What is Breast Reconstruction?

Breast reconstruction is the surgical procedure performed to restore the appearance of a breast for women who have had a mastectomy (surgical removal of the entire breast). Using sophisticated plastic surgical techniques, the breast is rebuilt, often including the nipple and surrounding area (areola).

Why Choose Breast Reconstruction?

When confronted with loss of a breast, each woman must decide if reconstruction of this lost part is suitable for her, weighing the emotional and physical results. Some reasons for pursuing reconstruction are:

To bolster self-esteem and body image (psychological reasons)
To provide symmetry when wearing a bra (differences are notable when nude)
For convenience (after reconstruction, an external prosthesis is not needed)
To maintain normal body balance

Factors Impacting Breast Reconstruction Decisions

Your general medical condition and other health factors which could impact healing ability
The stage of breast cancer when mastectomy was performed
The size of your natural/other breast (additional minimizing surgery of the remaining breast may be necessary for women with excessively large breasts)
Type of surgical procedure used
Insurance coverage, especially if surgery on remaining breast is required or if complications from the surgery occur
Your psychological health and level of expectation regarding the outcome of the surgery
The amount of natural body tissue available, particularly in very thin women

Types of Breast Reconstruction

Along with medical advances come options for the type of breast reconstruction available to you today. Final decisions are made after consultation with your family or support group, your oncologist/surgeon and a plastic surgeon. The two main types of reconstruction are implants (foreign substance placed beneath the skin and muscle covering your chest) or tissue transfer or flap surgery (use of muscle and tissue from the abdomen, back, hip or buttocks to create a new breast form; TRAM – transverse rectus abdominis muscle flap – being the most common).

Implant Procedures
There are several types of implants which are currently used for breast reconstruction; saline-filled, silicone gel-filled, and alternative.

Saline implants consist of a silicone rubber skin capsule/shell filled with a saline (salt water) solution. It’s size can be adjusted by adding more saline through a valve in the implant. Implants feel the most lifelike of all the reconstruction methods.

Silicone implants consist of a silicone rubber skin capsule/shell filled with a gel generally composed of silicone oil, cured and uncured silicones and an almost microscopic amount of metal. Because of all the controversy about whether silicone liquid leaching through the silicone skin can cause autoimmune diseases in women, these have dropped from favor and been pulled off the market in many areas.

Alternative implants - Usually still having a silicone rubber skin capsule/shell, an alternative implant uses filler other than saline or silicone or can contain a shell made of material other than silicone (e.g. Elast-Eon, a biostable material used in other medical devices, such has cardiovascular implants).

Tissue Transfer or Flap surgery
Using the latest and most sophisticated methods of plastic surgery, a breast can be reconstructed today with the patient’s own tissue and blood supply. This reconstruction must sometimes be augmented by implants.

TRAM Flap - In TRAM flap surgery, the transverse rectus abdominus muscle and subcutaneous tissue and skin above it are brought up to the chest area by a tunnel going up through the abdomen. With a pedicle tram flap, the abdominal muscle, with its blood supply intact, create a new breast. With a free flap, the portion of muscle is cut free and transplanted, with blood supply established from arteries in the transplanted area. A side benefit of these procedures is a much tighter lower abdomen or “tummy tuck”. Click here for Protocol.

Latissimus Dorsi Flap - In the latissimus dorsi procedure, part of this large muscle from the back, its skin and its own blood supply are moved to the chest by tunneling underneath the skin below the axilla (armpit). Implants are frequently used to fill this newly created pouch if it does not match the existing breast in size or shape. Click here for Protocol.

DIEP Flap - The DIEP (deep inferior epigastric artery perforator) flap procedure uses fat and skin from the same abdominal area as the TRAM, but does not use the muscle itself. By not disturbing the underlying muscle, certain potential complications, such as hernias or abdominal bulges, are minimized. When done as a free flap, microsurgery is required to connect all the tiny vessels to create a new blood supply.

GAP Flap - The GAP (gluteal artery perforator) flap uses tissue from the buttocks for reconstruction of a new breast. Ample tissue is required in the buttock area to maintain normal symmetry after surgery. A free flap procedure, microsurgery is required to connect all the tiny vessels to create a new blood supply.

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