For women who have lost one or both breasts to cancer, modern plastic surgery offers a wide range of options to improve self-image, self-confidence, and quality of life. It can be tough figuring out where to start, especially while trying to accept a breast cancer diagnosis. In honor of Breast Cancer Awareness Month, we’re taking time to address some of our patients’ most frequently voiced questions and concerns about the different breast reconstruction options available.
Breast reconstruction is a series of surgical procedures that restore breast size, shape, and appearance after a mastectomy. There are many different techniques for reconstruction, and the best option for you will depend on your physical needs and aesthetic goals. In general, the process breaks down into two phases:
- First, skin must be ‘created’ by placing an expander to stretch the existing skin over time.
- Once there is enough skin to work with, your surgeon can restore the volume of the breast using implants, your own tissue, or a combination of the two.
What are my options for breast implants?
Breast reconstruction can include a range of implant shapes and sizes to help restore symmetry and balance, and implants can be combined with nipple reconstruction or tattooing to create a more natural appearance. Silicone implants tend to be popular for breast reconstruction, as they move and feel more like natural breast tissue. Implants can also be placed with minimal risk and no additional time in the hospital. If you’re considering implants, your surgeon can help determine the safest options for your health and goals.
Can I have reconstruction done with my own tissue instead?
Many women opt to restore breast volume using their own tissue (known as autologous reconstruction), usually from the abdomen or back area. For women who need only one breast reconstructed, autologous procedures may offer better symmetry than implants.
- Deep inferior epigastric perforator flap (DIEP) reconstruction uses tissue and blood vessels from the lower belly to rebuild the breast. This procedure is popular because it uses no muscle tissue, and combines the contouring benefits of a tummy tuck. Bangor Plastic and Hand Surgery is the only practice north of the Dana-Farber Cancer Institute that performs this type of reconstruction.
- Superficial inferior epigastric artery flap (SIEA) reconstruction is similar to DIEP procedures, except that it draws the blood supply from a different section of the abdomen (making it a good option for women who need both breasts reconstructed and have an ample donor site).
- Transverse rectus abdominus myocutaneous flap (TRAM) reconstruction, the most common autologous procedure, rebuilds the breast using muscle from the abdomen. TRAM procedures don’t require advanced microsurgery like DIEP and SIEA, but they do involve a longer recovery time, and may increase the risk of hernias.
- Latissimus Dorsi flap reconstruction rebuilds the breast with muscle coverage taken from the upper back. Since the back doesn’t often carry a great deal of fatty tissue, this procedure is usually done with expander implants. The thickness and pliability of back skin, however, also makes it a good option for immediate nipple reconstruction. Latissimus procedures typically won’t affect your upper body function unless you are a competitive swimmer, climber, or paddler.
While autologous reconstruction requires extra time in the hospital, it can create a breast that feels, moves, and ages more naturally without implants. Not everyone is a candidate for autologous reconstruction. Talk to your surgeon to better understand the risks and determine whether the procedure is right for you.
What is a skin-sparing mastectomy?
A skin-sparing mastectomy removes cancerous breast tissue through an incision near the nipple, leaving much of the natural breast skin intact. Since they cause much less scarring than other procedures, skin-sparing mastectomies often create better aesthetic results, and leave more to work with for DIEP flap, latissimus, or nipple reconstructions.
I’ve heard of a technique called ‘fat grafting.’ What is that?
A new procedure, fat grafting injects the patients’ own liposuctioned and processed fat into the soft tissue of the chest for contouring of the breast. Fat grafting helps smooth out small irregularities, adds padding over implants, and can restore breast size over time.
Will radiation treatment affect my reconstruction options?
Breast implants tend not to react well to radiation, and it can also cause transferred breast tissue to shrink or harden. If you are or will be undergoing radiation, it’s best to postpone reconstructive surgery until after your treatments are finished.
There are so many options! How do I know what’s right for me?
Reconstruction is a highly individualized procedure. It’s important to understand that the physical results will vary between individuals, and reconstructed breasts may not have the same sensation or feel as the breast being replaced.