Breast Reconstruction

Breast reconstruction offers much hope for a woman losing her breast to cancer. Reconstruction can often be performed immediately after the mastectomy. Depending on health conditions, however, a mastectomy patient may have to wait before undergoing reconstructive surgery.

The Surgery

When reconstructive surgery is performed immediately following mastectomy, a breast mound is created in place of the breast that has been removed. This is done in the hospital or surgery center under general anesthesia. We will work with your oncologist to ensure the best possible conditions for reconstruction.

Tissue Expander Breast Reconstruction

Breast reconstruction usually involves more than one operation, and followup procedures may be performed on an outpatient basis. Sometimes surgery is then performed on the natural breast to match the reconstructed breast; however, this creates additional scars.

Skin Expander with Breast Implant

This is the most common of breast reconstructions. In this procedure, a tissue expander is placed under the skin. Once sutures are removed, saline is added weekly to the expander. This stretches the skin as it expands.

When the skin has been sufficiently stretched, the tissue expander is removed and replaced by a silicone-gel or saline-filled breast implant. Nipple reconstruction, if desired, may be performed when appropriate.

Advantages: Simplest surgery and shortest recovery from surgery. This is the favored procedure for persons who have health problems or contraindications to extensive surgery.

Disadvantages: Multiple trips to the office over several weeks or months to undergo expansion.

Possible Complications:

1. Loss of breast skin requiring removal of implant. If you have undergone radiation this procedure may not be advisable as you are at increased risk for skin loss.
2. Noticeable outlines of the implant due to capsule formation
3. Hard texture due to capsule formation
4. Thin breast skin

Latissimus Dorsi Myocutaneous Flap

This surgery involves moving the latissimus dorsi muscle and overlying skin from the back to the chest to create a new breast mound. The incision often made along the bra line so the scar may be concealed.

Blood transfusions are not usually required. A breast implant can be placed under the flap if necessary to balance a difference in size. Nipple reconstruction is done later.

Advantages: This is a very reliable procedure, which provides a good environment for an implant. The chances of capsule formation around the implant are reduced.

Disadvantages: Scar across the back.

Possible Complications:

1. Circulation problems with the flap
2. Formation of capsule around the implant
3. Symptoms from use of latissimus muscle, such as decreased strength
4. Loss of back skin requiring skin grafting
5. Collection of fluid (seroma) under incision requiring needle aspiration

Rectus Abdominis Myocutaneous Flap

This is the most complicated and the longest reconstructive procedure, involving about 4-5 hours of surgery. One of the abdominal muscles is tunneled, along with the overlying skin, up to the chest. The breast mound is created to match the opposite side. A blood transfusion may be required. You may donate your own blood prior to surgery to be reinfused during the surgery.

Breast implants are not usually required. The tissue is generally adequate to match the size of the opposing breast. If the opposite breast is large or pendulous it can be decreased in size by a breast reduction or, when appropriate, the opposite breast may be enlarged or lifted. Patients wishing to have this procedure must stop smoking six weeks prior to and six weeks following surgery. Failure to comply may result in death of the flap. A synthetic mesh may be placed over the area where the muscle is moved. This strengthens the abdominal wall and minimizes the chance of hernia formation. Nipple reconstruction is done as a second procedure. Some contouring of the new breast mound may be necessary at the same time.

Advantages: This provides the most natural-looking breast reconstruction with the added benefit of a tummy tuck. No implant is needed so capsule formation is not a risk. The scar is hidden with clothing.

Disadvantages: There is a risk of hernia formation resulting from moving the rectus abdominus muscle. Abdominal strength is diminished. This is the longest procedure and has the greatest risk for requiring a blood transfusion.
Possible Complications:

• Inadequate tissue requiring the use of a breast implant
• Poor circulation to the flap resulting in tissue loss
  
• Weakness or herniation of the abdominal wall.
• Placement of the umbilicus off center
• Collection of fluid (seroma) under the skin requiring needle aspiration.
• Infection, in particular of the mesh, requiring surgery for removal.

Detailed pre- and post-op instructions will be provided for you both during your consultation and after surgery.