Breast reconstruction is performed on women who have lost one or both breasts to mastectomy, or who lack breasts due to congenital or developmental abnormalities. The goal of breast reconstruction is to create a breast and nipple that resemble the natural breast as closely as possible in shape, size, and position.
As long as a woman is healthy, age is not a factor in whether she is a good candidate for breast reconstruction. However, women with health problems such as obesity and high blood pressure, and those who smoke, are advised to wait rather than have breast reconstruction immediately following mastectomy.
Breast reconstruction is performed in several steps, and there are essentially two types. Which one is used depends on whether there is enough tissue on the wall of the chest to cover/hold an implant. Whichever type is used, a woman’s breast surgeon and plastic surgeon should work as a team during reconstruction.
The Deep Inferior Epigastric Perforator flap consists of skin and fat from the lower abdomen, around and below the belly button, and its blood vessels which are used to reconstruct the breast.
Many women who undergo mastectomies opt for breast reconstruction. AlloDerm® Regenerative Tissue Matrix, which is manufactured by LifeCell, is frequently used during the reconstruction process.
The latissimus muscle is a large flat muscle below your shoulder blade. Your surgeon can use this muscle to support and protect a tissue expander and implant reconstruction, particularly after radiation therapy. Our surgeons perform an innovative scar-free latissimus flap where there is no scar left on the patient’s back.
In this innovative technique, the surgeon will take a tissue expander, which is a saline inflatable implant, wrap it in a sheet of collagen and secure it in front of the pectoralis muscle of the chest. The advantage of this method over subpectoral expander placement includes less pain and no animation deformity-movement and displacement of the implant with contraction of the pectoralis muscle.
In some cases, patients may not have much fat in the areas of the abdomen or thigh areas. It is possible to use these tissues stacked on top of each other to reconstruct one larger breast. Alternatively, a Hybrid combination of a DIEP flap, breast implant, and fat grafting may be employed in concert to reconstruct a larger breast with a natural look and feel.
The Transverse Upper Gracilis flap takes advantage of the soft skin and fat of the inner thigh which is creatively fashioned into a breast. The incision is concealed near the groin to complete the recontouring of the inner thigh. The DIEP or TUG flap results in a breast reconstruction made from your own tissue so it looks and feels natural. Since it is living tissue, there is no implant that could break or need replacement. Your surgeon will discuss the options for the best reconstruction.
Implant/tissue-expansion breast reconstruction involves inserting an implant in the chest after the skin has been stretched enough by an expander to contain it.
First, the surgeon inserts a balloon expander beneath the skin and chest muscle where the reconstructed breast will be built. Then, during the next few weeks or months, a saline solution is injected through a tiny valve beneath the skin into the expander.
As the expander fills with saline, it stretches the skin and creates a pocket for the implant. The expander is left in place to serve as the implant or replaced with another one, which can be made of saline or silicone gel. A final procedure reconstructs the areola and nipple. Some patients do not require tissue expansion, which can take up to a year to complete and begin reconstruction with the insertion of the implant.
Autologous-tissue breast reconstruction is used if there is not enough tissue left post-mastectomy to create a new breast using tissue expansion, or a woman does not want implants. During autologous-tissue breast reconstruction, a breast is created using skin, fat, and sometimes muscle from other parts of the body. The abdomen, back, buttocks, or thighs are all donor sites.
The donor tissue, which is called a “flap,” is either surgically removed and reattached (free flap) to the chest, or left connected to its original blood supply and “tunneled” through the body to the chest (pedicle flap). There are a number of different flap techniques; which one is used depends on the individual patient.
Factors taken into consideration include how much extra tissue is available for transfer; the width and flexibility of blood vessels; and how large the breast(s) needs to be. Implants may or may not be used with autologous-tissue breast reconstruction. Constructing a nipple and areola is performed in a separate surgery. It is essential that a patient has reasonable expectations about the results reconstruction provides.
Recovery varies widely based upon the type of procedure used for breast reconstruction, as well as whether reconstruction immediately follows mastectomy. Hospital stays range from 1 to 6 days. Patients are tired and sore for 1 to 2 weeks, and recovery takes 3 to 6 weeks.
Compression garments are typically worn, and stitches are taken out in a week to 10 days. A surgical drain may be left in place to prevent a buildup of fluid in the reconstructed breast; if so, it is removed within 1 or 2 weeks.
In addition to the risks associated with surgery and anesthesia, those related to implant/tissue-expansion breast reconstruction include infection around the implant, implant leaks and ruptures, and implant deflation or shifting.
Risks related to autologous breast reconstruction, depending upon the technique used, include fat necrosis, abdominal weakness, hernia, and a mismatch between chest tissue and donor tissue. Correcting reconstructive problems typically requires additional surgery.
A reconstructed breast will not look the same as the original breast. And although a surgeon attempts to match the size, shape, position, and other attributes of the remaining breast, an exact match is not possible.
To achieve symmetry, the remaining breast may be operated on to make it bigger or smaller, or to lift it. In addition to not looking the same as the original, a reconstructed breast has little sensation, although there may be more when autologous tissue rather than an implant is used.
If you are considering plastic surgery in Fairfield County or anywhere in Connecticut, contact us to schedule a one-on-one consultation with one of our expert plastic surgeons.
722 Post Rd, Suite 202, Darien, CT 06820