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Breast reconstruction refers to a series of surgical procedures to re-create breasts after mastectomies. These are usually performed as a result of breast cancer; the procedures must be integrated and coordinated into the overall plan for treatment as part of a team approach. Reconstruction is performed by transferring flaps of a patients own tissue (muscle and/or fat), placing implants, or both. A consultation with Dr. Ha can help you determine which of these procedures is most appropriate for you.
Breast reconstruction involves a series of life-changing surgeries and periods of recovery. There are many different options available to women today though careful consideration is given to the particular treatment course, depending on variety of factors. Generally speaking, reconstructive options are categorized into two main categories: autogenous (utilization of a patient's own tissues) and alloplastic (implantation). There are pros and cons to each type, and some patients are not suitable candidates.
The use of implants for reconstruction is often the easiest option. The recovery from surgery is quick and extensive surgery is often avoided. However, this option requires the most "maintenance" and additional surgeries are needed. The implants themselves are composed of saline (salt water) or silicone and do not last forever. The shells of the implants weaken over 10 to 15 years and eventually rupture, which requires surgicial removal and replacement. Replacement surgery may be necessary if the implants are affected by abnormal scar tissue or migration.
Typically, implants are not placed immediately at the time of mastectomy. A tissue expander is a temporary implant that is initially placed to help stretch the skin and muscle (over 3 to 6 weeks) prior to a second surgery which involves the removal of the expander and placement of the final implant. This implant, which is softer and more natural appearing, is placed into the pocket created by the expander. The expansion process involves weekly injections of saline into the expander during post-operative clinic visits.
Autogenous reconstructive options involve the use of a patient's own body tissues to help create a new breast. Most often, "flaps" or regions of fat/muscle are borrowed from one area of the body and transplanted or transposed to the chest area. After a mastectomy, the majority of breast is removed except for varying amounts of the overlying skin. The cavity can be filled with these "flaps" to restore the missing volume and shape. The most common options involve the use of muscle and fat from either the abdomen (TRAM flap) or the back (Latissimus Dorsi Muscle flap). Recovery for these operations is often quite lengthy (up to 6-12 months) because of the greater magnitude of surgery and the sacrifice of muscles. However there are many benefits, including a reduction in the number of surgeries, less maintenance, and improved appearance and feel.
With either mode of reconstruction, multiple procedures are still required. A total mastectomy involves the removal of breast tissue and the nipple. Nipple reconstruction is an additional surgical procedure after the breast mound has been created. This is usually done by rearranging the skin on the newly reconstructive breast itself. Tattooing of the nipple pigment is the final step in reconstruction, which can be done under local anesthesia in the office.
From start to finish, breast reconstruction can taken anywhere from 3 to 12 months depending on the type of surgeries required and any additional cancer treatment involved. Patients who undergo chemotherapy and/or radiation therapy may take longer to complete their reconstructions.
Breast reconstruction is ideally performed at the time of mastectomy - termed "immediate" reconstruction. The benefits are improved tissue pliability and avoidance of a time period without a breast mound. Some coordination between your breast oncology surgeon and Dr. Ha is required so that both mastectomy and reconstructive surgery can be performed at the same time.
A summary of breast reconstructive options that Dr. Ha performs include:
- Tissue expander alone
- Latissimus Dorsi Muscle flap (back) with Tissue Expander
- Latissimus Dorsi Muscle flap alone
- TRAM flap (abdomen)
- Free TRAM flap (microsurgical transfer)
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