Breast reconstruction is accomplished using several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy. More than one procedure may be required to complete the process.
Consultation with Dr Philip Fleming is the best way to determine how breast reconstruction can help you achieve your personal goals. Having breast reconstruction is a personal choice. Dr Fleming can help you weigh the benefits and risks of the procedures as they relate to your individual situation. Dr Fleming is certified by the American Board of Plastic Surgery, Inc and he has more than 25 years of experience in performing breast reconstruction. The following is an overview of the breast reconstruction procedure.
What happens during breast reconstruction surgery?
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – Flap techniques reposition a woman’s own muscle, fat and skin to create or cover the breast mound.
Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion.
A 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 through the chest wall, or be completely detached, and formed into a breast mound.
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.
A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.
Latissimus Dorsi Flap (Back)
Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.
Latissimus Dorsi Flap (Front)
Step 3 – Tissue expansion stretches healthy skin to provide coverage for a breast implant.
Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process.
It requires many office visits over 4-6 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.
Step 4 – Surgical placement of a breast implant creates a breast mound.
A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction.
Your surgeon will help you decide what is best for you. Reconstruction with an implant alone usually requires tissue expansion.
Step 5 – Grafting and other specialized techniques create a nipple and areola.
Breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola