Many women who have faced the devastating diagnosis of breast cancer and having their breasts removed regard breast reconstruction as an important step to restoring their lives.  Breast reconstruction can significantly improve a woman’s self-image, self-esteem, and quality of life.  Rebuilding the breast after mastectomy attempts to create a natural looking breast; however, it may never look and feel exactly like the breast that was removed.

Breast reconstruction can be performed immediately after mastectomy in the same operative setting or as a delayed procedure, anywhere from several weeks to years following mastectomy.  Different circumstances such as the likelihood of needing additional treatments like radiation therapy and certain characteristics of the breast tumor help determine whether immediate or delayed reconstruction is best for you.  Breast reconstruction typically requires more than one operative procedure, with additional surgeries to optimize symmetry and rebuild the nipple areolar complex.  It could take a full year to reach the end point of breast reconstruction.

Several options exist for rebuilding a breast that has been removed.  Some utilize your own tissue only (called autologous reconstruction), some utilize implants alone, and some incorporate both techniques.  The three most common modalities are implant/expander reconstruction, latissimus flap reconstruction, and TRAM flap reconstruction.   A flap is a term that describes moving tissue from one part of the body to replace/ rebuild tissue in another part of the body.

An implant/expander reconstruction involves placement of a temporary implant called a tissue expander beneath the pectoralis muscle in the chest.  It is gradually filled through an access port in the expander over the course of 6-12 weeks following initial placement.  A second operation is required to remove the tissue expander and replace it with a permanent implant.

Latissimus flap reconstruction uses muscle, fat, and skin from the back to help reconstruct the breast. It is tunneled to the mastectomy site and remains attached to its blood supply.  In most cases, the latissimus flap is combined with a tissue expander/implant to complete the reconstruction.  It adds additional support and coverage of the implant to give a very natural appearing breast.  This additional tissue can be particularly important in situations where radiation of the breast tissue has been involved.

The TRAM (Transverse Rectus Abdominus Myocutaneous) flap uses a woman’s own abdominal tissue to reconstruct the breast.  It comes from the lower abdominal region and utilizes the same tissue that is removed in a tummy tuck procedure in addition to some of the rectus abdominus muscle that provides blood supply to the skin and fat.  The TRAM flap generally provides enough tissue to reconstruct the breast without the additional need for an implant. 

In the final stage of breast reconstruction, the nipple and areolar complex are reconstructed through a variety of techniques.  Surgery on the opposite breast to lift, reduce, or augment the breast may also be recommended to improve symmetry with the reconstructed side and is often covered by insurance.

Many factors must be considered when determining the best reconstructive technique for each individual.  A person’s age, weight, smoking history, other medical conditions, prior surgeries, and emotional state must be taken into account while making this decision.  Our surgeons and staff at CRPS will help you with this process and answer all of your questions.