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Breast Evaluation and Treatment Program

Breast Cancer

Breast Reconstruction

• What is breast reconstruction?
• What are criteria for breast reconstruction surgery?
• When is breast reconstruction surgery performed?
• What are the risks or complications of having breast reconstructive surgery?
• What are the types of breast reconstruction surgery?
  • Expander/Implant Reconstruction
  • DIEP Flap - Deep Inferior Epigastric Perforator Flap
  • TRAM (transverse rectus abdominus myocutaneous) Flap
  • Free tissue transfer (also called Free Flap, or Free TRAM)
  • Latissimus dorsi flap

 

What is breast reconstruction?

Reconstruction of a breast is a surgical procedure that recreates a breast mound to replace a breast that has been removed due to cancer or other disease. It also can improve the defects that result from mastectomy. New medical procedures and devices have made it possible for surgeons to create a breast mound that can come close in form and appearance to matching a natural breast.

The goal of reconstructive surgery is to create a breast mound that matches the opposite breast and to achieve symmetry. If both breasts have been removed, the goal of breast reconstructive surgery is to create both breast mounds approximately the size of the patient's natural breasts.

What are criteria for breast reconstruction surgery?

In general, all women undergoing a mastectomy are candidates for immediate or delayed breast reconstruction. However, there are criteria for selecting the best candidates for the procedure:

• The size and location of the cancer, which determines the amount of skin and tissue to be removed in the mastectomy, are primary consideration factors when making recommendations for reconstruction.

• Whether tissue has been damaged by radiation therapy or aging, and is not sufficiently healthy to withstand surgery.

• Other considerations include:
  • potential for complications
  • patient's desires
  • the amount of tissue removed from the breast
  • the health of the tissue at the planned operation site
  • whether radiation therapy is part of treatment
  • the patient's general health and body build
  • overall health
  • past medical history
  • co-existing illnesses
  • other risk factors such as cardiac disease, diabetes mellitus, smoking, and obesity

When is breast reconstruction surgery performed?

The patient is usually educated and counseled in breast reconstructive possibilities prior to mastectomy, so that she can make the decision for or against reconstruction before going into surgery. Based on the personal medical history of each patient, a recommendation will be made for either:

• immediate reconstruction - surgery performed at the same time as mastectomy.

• delayed reconstruction - a second operation performed after recovery from mastectomy is complete.

What are the risks or complications of having breast reconstructive surgery?

The general problems connected with any surgery are possible, such as:

• bleeding
• fluid collection
• infection
• excessive scar tissue
• difficulties with anesthesia

Occasionally, these complications are severe enough to require a second operation.

The most common problem in breast reconstruction is capsular contracture, which occurs if the scar or capsule around the implant begins to tighten.

What are the types of breast reconstruction surgery?

Expander/Implant Reconstruction
The use of an expander to create a breast mound followed by the placement with a permanent filled breast implant. Surgery to insert an implant is a relatively simple procedure. Drains are put in place, and recovery time is longer due to the additional surgery, but the care afterward is the same as for mastectomy alone. In delayed reconstruction, drains are not routinely inserted. The recovery is much quicker than it is after immediate reconstruction because the mastectomy wound has already healed.

Tissue Flap Procedures
Tissue flap procedures use the body's own tissue -- from the lower abdomen, back or buttocks -- to create a breast shape. There are several different types of tissue flap breast reconstruction:

• DIEP Flap - Deep Inferior Epigastric Perforator Flap -- Perforator flaps represent the state-of-the art in microvascular breast reconstruction. The mastectomy defect is replaced with skin and soft tissue from the abdomen following a bikini-type incision similar to a tummy tuck. The necessary skin, soft tissue and feeding blood vessels are removed together as a single unit. These blood vessels are connected to supplying blood vessels at the mastectomy site with a microscope. This tissue is then surgically moulded into a new breast mound. The abdomen is the most common donor location, since it commonly contains excess fat and skin.
  
  Unlike traditional TRAM flap reconstructions, refined perforator flap techniques allow for use of this tissue without sacrificing essential abdominal muscles. In addition to reconstructing the breast, the contour of the abdomen is often improved similar to a tummy tuck.

• TRAM (transverse rectus abdominus myocutaneous) Flap uses tissue from the lower abdominal wall, leaving enough blood vessels intact to provide permanent circulation to the transferred tissue.

• Free tissue transfer (also called Free Flap, or Free TRAM) involves completely removing an island of fat and skin from the abdomen and stitching it in place to the mastectomy wound. This techniques requires microsurgery to attach blood vessels supplying the flap to those in the chest wall.  (A free flap graft can also be made from the soft tissue, muscle and skin of the buttock's gluteal free flap.)

• Latissimus dorsi flap -- This procedure uses muscle and skin tissue from the upper back for breast reconstruction. An implant may also be necessary.

This page was last updated on: May 14, 2009.

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