Breast Reconstruction

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    Breast reconstruction is a procedure following a mastectomy or lumpectomy in which the size and shape of the breast is surgically reconstructed by a plastic surgeon. Restoring the size and shape of a women’s body to resemble its natural form can help in maintaining a confident and comfortable body image.

    One technique to reconstruct the breast is the insertion of a synthetic implant that is composed of saline and/or silicone gel. Another technique is flap reconstruction which is the use of autologous tissue, which is tissue obtained from another part of your body such as your abdomen, back, buttocks, to reconstruct the breast. Reconstruction using a synthetic implant is a less complicated procedure and quicker to recover from than flap reconstruction, however, in the long-term they are likely to require reoperations and corrective procedures. The inverse is true regarding flap reconstructions which is a more complicated procedure with a longer recovery but will last a lifetime if done correctly.

    Many factors influence whether reconstructive surgery should be immediate, delayed immediate, or delayed such as the type of mastectomy or lumpectomy, the stage of breast cancer, if radiation therapy is required after surgery, and the lifestyle/ preferences of the individual.

    For example, if performing a skin-sparing mastectomy in which the breast tissue is removed but the nipple, areola (the circular pigmented skin surrounding the nipple), and the majority of the skin is not, the patient must have immediate or delayed immediate breast reconstruction. During immediate reconstruction, the pouch of skin that remains is used to form the new breast.


    Reconstruction Options

    Simultaneous “Immediate” Reconstruction

    • Occurs in the same surgical setting as the mastectomy. Directly following the surgical oncologist’s removal of the breast tissue the plastic surgeon begins the reconstructive surgery.

    Staged “Delayed Immediate” Reconstruction

    • Following a skin-sparring or nipple-sparring mastectomy an inflatable balloon-like device called a tissue expander is inserted under the chest muscles and remaining skin. Over the course of several weeks or months it is used to maintain the size and shape of the breast until the reconstructive surgery takes place. Staged reconstruction is chosen if additional therapies such as radiation therapy are required after the mastectomy because the appearance, size, and texture of the implant can be altered due to the high doses of radiation exposure. If radiation therapy is required after the mastectomy the port that is used to increase the amount of liquid in the expander should be plastic (not metal) as to not interfere with the radiation.

    Delayed Reconstruction

    • Follows a total or modified radical mastectomy in which the entire breast is removed. Over the course of several months an inflatable balloon-like device called a tissue expander is used to expand the skin and muscles to create room for the insertion of the implant or autologous tissue.

    If a patient has a lumpectomy, in which portion(s) of the breast are removed, there will be scars or dents in the breast or other deformities following the procedure. There are far more surgical variations for lumpectomies then there are mastectomies so there are varying reconstructive options including breast implants, lipofillings (fat grafting), and flap procedures. Lipofilling also known as “fat grafting” is the use of fat, which is obtained by liposuction from another part of the body such as the abdomen, back, or buttocks, to fill and reshape the breast deformities. To do so, the fat is converted into a liquid form, injected in the contours, and thereby grafted to the breast.
     

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    Physicians

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