Women who have had a breast removed (mastectomy) due to cancer or other disease process may seek reconstructive surgery to replace the missing breast. These patients may desire restoration in order to feel whole again. Sometimes patients do not want to wear an external prosthesis because it is uncomfortable or does not work with certain clothing options.
Breast reconstruction usually involves several procedures performed in stages. The first stage may begin at the same time as the mastectomy procedure or be delayed until the patient heals from the mastectomy and has completed cancer treatments.
There are several surgical options for breast reconstruction. The patient’s own muscle, fat and skin can be taken from either the abdominal area (TRAM flap) or from the back (latissimus dorsi flap) to form a new breast mound.
Another option is to place a breast implant (silicone or saline) under the skin to create the mound. Placement of an implant is preceded by tissue expansion. The expansion process uses a tissue expander device that is placed under the skin and muscle. It is slowly filled with saline weekly to expand the overlying skin and create an implant pocket. The tissue expander is then replaced with a softer more natural saline or silicone implant.
Breast reconstruction is completed by nipple reconstruction using skin flaps and grafts. Often, fat grafting is done to fill contour irregularities or thicken the natural tissue to better hide an implant. The reconstructed nipple is later tattooed to match the opposing nipple color.
Some patients also require surgery on their non-affected breast to achieve symmetry.
Some patients also require surgery on their non-affected breast to achieve symmetry. This can be accomplished with breast reduction, mastopexy or even augmentation. Your body size, shape and desired result will dictate the best surgical plan to achieve symmetry.
The initial breast reconstruction surgery (first stage) is often performed in the hospital under general anesthesia. Subsequent stages of reconstruction may be performed in an outpatient surgical center or office setting. Your surgeon will choose the best facility option for the procedure based on the procedure itself and insurance company requirements.
