Breast Reconstruction after Mastectomy for Breast Cancer
Ranked #4,536 in Healthy Living, #84,820 overall | Donates to Squidoo Charity Fund
Breast Reconstruction Options After Mastectomy
Every woman has a right to breast reconstruction. Breast reconstruction is not a form of cosmetic surgery. Breast reconstruction restores something that nature has provided but breast cancer has taken away. There is no age limitation for reconstructive surgery and there are multiple surgical options available. So what are the reconstructive options?
Breast Reconstruction Surgery after Mastectomy
Reconstructive Options after Mastectomy for Breast Cancer
Every woman has a right to breast reconstruction. This is now a federal mandate and insurance companies have to cover breast reconstruction surgery by law. There is no age limitation for breast reconstruction and there are multiple reconstructive options available. There is no single procedure that is best for everyone; the best option will become clear after detailed discussion between the patient and their plastic surgeon.
As the term implies, "immediate" breast reconstruction is performed at the same time as the mastectomy. Once the general surgeon has removed one or both breasts, the plastic surgeon will then take over and begin creating the new breast(s). Some advantages of immediate reconstruction include: preserving most of the patient's breast skin, a shorter/less obvious mastectomy scar and waking up with the new breast already in place (and avoiding the experience of a flat chest). Immediate reconstruction generally provides better aesthetic results particularly when combined with nipple-sparing or skin-sparing mastectomy.
"Delayed" reconstruction generally takes place starting at 6 months to 1 year after the mastectomy. Many times patients required to undergo radiation following their mastectomies are advised to delay reconstructive surgery in order to achieve the best results. It is common to wait several months after the last radiation therapy session before proceeding with the surgery in order to allow the soft tissues to recover completely from the radiotherapy.
Tissue Expanders/Implant Reconstruction/Alloderm One-Step Reconstruction
The most common method of reconstructive breast surgery in the United States is using expanders and breast implants. Most plastic surgeons perform this as a two-stage procedure. The expander can be placed at the same time as the mastectomy (immediate reconstruction) or after the mastectomy has healed (delayed reconstruction). The expander is used to stretch the skin envelope and recreate the size of breast the patient and plastic surgeon desire. The expander is replaced by a permanent breast implant (saline or silicone) at a separate procedure several months later.
Some patients are candidates for Alloderm one-step implant reconstruction (without expanders): a permanent breast implant is inserted immediately without going through the whole expansion process. In the one-step implant reconstruction the implant is completely covered by the pectoralis muscle and Alloderm (an acellular dermal graft).
Implant reconstruction can be the best option for some patients. However, reconstruction with expanders and breast implants can be associated with more complications than cosmetic breast augmentation. Potential long-term issues include capsular contracture, deformity, and pain, particularly if the patient has had or is going to have radiation therapy as part of the cancer treatment. There is a risk of requiring further surgery due to these complications. For these reasons, many plastic surgeons and patients prefer autologous reconstruction, ie reconstruction using the patient's own tissue taken from another part of the body (especially if radiation therapy is planned).
Latissimus Dorsi Flap
The Latissimus procedure uses muscle from the back of the shoulder blade which is brought around to the breast mound to create a new breast. During the procedure a section of skin, fat and muscle is detached from the back and brought to the breast area. A majority of patients who undergo the Latissimus Flap procedure also need an expander to obtain a satisfactory result. The expander is replaced by a permanent implant at a second procedure down the line. Patients will have a scar on their back shoulder region that can sometimes be seen through a tank-top, swimsuit or sundress. Women who are very active in sports should know that this procedure can reduce your ability to participate in such activities like golf, climbing, swimming, or tennis.
TRAM Flap (Transverse Rectus Abdominus Myocutaneous Flap)
TRAM flap surgery is a common breast reconstruction technique that uses skin, fat and muscle (rectus abdominus or sit-up muscle) from the lower abdomen. The tissue (or flap) is then relocated to the chest to create the new breast. This procedure also results in a tightening of the lower abdomen, or a "tummy tuck."
There are 3 main forms of TRAM flap reconstruction that are commonly used:
1) The PEDICLED TRAM flap: the flap is transferred to the chest by tunneling the tissue under the skin up to the chest to create a new breast. Unfortunately, sacrifice of all of the sit-up muscles can be associated with significant post-operative pain, prolonged recovery, loss of abdominal muscle strength (up to 20%), abdominal bulging (or "pooching"), and even abdominal hernia.
2) The FREE TRAM flap: this procedure involves disconnecting the flap from the patient's body, transplanting it to the chest, and reconnecting it to the body using microsurgery. Advantages over the pedicled TRAM include: improved blood supply (and therefore less risk of healing problems and fat necrosis), and less muscle sacrifice (so the abdominal recovery is a little easier, potentially more strength is maintained long-term, and the risk of bulging and hernia formation is lower). Since the tissue is disconnected and transplanted to the chest, there is also no tunneling under the skin as there is with the pedicled TRAM and no subsequent bulge in the upper abdomen (which is typically seen with tunneling).
