What is Breast Reconstruction:

The goal of breast reconstruction is to restore one or both breasts to near normal shape, appearance, symmetry, and size following mastectomy, lumpectomy, or other trauma.

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Breast reconstruction often involves several procedures performed in stages and can either begin at the time of mastectomy or be delayed until a later date. Breast reconstruction generally falls into two categories: implant-based reconstruction or flap reconstruction. Implant reconstruction relies on breast implants to help form a new breast mound. Flap reconstruction uses the patient’s own tissue from another part of the body to form a new breast. There are a number of factors that should be taken into consideration when choosing which option is best:

• Type of mastectomy
  Partial vs. Total

• Cancer treatments

• Patient’s body type

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Is Breast Reconstruction Right for Me?

Breast reconstruction is a highly individualized procedure. You should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image. Breast reconstruction may be a good option for you if:

• You are able to cope well with your diagnosis and treatment

• You do not have additional medical conditions or other illnesses that may impair healing

• You have a positive outlook and realistic goals for restoring your breast and body image

 

Although breast reconstruction can rebuild your breast, the results are highly variable:

A reconstructed breast will not have the same sensation or feel as the breast it replaces.

• Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.

• Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.

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The Procedure:

Your breast reconstruction surgery can be achieved through a variety of different techniques. The appropriate reconstructive procedure for you will be determined based on discussions with your surgeon, your body type, and prior therapy and/or surgical treatment.

Types of Breast Reconstruction After a Mastectomy:

Implant Reconstructions:

Expander/Implant

First, a temporary device known as a tissue expander is placed in the breast to create the soft pocket that will contain the permanent implant. Some surgeons may also use biological materials such as acellular dermal matrix to assist with reconstruction. Once expansion is complete, the expander will be exchanged for the permanent implant during an outpatient procedure. In expander/implant reconstructions, patients can expect the following to occur with some exceptions:

​          - Hospital Stay (Mastectomy/Expander): 1-2 Days​

          - Recovery Time (Mastectomy/Expander): 4 - 6 weeks

          - Hospital Stay (Implant Exchange): Outpatient

          - Recovery Time (Implant Exchange): 1 - 2 weeks

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Flap Reconstructions: Use of the patient's own tissue – skin, fat and possibly muscle – to create a breast mound.

Donor Site: Abdomen

TRAM flap: The pedicled transverse rectus abdominus myocutaneous (TRAM) flap uses abdominal muscle, tissue, skin, and fat to create breast shape. The patient will have the benefit of a flatter looking abdomen. The scar on the abdomen is low and extends from hip to hip. In TRAM flap reconstructions, patients can expect the following to occur with some exceptions:

          - Hospital Stay: 2 - 5 days

          - Recovery Time: Several weeks to several months

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• Donor Site: Abdomen

Abdominal free flap: These microsurgical (DIEP, SIEP) procedures may or may not use the actual abdominal muscle. Free flaps rely on the identification, transfer and re-attachment of blood vessels feeding the segment of abdominal skin and fat that will rebuild the breast to arteries and veins in the chest using a surgical microscope. These procedures normally take a number of hours and will require close, specialized monitoring in the hospital. These microvascular techniques may spare abdominal muscles, safeguarding abdominal strength and competence after tissue harvest. In free flap reconstructions, patients can expect the following to occur with some exceptions:

          - Hospital Stay: 3 - 5 days

          - Recovery Time: Several weeks to several months

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• Donor Site: Back

LD flap: The latissimus dorsi (LD) flap is most commonly combined with an implant. At the time of breast reconstruction, the muscle and fatty tissue, with or without attached skin, is removed from the back and implanted in the breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape compared to an implant alone. The scar on the back can often be concealed under a bra strap. In LD flap reconstructions, patients can expect the following to occur with some exceptions:

          - Hospital Stay: 1 - 3 days

          - Recovery Time: Several weeks

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• Donor Site: Buttock

GAP flap: The gluteal artery perforator (GAP) free flap uses skin and fat from the buttocks. The buttock is typically an option for tissue reconstruction in women who desire flap reconstruction but no longer have the ability to transfer tissue from the abdomen, such as women who have had tummy tucks in the past. In GAP free flap reconstructions, patients can expect the following to occur with some exceptions:

          - Hospital Stay: 3 - 5 days

          - Recovery Time: Several weeks

 

• Donor Site: Thigh

Inner thigh free flap: This procedure uses skin, fat, and muscle from the inner portion of the upper thigh to reconstruct the breast. The tissue is dissected from the inner thigh and transplanted to the chest where it is reattached using microsurgery. The resulting thigh scar is generally well hidden. In thigh free flap reconstructions, patients can expect the following to occur with some exceptions:

          - Hospital Stay: 3 - 5 days

          - Recovery Time: Several weeks

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Types of Breast Reconstruction After a Lumpectomy:

 

Women who are having a partial mastectomy (also known as a lumpectomy or a segmental mastectomy) can also undergo a reconstruction of their affected breast. The appropriate procedure will be determined based on the size of woman’s breasts, how much and what portion of the affected breast needs to be removed, the patient’s desires and the likely need for radiation therapy.

Implant Reconstructions

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An implant can be used to give more volume to the entire breast. However, any implant will affect the shape of the upper portion of the breast so an implant may have to be placed in the unaffected breast to achieve better symmetry. Patients can expect the following to occur with some exceptions::

          - Hospital Stay: Day surgery to 1 day

          - Recovery Time: 1 - 2 weeks

 

Flap Reconstructions:

• Donor Site: Back

Usually, tissue brought in from another location does not need to be used after a lumpectomy.

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In some instances, rearrangement of the remaining breast tissues can be used to reconstruct the defect. If a tissue flap is necessary, the common flap used to restore volume is the latissimus dorsi (LD) flap (described earlier.)

 

Fat Grafting
final option to reconstruct a portion of a breast is to employ fat grafting. Fat is liposuctioned out of another area of the body, processed and then reinjected back into the patient’s breast. Fat grafting can be helpful to fill in contour depressions (a scar or dimpling in the skin) that may appear after a lumpectomy, but this may require more than one fat grafting procedure. It is believed that fat grafting not only adds volume but may also include a stem cell effect that is being studied, which may help improve overall tissue quality, particularly tissue impacted by radiation therapy. Although not widely employed, modifications of this procedure have even been used to reconstruct entire breasts. Patients can expect the following to occur with some exceptions:

          - Hospital Stay: Day surgery to 1 day

          - Recovery Time: 1 day to 2 weeks depending on the amount of fat grafted

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Implant Choices:

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Your plastic surgeon will talk to you about your breast reconstruction options. There are a number of different options for implants that may be used during your breast reconstruction.

• Saline implants are filled with sterile salt water. They can be filled with varying amounts of saline which can affect the shape, firmness and feel of the breast. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body. Saline implants can feel or look wrinkled in thin patients.

 

• Silicone implants are filled with silicone gel. The gel feels and moves much like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket. A leaking implant filled with silicone gel may not collapse. If you choose these implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of breast implants.

Shape
Anatomically shaped implants, also known as form-stable implants mimic the natural shape of the breast and are shaped like a tear drop. They are thicker at the bottom and tapered toward the top. These implants are more often used in one-sided reconstructions aiming to match an opposite breast that has not been operated on.

They are filled with a cohesive, cross-linked, “gummy bear-like” gel. These implants are textured to maintain implant position in the chest which is critical for anatomically shaped implants.

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​Round implants have a tendency to make reconstructed breasts appear fuller than form-stable implants. They also often will make the breast project out further away from the body. New high-profile options can lead to even more projection, if that is a concern for you. Because they are the same shape all over, there is less concern about them rotating out of place.

Texture
Textured breast implants allow the scar tissue to stick to the implant, making them less likely to move around inside of the breast and get repositioned.

Smooth breast implants move around freely inside of the breast, which may give more natural movement. These implants also have an increased risk of rippling. The FDA has approved the safety of the current generation of silicone gel implants for over 10 years.

Your plastic surgeon will take into account your wishes and concerns and will choose the right breast reconstruction option for you.

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Click here to read safety information about this procedure. 

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