If you’ve had a mastectomy or lumpectomy after a breast cancer diagnosis and would like to restore your breast shape and appearance, surgical breast reconstruction is worth considering.

What's Breast Reconstruction?

Breast reconstruction uses plastic surgery techniques to help you look and feel more like yourself again. It often involves several procedures performed at separate times and can either begin at the time of your mastectomy or be delayed, depending on your individual circumstances and preferences.

Breast Reconstruction Options

The type of mastectomy you had, your cancer treatments and your body type should be taken into consideration when choosing which option is best for you. Symmetry (balance) is also important in breast reconstruction. If only one of your breasts has been affected, you may also choose to have a breast lift, reduction or augmentation on the opposite breast to improve the balance of size, shape and position of both breasts.
We know there are a lot of decisions to make while dealing with breast cancer, and our trusted specialists will discuss all your options with you so you can make an informed decision during this challenging time.

Breast Reconstruction with Implants

Implant reconstruction uses saline or silicone breast implants placed on top or under your chest muscle to help form a new breast mound. Since the skin of your breast may also be removed during a mastectomy, implant reconstruction may also require using a tissue expander. A tissue expander stretches the remaining skin to create room for the implant. After it's placed, the tissue expander is then gradually filled with saline by your plastic surgeon (over a number of weeks,) which stretches the skin. Implants typically need to be replaced after 10 to 20 years.

Breast Reconstruction Using Your Own Tissue

In flap reconstruction, AKA autologous reconstruction, tissue from another part of your body is used to form your new breast. This can be done at the time of your mastectomy (immediate reconstruction), or later as a separate procedure (delayed reconstruction). During flap reconstruction, your surgeon transfers a section of skin, muscle, fat and blood vessels from one part of your body to your chest to create a new breast mound. Sometimes, a breast implant may be added to get the preferred breast size.
Breast flap reconstruction surgery is complex and more extensive than mastectomy or implant reconstruction. This type of breast reconstruction results in larger incisions that take longer to heal, so they often require a longer recovery period and a longer hospital stay.

Types of Flap Breast Reconstruction

There are a number of flap breast reconstruction procedures available to reconstruct your breasts after a mastectomy. The tissue for your breast reconstruction could come from your abdomen, back or buttocks. Your surgeon will discuss the method that's best for you based on your medical and surgical history.

In a TRAM flap procedure, your surgeon removes fat, skin, blood vessels and muscle from your lower abdomen to reconstruct your breasts. There are two types of TRAM flaps - a pedicled TRAM flap and a free TRAM flap.
In a pedicled (attached) TRAM flap, the muscle and tissue remain attached to their blood supply in your abdomen and are moved underneath the skin to your chest.

In a free TRAM flap, the tissues are detached from their blood supply then reattached to the blood vessels in your armpit area using microsurgery (surgery that repairs tiny, intricate structures like blood vessels and nerves.)

In a DIEP flap procedure, skin, fat and blood vessels are removed from your abdomen, leaving most of your abdominal muscle (rectus abdominis) in place.

Using a microscope, your surgeon will then connect the blood vessels in the flap to vessels in your chest and rebuild your breast. Reconnecting the vessels may also require your surgeon to remove a small part of a rib to attach the abdominal tissue to an artery and a vein in the chest.

The SIEA flap breast reconstruction removes skin, fat and blood vessels from your abdomen. It's similar to a DIEP flap, but uses blood vessels that aren't as deep within your abdomen. This makes a SIEA flap a less invasive option.

However, not everyone has appropriate SIEA blood vessels for this surgery, so it’s important to discuss with your surgeon whether or not you’re a candidate for it.

The latissimus dorsi flap uses skin, fat and muscle from your upper back to reconstruct your breasts. The tissue from your back is removed and moved to your chest, with the arteries and veins still attached.

A gluteal flap is a procedure that takes tissue from your buttocks and transplants it to your chest. It may be an option for women who prefer tissue reconstruction but don't have enough extra tissue in their backs or abdomens.

A TUG flap uses skin, muscle and fatty tissue from the bottom of the buttocks to the inner thigh to reconstruct your breast. The muscle used from the inner thigh is called the gracilis and it's one of four muscles that pull the thigh inward. However, this muscle can be used for your reconstruction without significant functional loss.

Breast reconstruction using your own tissue is done under general anesthesia and takes between 5 and 10 hours, depending on your case. Your surgeon will help you decide which type of flap breast reconstruction is right for you.

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