3) The MUSCLE-SPARING FREE TRAM flap: similar to the free TRAM except the amount of muscle taken is typically very minimal (postage-stamp size). This procedure is associated with all the benefits of the free TRAM but with significantly fewer abdominal side-effects and complications (pain, bulging, hernia, strength loss) because such a small amount of muscle is sacrificed.
DIEP Flap (Deep Inferior Epigastric Perforator Flap)
DIEP flap breast reconstruction has replaced the TRAM flap as today's gold standard in breast reconstruction.
The DIEP flap procedure is similar to the free TRAM flap but only requires the removal of skin and fat. NO MUSCLE is sacrificed. The blood vessels required to keep the tissue alive lay just beneath the abdominal muscle. Therefore, a small incision is made in the abdominal muscle in order to access the vessels. As with the free and muscle-sparing free TRAM flap procedures, microsurgery is required to reattach the blood vessels to the chest area. Even though an incision is made in the abdominal muscle NO abdominal muscle is removed or transferred to the breast in the DIEP flap procedure. As a result, patients do not have to sacrifice their abdominal strength and experience less pain and a much quicker recovery. The risk of abdominal bulging and hernia is also very small. Like the TRAM flap, the patient benefits from a simultaneous tummy tuck.
The DIEP flap was first described in the early 1990's but has remained less popular than the TRAM flap, presumably because of the increased complexity and difficulty of the procedure compared to the TRAM. Though the DIEP flap is a very technically demanding operation, the benefits are tremendous for the patient.
SIEA Flap (Superficial Inferior Epigastric Artery Flap)
The SIEA flap procedure is very similar to the DIEP flap procedure. The main difference between the SIEA and DIEP is the artery used for blood supply to the reconstructed breast. The SIEA arteries are generally found in the fatty tissue just below skin. As in the DIEP the SIEA flap reconstruction does not sacrifice the abdominal muscle and only uses the patient's skin and fat to reconstruct the breast. While the SIEA flap procedure is similar to the DIEP it is used less frequently since the arteries required are generally too small to sustain the flap in most patients. Only about 20% of patients have the anatomy required to allow for this procedure.
GAP Flap (Gluteal Artery Perforator Flap)
Women who do not have an adequate amount of abdominal tissue for reconstruction may be eligible for the GAP flap. This procedure uses excess skin and fat from the upper or lower gluteal (buttock) region. Like the DIEP and SIEA perforator flap procedures, all muscle in the area is spared. The incisions are generally easily hidden with most underwear. Most surgeons prefer to only perform reconstruction of only one breast at a time when using this technique. It is important to discuss this possibility with your surgeon. If only one breast is reconstructed, the patient may need surgery on the other buttock in the future for optimal symmetry.
More breast reconstruction options are discussed here.
---
Dr Chrysopoulo
PRMA Plastic Surgery
(800) 692-5565
The Breast Cancer Reconstruction Blog
Follow us on Twitter!

- mchrysopoulo
- aka Dr C | PRMA
- 3,970 followers
- 3,624 following
-
- @bethlgainer @lauraburdette Some more info for you on Breast Fat Grafting (Lipofilling): http://t.co/S6RfWZPn #breastcancer #fatgrafting
-
- The PRMA Breast Cancer News is out! http://t.co/fbsjDUSL ▸ Top stories today via @vabc
-
- @Bethlgainer @lauraburdette Sorry to hear that. Talk to your surgeon about fat grafting the smaller breast. May be an option for you.
-
- The PRMA Breast Cancer News is out! http://t.co/fbsjDUSL ▸ Top stories today via @chemobrainfog @cloudhealth @stales @thelizarmy @harriseve
-
- Breast Reconstruction after Mastectomy or Lumpectomy - latest options http://t.co/HNhSLu0h #breastcancer #breastreconstruction #bcsm
Breast Cancer Reconstruction News
www.breast-cancer-reconstruction.blogspot.com
Fetching RSS feed... please stand byUseful Links
- PRMA Plastic Surgery, San Antonio, Texas
- A great information source for breast reconstruction and cosmetic plastic surgery.
- LookYourBest.com
- Dr Chrysopoulo's personal website.
- Breast Cancer Reconstruction Blog
- Dr Chrysopoulo's Blog on breast cancer reconstruction.
- PRMA Breast Reconstruction Blog
- Breast reconstruction blog brought to you by PRMA Plastic Surgery.
- DIEP Flap Surgery and Finding A DIEP Surgeon
- Learn about the gold standard in breast reconstruction, the DIEP flap procedure and how to find a DIEP flap surgeon near you.
