your options in breast reconstruction following mastectomy
Being diagnosed with breast
cancer can be overwhelming. It is important to remember that if faced with a
breast cancer diagnosis, you will have choices on how, and if, you would like
to reconstruct your breasts following removal of the cancer.
For women who opt for breast reconstruction following
mastectomy, there are two main options – using implants to create a breast
mound or using your own body tissue to reconstruct.
Breast reconstruction options
When considering implant-based
reconstruction, there are different approaches depending on the patient’s
bodily build, breast size and desired goals. These procedures work well on
women who are reconstructing two matching breasts or who are reconstructing a
breast to match an existing “perky” breast that is no larger than a
“DD” cup size.
Traditionally, tissue expanders
would be placed under the muscle to slowly stretch the tissue over time so that
it could then be replaced with a permanent implant. This option would require
the first surgery to place the expander (usually at the time of mastectomy) and
then weekly or bi-weekly visits to the doctor’s office to add water to expand
the skin; a second, outpatient surgery would then be performed to remove the
tissue expanders and replace with permanent implants.
Many surgeons today are using
tissue grown in a lab (ADM) to create a pocket between the chest wall and the
skin where an implant can be placed. This procedure is called
“one-step” or “straight-to-implant” reconstruction and it
can be done on patients who have enough skin left following the mastectomy to
accommodate the desired size implant. For example, this may be a good option if
you want to recreate the same or smaller size breast following mastectomy and
had a skin-sparing mastectomy performed.
For body tissue (or flap) reconstruction,
excess tissue will be removed from a different part of the body and transferred
to the chest to recreate a breast mound. This procedure is good for women who
do not want to use implants or who are trying to reconstruct a breast to match
a natural, drooping breast of any size.
The following are examples of
body tissue reconstruction:
- TRAM flap: A TRAM flap uses the tissue from the lower
abdomen and rotates it up to the chest. This leaves a tummy tuck scar in
the lower abdomen and has a pedicle that folds up over the rib cage to the
- Free TRAM or
DIEP flap: A free TRAM or DIEP flap
is similar to the TRAM flap, but these procedures leave the abdominal
muscle mostly or entirely intact and use microsurgery to connect the
abdominal tissue to blood vessels in the chest.
- Free gluteal
or later thigh flaps: A
free gluteal or later thigh flap removes tissue from the buttocks or thighs
and relocates it to the chest where microsurgery will connect to blood
vessels in the chest.
Breast reconstruction recovery
For implant reconstruction, the
surgery is usually outpatient with a 4-6 week healing time before returning to
normal activities. However, if the reconstruction is done at the same time as
the mastectomy, patients may need a brief stay in the hospital, typically only
one night. The up-front recovery tends to be less involved than tissue flap
surgery, but there is a higher potential down the road for more surgery because
of changes in implant location or integrity.
In tissue flap reconstruction,
the initial surgery is more involved and may require a hospital stay of 2-5
days with a 3-6 month recovery before returning to all normal activities. There
is a donor site that needs to heal, as well as the chest area. But, once
healed, the body flap reconstructive surgeries tend to require little-to-no
maintenance surgery down the road.
The choice to reconstruct is yours
Most importantly, patients should
remember that they have a choice and should discuss all the different options
with their board-certified plastic surgeon to determine the best reconstructive
option to achieve their goals and desires.
If you think breast
reconstruction is right for you and you want to further research your options,
please be sure to visit the ASPS Breast Reconstruction Awareness website. You
can also use our Plastic Surgeon Match referral service to
find board-certified plastic surgeons in your area who offer breast