With the enhanced techniques in early detection of breast cancer throughout the United States, many women find that they are candidates for lumpectomy and radiation instead of mastectomy. Nevertheless, some women still find that their breast cancer may require mastectomy, as determined by their oncologist and surgeon. For those women, breast reconstruction surgery may be an option both in the immediate setting at the time of mastectomy, or subsequently several months later. Breast reconstruction can improve the quality of life of many women by restoring a sense of balance and symmetry, allowing a woman to shed her need for an external prosthesis, and heightening both self-esteem and confidence.
Breast Reconstruction Techniques
Breast reconstruction surgery is usually performed in stages and can span across a period of several months. There are two categories of reconstruction: implant-based reconstruction and reconstruction using the patient’s own tissue. There are many factors and variables to consider in deciding whether to use one’s own tissue to reconstruct breasts or to utilize breast implants.
Tissue Flap Reconstruction (Autologous Reconstruction)
A tissue flap procedure uses a woman’s own tissue to reconstruct one or both breasts. Also referred to as autologous breast reconstruction, this option utilizes tissue from other parts of the body, such as the abdomen, back, thighs, or buttocks, to build the new breast mound. While a reconstructed breast will never exactly mimic a natural breast in appearance or feeling, tissue flap reconstruction typically allows a more natural-looking aesthetic than other reconstruction options. Additionally, the resulting breast from a flap procedure can more closely resemble a natural breast in behavior, as breasts formed by a woman’s own tissue typically shrink or grow proportional to an individual’s weight fluctuation. Because the flaps used in autologous breast reconstruction require healthy blood vessels for the tissue’s blood supply, some patients may not be optimal candidates for a tissue flap procedure. Factors taken into consideration include tobacco use, a history of uncontrolled diabetes, poor blood circulation (vascular disease), or connective tissue diseases.
Depending on the location of the donor site, tissue flap techniques employed may include:
- TRAM (transverse rectus abdominis muscle) or DIEP (deep inferior epigastric perforator): Utilized most commonly, TRAM and DIEP flaps use tissue from the abdomen to form the new breast. While a TRAM flap transfers muscle, skin, and fat to the chest for breast reconstruction, a DIEP flap relocates only skin and fat and is useful when muscle transfer is not necessary.
- Latissimus dorsi flaps: This technique borrows tissue from the upper back and transfers blood vessels, skin, muscles, and fat to the chest in order to rebuild the breast. Latissimus dorsi flaps can be an ideal reconstruction option for women who may not be good candidates for TRAM or DIEP flaps due to inadequate donor tissue on the abdomen.
- GAP (gluteal artery perforator): GAP flaps transfer skin and fat from the buttocks in order to reconstruct the breast mound. Though used less often, GAP flaps can be used as an alternative to TRAM or DIEP flaps when the abdominal tissue is not suitable as a donor site.
- TUG (transverse upper gracilis): TUG flaps use tissue from the inner thigh, and are generally most successful for women with a small amount of breast volume to re-create. TUG techniques are utilized when donor tissue in the abdomen, upper back, or buttocks is insufficient to reconstruct the new breast.
For some women, an implant may be a more beneficial option to re-create the breast shape. Depending on each patient’s unique needs, implant-based reconstruction can often be performed at the same time as cancer removal surgery (mastectomy). A tissue expander or fat grafting may be used to provide proper coverage for the breast implant(s) in the event that a woman’s skin tissue is too thin, or if the implant requires extra support. It is also common for flap techniques to be combined with implant-based reconstruction to provide the best cosmetic result possible.
Today there are more breast implant options than ever before. Implants can be textured or smooth, round or anatomic, or saline-filled or silicone gel-filled. They are available in all sizes, shapes, and degrees of projection to accommodate each woman’s unique anatomy, needs, and desires for enhancement. Anatomic or shaped implants have a textured surface to help achieve better stability within the breast to avoid unwanted shifting or movement. This type of implant might be useful in breast reconstruction, or for a woman who has a greater need for shape in her own breast. A smooth round implant is the most popular choice for many women because it typically moves slightly with a woman’s breast and more accurately resembles the natural breast.
MemoryGel® Breast Implants Video
View Our Breast Reconstruction Patient Galleries
Considerations for Breast Reconstruction
Breast reconstruction is a multi-stage operation that requires careful deliberation of a number of factors. While the procedural outcome can be extremely rewarding for women who have lost one or both breasts to mastectomy—or have a deformed breast appearance from lumpectomy, injury, or a previous surgery—breast reconstruction is an extremely personal decision that should not be influenced by outside factors. Considerations to take into account include:
- The potential length of the process, particularly if cancer treatment is necessary
- Any existing medical conditions, and your overall physical and emotional health
- Your willingness to potentially undergo more than one surgery as part of your reconstruction
- Your willingness to make decisions regarding breast reconstruction while being treated for cancer (if applicable)
- Whether you have realistic surgical goals and expectations
It is important to remember that a reconstructed breast will not look or feel the same as a natural breast. The goal of breast reconstruction is to diminish the physical and emotional impact of mastectomy or lumpectomy by re-creating as close to a normal breast size, shape, symmetry, and overall appearance as possible. During a thorough consultation, board-certified plastic surgeon Ram Kalus, MD will review your medical history and assess your unique needs for breast reconstruction. He will ask you about your concerns and preferences and recommend the most ideal options for reconstruction based on your health, body type, lifestyle, and surgical goals.
How Is the Breast Reconstruction Procedure Performed?
Patients may have a choice between starting the breast reconstruction process immediately after cancer treatment surgery or delaying the procedure to a later time. This decision is typically made according to an individual’s preference, the nature of their cancer, and their overall physical and emotional health.
According to the details of your treatment plan, your breast reconstruction will primarily utilize either tissue flap or implant-based reconstruction techniques, with secondary approaches like fat grafting employed when necessary. Dr. Kalus will inform you of every step of your reconstruction prior to surgery. If both methods are being used to rebuild the breast(s), a tissue flap procedure is usually performed before implant placement. In the event that only one breast is being reconstructed, other surgeries like a breast lift or breast reduction may help achieve symmetry between the reconstructed breast and the natural breast, depending on your aesthetic goals and whether additional procedures will be necessary to achieve them. Reconstruction of the nipple and areola is generally completed after formation of the re-created breast(s).
Direct To Implant Single Stage Breast Reconstruction Video
Watch Fewer Surgeries for Breast Reconstruction?
from WLTX-TV, Columbia – November 19, 2010
Breast Reconstruction Articles
- American Breast Cancer Guide, 2004 – Rebuilding the Body
- Charleston Post and Courier, 2013 – Kicking Cancer
- Letters: Think About Pink – The New York Times
At our office in Charleston, plastic surgeon Dr. Ram Kalus formulates individualized treatment plans for each of his patients. To discuss a breast reconstruction strategy that includes breast implant selection, please contact Plastic Surgery of the Carolinas today.