- Microsurgical Breast Reconstruction With Perforator Flaps
- Learn about DIEP flap, SIEA flap and GAP flap reconstructive breast surgery.
- FDA re-introduces Silicone Breast Implants
- This article describes the potential impact of the re-introduction of silicone breast implants in the USA.
- Breast Reconstruction Surgical Options
- More breast reconstruction options.
- TUG Flap Breast Reconstruction
- Innovative new plastic surgery procedure uses the patient's upper, inner thigh tissue to reconstruct a "natural", warm, soft breast after mastectomy and provides a "thigh lift" as a bonus.
- Breast Reconstruction With Abdominal Flaps (DIEP, SIEA & TRAM)
- Breast reconstruction using abdominal tissue - DIEP, SIEA and TRAM flaps.
- Breast Augmentation, Breast Reduction and Breast Lift
- More plastic surgery breast procedures.
- Breast Plastic Surgery
- "Fantastic Four" of breast procedures leave women extremely satisfied -
99% would have breast plastic surgery again, says study presented at ASPS meeting. - DIEP Flap Breast Reconstruction
- Website devoted to DIEP flap breast reconstruction.
- Advanced Scar Treatment
- InviCible Scars - Scientifically proven scar-minimizing treatment. Hypo-allergenic. No preservatives, fragrances or harmful D4/D5 silicones.
More Interesting Lenses
New Guestbook
-
Reply
-
Clevelandcosmeticsurgery
Feb 7, 2012 @ 1:50 am | delete
- Attractive section of content. I just stumbled upon your weblog and in accession capital to assert that I get in fact enjoyed if u r looking for more detail please join my blog
http://www.squidoo.com/cleveland-cosmetic-surgery
-
-
Reply
-
Mia-Mia
Aug 16, 2011 @ 8:25 pm | delete
- Thank you for a sensitive and informative lens.
-
-
Reply
-
BHPSC90211
May 11, 2011 @ 9:45 pm | delete
- Nice Lens come check out our plastic surgery lens and give us a SquidLike Thank you and I will check back soon.
http://www.squidoo.com/bhpsc
-
-
Reply
-
linkbuildingpackages
Jan 1, 2011 @ 3:37 am | delete
- This is a beautiful site. I love its content and its design. I recommend this site among other people.
Mens Underwear
Calvin Klein Underwear
-
-
Reply
-
claudcarter
Aug 15, 2011 @ 9:22 pm | delete
- I really loved reading your blog. It was very well authored and easy to understand. Just the same as my blog Breast Lift San Francisco. Unlike additional blogs I have read which really not that are good. I also found your posts very interesting. In fact after reading, I had to go show it to my friend and he enjoyed it as well!
-
-
Reply
-
CosmeticSurgeryMarketing
Apr 27, 2010 @ 3:26 pm | delete
- Great Lens that is sure to help every woman who is struggling with this type of decision. You covered it all from the physical benefits of immediate versus delayed procedure to the insurance information. Thanks so much for taking the time to publish this extremely useful Lens. As a plastic surgery patient myself, I very much appreciate everything plastic surgeons do, you included. Thanks! I'm looking forward to more of your Lenses.
-
-
Reply
-
neomatrix
Apr 21, 2010 @ 3:07 pm | delete
- Very informative lense! Thanks for putting this together.
-
-
Reply
-
advman70
Mar 4, 2010 @ 7:46 pm | delete
- Great information 5* for what must be one of life's traumatic events.
-----------------------
Chiropractor Plano
-
-
Reply
-
Nov 29, 2009 @ 2:24 pm | delete
- nice page thanks great for
tummy tuck before and after operations
-
-
Reply
-
Dr_Joe
Jul 15, 2008 @ 8:12 pm | delete
- Very informative.
Great lens. Rated it 5 stars.
Feel free to visit Pregnancy Ultrasound | Baby Scans | 4D Baby Scans.
-
- Load More
by DrChrysopoulo
Board certified plastic surgeon specializing in breast reconstruction after breast cancer, and scar healing. www.prma-Enhance.com , Breast-Cancer-Reconstruction.blogspot.com,... more »
- 3 featured lenses
- Winner of 3 trophies!
- Top lens » Breast Reconstruction after Mastectomy for Breast Cancer
Explore related pages
- Scar Healing - 6 Tips For Better Scars Scar Healing - 6 Tips For Better Scars
- Best Scar Treatments Best Scar Treatments
- Diagnosed with Breast Cancer - My Story Diagnosed with Breast Cancer - My Story
- ❤ Open MRI Units ❤ Claustrophobia - No More Fear! ❤ Open MRI Units ❤ Claustrophobia - No More Fear!
- Silicone vs. Saline : Debate Silicone vs. Saline : Debate
- Witches milk Witches milk