Breast Reconstruction

A good candidate for breast reconstruction should not have additional medical conditions or illnesses which may interfere with healing after breast reconstruction surgery. In addition, the patient should have a positive outlook and realistic goals for the outcome of the surgery.

When it Comes to Breast Reconstruction, Information is Key. Know Your Options.

Video from the American Society of Plastic Surgeons

The American Society of Plastic Surgeons’ website also maintains a collection of video patient stories from women who have gone through breast cancer and reconstruction. This is a good place to hear first-person accounts of several types of breast reconstruction.

The best place to get information, answers, and advice on breast reconstruction options specific to your situation is from your plastic surgeon. Dr. Houser and our staff are here to help. Please contact us with any questions and concerns. Many patients find it helpful to come to appointments with a list of questions.

About the Breast Reconstruction Process

Step 1. Choose lumpectomy or mastectomy.

The choice between lumpectomy and mastectomy is a choice that is made with the help of your breast cancer surgeon (either a breast cancer specialist or a general surgeon). A lumpectomy, also called partial mastectomy or breast conservation surgery, is an option for breast cancer treatment for many women. This is sometimes combined with reconstructive surgery to reshape the breast at the time of the initial surgery either as a breast lift or breast reduction as well as matching procedures on the unaffected breast. Radiation therapy is then often used after surgery to complete the cancer treatment.

Should you choose mastectomy, then reconstruction and information on all of your reconstruction options, should be offered. A plastic surgery consultation will provide information regarding the various reconstructive techniques and which may be best for you.

Step 2. Choose either immediate or delayed reconstruction.

Although many women elect to start reconstruction at the time of the mastectomy (immediate reconstruction), others prefer to wait until after completing all of their treatments. This is delayed reconstruction. Delayed reconstruction is sometimes recommended if radiation therapy is to be used after surgery or if a patient is unsure if reconstruction is right for her. A discussion with a plastic surgeon will help guide this decision.

Step 3. Choose either reconstruction with a breast implant or a flap technique.

The choice of reconstructive technique depends of many factors including body type, breast size, age, tobacco use, and activity level. The process can be very different from surgeon to surgeon as there are many ways to perform these procedures. The type of reconstruction and the process will be reviewed at the time of your consultation with Dr. Houser.

Immediate reconstruction with a breast implant

The immediate placement of a breast implant at the time of the mastectomy is occasionally an option for women. Both saline and silicone implants are available to women for reconstruction. This usually involves the use of an allograft (cadaver skin) to make the pocket for the implant. This is restricted to use in relatively thin women with a small breast. Although it is performed in a single stage, there are revisions that may be needed to obtain the optimal shape.

Tissue Expansion

Tissue expansion stretches the skin and creates a pocket beneath the muscle to provide coverage for a breast implant. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it may be a more lengthy reconstruction process. A tissue expander (temporary spacer) is placed at the time of the mastectomy, and then filled over the ensuing months. It requires office visits over the following few months after placement of the expander to slowly fill the device through an internal valve to expand the skin. A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.

Transverse Rectus Abdominus Myocutaneous Flap (TRAM)

The TRAM flap repositions a woman’s own fat and skin to create the breast mound. Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant, or a woman may desire an autologous reconstruction without the use of an implant. If there is sufficient tissue on the abdomen, the woman is generally in good health, and the abdomen is relatively free of scars from prior surgery, then the TRAM flap may be an option.

The TRAM flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up to the chest wall (pedicled TRAM flap), or be completely detached then reattached by sewing the blood vessels under a microscope (free TRAM flap).

Alternatively, your surgeon may choose the DIEP or SGAP flap techniques which do not use muscle but transport tissue to the chest from the abdomen or buttock.

Latissimus Dorsi Flap (LD)

A latissimus dorsi flap uses muscle, fat and skin from the back, tunneled to the mastectomy site under the arm. Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.

Step 4. Nipple/Areolar Reconstruction

Not all women who undergo breast reconstruction will elect to have nipple/areolar reconstruction. For those who do, there are several options available. For Dr. Houser, the process usually begins with a tattoo to create the areola. Some surgeons will use a skin graft (traditionally taken from the groin), but a tattoo allows for a better color match if there is an areola to match on the other side and does not require an additionally surgical incision. For those women who then want the nipple reconstructed, a series of specially designed flap on the chest will create the nipple. This is generally a simple office procedure, but is only undertaken once a woman is happy with her reconstructed breast.

Some content excerpted from the ASPS/ASAPS Patient Education Brochures – ASPS/ASAPS 2008

I have noticed that not all surgeons performing breast reconstruction in Ohio are board certified. Why should I choose a plastic surgeon who is a member of the American Society of Plastic Surgery (ASPS)? Is this important?

An ASPS member surgeon has fulfilled the following requirements:

• Has at least five years of surgical training and a minimum of two years of plastic surgery training.
• Is board-certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
• Is trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
• Is peer-reviewed for safety and ethical standards prior to attaining the honor of active membership.
• Only operates in accredited facilities.

Why is it important to choose a plastic surgeon certified by the American Board of Plastic Surgery?

Many physicians who perform cosmetic procedures will claim board certification, but it is important to clarify which board. The American Board of Plastic Surgery is a part of the American Board of Medical Specialties and has been in existence since 1937. Certification by this board signifies that the surgeon has completed an approved plastic surgery residency, has passed a comprehensive written examination, and has passed an oral examination. Following this, he or she is then required to maintain certification through case submissions, continuing medical education and written examinations. This rigorous process ensures that those who identify themselves as a diplomat of the American Board of Plastic Surgery are held to the highest standards of patient safety, patient satisfaction and ethical behavior.