later time.  The best candidates, however, are women whose cancer, as far as can be determined, seems to be eliminated by mastectomy.  There are legitimate reasons to delay breast reconstruction.  Some women may be advised by their surgeon or oncologist to wait until other forms of necessary cancer treatment are completed, or to wait until the pathology is complete from the mastectomy.  Other patients may require more complex breast reconstruction procedures.  Women who smoke, or who have other health conditions, such as obesity or high blood pressure, may be advised to postpone surgery.  In any case, being informed of your options concerning breast reconstruction can help you prepare for a mastectomy with a more positive outlook on the future.

Breast reconstruction has no known effect on altering the natural history of breast cancer or interfering with other forms of breast cancer treatment such as chemotherapy or radiation. However, breast reconstruction techniques and results may be impacted by the administration of other forms of breast cancer treatment.

In breast reconstruction with the latissimusdorsi, a muscle located on the back along with its attached skin (and some intervening fat) is transferred to the chest region for the breast reconstruction procedure.  The muscle flap maintains its own blood supply, and helps nourish the tissue that is transferred to the chest wall region.  There are several variations on the surgical technique of latissimus muscle flap breast reconstruction, including microvascular surgery to attach the flap to the chest region.  In many cases, your plastic surgeon may recommend that a breast implant be inserted underneath the muscle flap to give the breast mound additional projection. Many patients do not have enough soft tissue overlying the muscle to have sufficient projection without an implant, but this depends on the patient’s body frame and breast size as well.

Muscle flap techniques of breast reconstruction are useful in the following situations:

  • Inadequate chest wall tissue for breast reconstruction with implants or expanders
  • Past history of radiation to chest wall after mastectomy
  • Patient with concerns about breast implants, although implants may be necessary to achieve symmetry
  • Failure of earlier breast reconstruction

Contraindications to latissimus muscle flap breast reconstruction procedure exist:

  • A patient who is medically or psychologically unsuitable for breast reconstruction
  • Previous injury to the latissimus muscle or local blood supply from surgery or other treatments

Breast Reconstruction with Tissue Expander

There are a variety of surgical techniques for breast reconstruction.  Breast cancer patients who are medically appropriate for breast reconstruction may consider tissue expander breast reconstruction, either immediately following mastectomy or at a later time.  The best candidates, however, are women whose breast cancer, as far as can be determined, seems to be eliminated by mastectomy and other treatments.

Breast reconstruction has no known effect on altering the natural history of breast cancer or interfering with other forms of breast cancer treatment such as chemotherapy or radiation.

  • Breast reconstruction with tissue expansion is a two-stage It first involves the use of a silicone rubber balloon-like tissue expander that is inserted beneath the skin and often also beneath chest muscles.  Saline or air is gradually injected into the tissue expander to fill it over a period of weeks or months.  This process allows the skin on the chest to be stretched over the expander, creating a breast mound.  In most cases, once the skin has been stretched enough, the expander is surgically removed and replaced with a permanent breast implant.  Some tissue expanders are designed to be left in place as a breast implant.

There are legitimate reasons to delay breast reconstruction.  Some women may be advised by their surgeon or oncologist to wait until other forms of necessary cancer treatment are completed or disease staging has been accomplished.  Other patients may require more complex breast reconstruction procedures.  Women who smoke or who have other health conditions such as obesity may be advised to postpone surgery.  Individuals with a weakened immune system (currently receiving chemotherapy or drugs to suppress the immune system), conditions that interfere with blood clotting or wound healing, or have reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments may be at greater risk for complications and poor surgical outcome.  In any case, being informed of your options concerning breast reconstruction can help you prepare for a mastectomy with a more positive outlook on the future.

The shape and size of your breasts prior to surgery will influence both the recommended placement of the tissue expander and the final shape of your reconstructed breast.  Tissue expander breast reconstruction cannot produce an exact replica of the removed breast.  Breast symmetry surgery on the opposite breast may be needed to produce similar size.  The nipple and darker skin surrounding it, called the areola, may be reconstructed in a subsequent procedure after the breast mound is created through tissue expansion.

Since May 2000, saline-filled breast implant and tissue expander devices have been approved by the United States Food and Drug Administration (USFDA) for use in breast augmentation and reconstruction. The FDA approved silicone gel implants for use in breast augmentation and reconstruction in November 2006.

Patients undergoing breast surgery with tissue expanders and implants must consider the following:

  • Breast augmentation or reconstruction with implants may not be a one-time surgery.
  • Breast implants and tissue expanders of any type are not considered lifetime devices. They cannot be expected to last forever.  You will likely require future surgery for implant replacement or removal.
  • Changes that occur to the breasts following augmentation or reconstruction with implants are not reversible. There may be an unacceptable appearance to the breast if you later choose to have breast implants or tissue expanders removed.

Breast Reconstruction with TRAM Flap

There are a variety of surgical techniques for breast reconstruction.  Most mastectomy patients are medically appropriate for breast reconstruction, either immediately following breast removal or at a later time.  The best candidates, however, are women whose cancer, as far as can be determined, seems to be eliminated by mastectomy.  There are legitimate reasons to delay breast reconstruction.  Some women may be advised by their surgeon or oncologist to wait until other forms of necessary cancer treatment are completed.  Other patients may require more complex breast reconstruction procedures.  Women who smoke or who have other health conditions such as obesity or high blood pressure may be advised to postpone surgery.  In any case, being informed of your options concerning breast reconstruction can help you prepare for a mastectomy with a more positive outlook on the future.  Some individuals who are of thin body habitus may not be suitable candidates for TRAM flap procedures. Individuals of obese body habitus are also advised of increase risk due to the effect of obesity on surgical complications.

Breast reconstruction has no known effect on altering the natural history of breast cancer or interfering with other forms of breast cancer treatment such as chemotherapy or radiation.

The TRAM flap technique of breast reconstruction involves the use of abdominal muscle flap(s) made from the rectus abdominus muscle.  This muscle and a portion of lower abdominal skin and other tissue are repositioned to the chest wall region in order to reconstruct a breast mound.  The muscle flap maintains its own blood supply, and helps nourish the tissue that is transferred to the chest wall region.  Following the reconstruction of the breast mound, the lower abdominal incisions are closed.  There are several variations on the surgical technique of TRAM flap breast reconstruction, including micro vascular surgery, to attach the flap to the chest region.  In some cases, your plastic surgeon may recommend that a breast implant be inserted underneath the muscle flap to give the breast mound additional projection.

Muscle flap techniques of breast reconstruction are useful in the following situations:

  • Inadequate chest wall tissue for breast reconstruction with implants or expanders
  • Past history of radiation to chest wall after mastectomy
  • Patient with concerns about breast implants
  • Failure of earlier breast reconstruction

*Disclaimer: Plastic & Cosmetic Surgery Results Can Vary Significantly Between Patients. In terms of results and expectations, there are numerous variables with every patient, each surgery and every recovery and healing period. For more information click to read our full Disclaimer