Breast reconstruction can be a very rewarding procedure for a woman who has lost her breast due to cancer or other conditions. The course of breast reconstruction may take a few weeks or up to several months and may entail more than one operation. Reconstruction may be done at the time of the mastectomy or at a later date. Many factors will be considered when choosing the type and timing of reconstruction such as:
- stage of your tumor
- need for postoperative chemotherapy or
- radiation
- other medical problems
- medicines that you are taking
- smoking, etc.
Essentially, there are three types of reconstruction: tissue expander/implant reconstruction, reconstruction using your own tissues or a combination of the two. Your surgeon will work with you to determine which type of reconstruction will be best for you.
Types of Reconstruction
Tissue Expander: This is an expandable shell that is placed under the chest muscle during surgery. Saline or IV fluid is injected into a port in the tissue expander every one to two weeks. The shell expands and allows your own tissue to expand and grow to accommodate a breast implant, similar to the gradual expansion of a woman’s abdomen during pregnancy. After expansion your chest may feel full or tight but that sensation usually subsides in 1-2 days. Expansion continues until the appropriate size is attained then removal of the tissue expander and placement of a permanent implant occurs. Alteration of the opposite breast to improve symmetry and nipple/areolar reconstruction may occur at this time as well.
Saline Implants: This type of breast implant has a soft shell and is filled with normal saline or IV fluid to create a breast.
Silicone Implants: This type of breast implant has a soft shell and is filled with silicone. Silicone implants today have changed immensely from the implants of the 1980’s and feel more natural than saline. Extensive research regarding the safety of silicone gel implants has occurred and based on those safety studies, silicone gel implants were approved by the FDA in November 2006.
Latissimus Dorsi reconstruction: This procedure takes tissue (skin, fat and muscle) from your back just below the shoulder blade and is tunneled to the chest to reconstruct the breast. A tissue expander or single staged implant may be required as well. This procedure may entail a longer hospital stay and a longer recovery period than the tissue expander alone.
TRAM reconstruction (Transverse Rectus Abdominis Myocutaneous Reconstruction): This procedure takes tissue (skin, fat and muscle along with its blood supply) from the abdomen and tunnels it into the chest to reconstruct a breast. This method will require a hospital stay and the recovery period is slightly longer than the latissimus dorsi reconstruction.
DIEP reconstruction (Deep Inferior Epigastric Perforator Reconstruction): This procedure moves tissue (skin and fat) with its blood supply and involves a microsurgical procedure but leaves the abdominal muscles intact. The Free TRAM or free muscle sparing TRAM are similar to the DIEP flap but varying amounts of muscle are taken as well as skin and fat. The operations require hospitalization and the recovery period is about the same as the TRAM reconstruction.
Much information will be given to you during your first visit. The plastic surgeon and his/her staff will be available to answer your questions to help you decide which treatment option would be best for you.
Your plastic surgeon will see you at regular intervals during your recovery to monitor your progress, answer your questions and provide you with support.
Questions to ask your Plastic Surgeon:
- What types of breast reconstruction are available?
- Which type would I be a candidate?
- Can reconstructive surgery be done at the same time as the mastectomy?
- Can reconstructive surgery be done at a later date if I don’t have it done with my mastectomy?
- Is reconstruction covered by my insurance?
- How long will I be in the hospital?
- Are there any long term considerations with breast implants?
- Do you have before and after photos of previous reconstructions?