What is breast reconstruction?
Breast reconstruction is a reconstructive procedure performed following a mastectomy. It helps restore the natural look and feel of a woman’s breast. Breast reconstruction can allow clothing to fit better, help maintain the natural proportion of a woman’s body, and most importantly boost the self-confidence for women that have lost one or both breasts to mastectomy. Breast reconstruction is most generally a multi-phased procedure.
What is a mastectomy?
A mastectomy is a procedure in which a woman’s breast tissue is partially or completely removed. This may be due to breast cancer or as a preventative measure if you are more genetically inclined to develop breast cancer.
How long do I wait between getting a mastectomy and beginning breast reconstruction?
Breast reconstruction surgery may be performed immediately following a mastectomy or at a later date. The timing of the reconstructive surgery is based on the patient’s preferences, health, and other needs.
What is the first step in breast reconstruction?
Tissue Expander – Generally the first step in breast reconstruction is the insertion of a tissue expander beneath the pectoralis muscle and remaining breast skin. The tissue expander is gradually inflated with a saline solution over a period of time. The process of expanding the breast area is done so that the skin can stretch and there is room for the implant of your chosen size.
Immediate permanent implant – A tissue expander is not always necessary. Depending on whether you have a partial or complete mastectomy, you may be able to skip the tissue expander and go directly to a permanent silicone implant. Silicone implants have several advantages over a saline implant; however, it is important for you to discuss what your individual needs and desires are with Dr. McClellan as you plan your reconstructive pathway.
Natural graft or tissue flap – Some women prefer not to have an artificial implant placed in their bodies and opt for a natural graft or tissue flap reconstruction. This type of reconstruction gives your breasts the most natural-looking and feeling breasts. There are several types of tissue flap reconstruction. Here is a list and brief description of the forms of tissue flaps:
- The TRAM (transverse rectus abdominus musculocutaneous) flap breast reconstruction is a procedure that involves the transfer of skin, fat, and muscle from the lower abdomen to the chest to create a new breast. A TRAM flap creates a very natural looking breast and usually does not require the use of an implant as long as a woman has enough excess skin and fatty tissue in her lower abdomen.
- The latissimus dorsi muscle flap procedure removes this large muscle from the back along with skin and underlying fatty tissue and uses them to reconstruct the breast. The inclusion of fatty tissue helps create a more natural looking breast. The flap itself is only about one inch thick and even with the additional fatty tissue; this procedure usually requires an artificial implant in addition to the natural breast tissue in order to make the reconstructed breast match the size of the unaffected breast.
- The deep inferior epigastric perforator (DIEP) flap procedure, like the TRAM flap procedure uses skin and fatty tissue from the lower abdomen to form the reconstructed breast. Unlike the TRAM flap technique, the DIEP flap procedure keeps the abdominal muscle intact, which speeds recovery and preserves abdominal strength after the procedure.
- The S-GAP, or superior gluteal artery perforator, flap procedure uses skin and fatty tissue to reconstruct the breast taken from the upper part of a buttock. This procedure is a good option for women that have more fatty tissue in their buttocks rather than their abdomen.
How do I know which procedure is best for me?
It is important for you to discuss what your best options are for breast reconstruction with your surgeon. A reconstructive plan is as unique as the patient is so your best options may be different than another patient’s. To discuss your breast reconstruction with Dr. McClellan, please contact our office to schedule a consultation.
