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Breast reconstruction can be a very rewarding procedure for a woman who has lost her breast due to cancer or other condition. The course of breast reconstruction may take a few weeks 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 such as stage of your tumor, need for postoperative chemotherapy or radiation, other medical problems, medicines that you are taking and smoking, etc. will be considered when choosing the type and timing of reconstruction.
Essentially, there are three types of reconstruction: tissue expander/implant reconstruction using your own tissues, or a combination of the two. Your surgeon will work with you to determine which type of reconstruction would 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 each 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 Implant: This type of breast implant has a soft shell and is filled with saline or IV fluid to create a breast.
- Silicone Implant: This type of breast implant has a soft shell and is filled with silicone gel. Silicone gel implants 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 these safety studies, silicone gel implants were approved by the FDA in November 2006.
- Latissimus Dorsi Flap Reconstruction: This procedure takes tissue (skin, fat & muscle) from your back just below the shoulder blade and tunnels it to the chest to reconstruct the breast. A tissue expander or single staged implant may be required as well. This procedure may entail a hospital stay and has a slightly longer recovery period than the tissue expander alone.
- TRAM Flap (transverse rectus abdominis myocutaneous flap): 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.
- Microsurgical Flap: Tissue can also be taken from the abdomen, hips and thighs to reconstruct the breast using microsurgery. This method will require a hospital stay and have a recovery period similar to a TRAM flap procedure.
- DIEP Flap (deep inferior epigastric perforator reconstruction): This operation moves tissue (skin, fat) with its blood supply and involves a microsurgical procedure but leaves the abdominal muscles intact. The Free TRAM or free muscle sparing TRAM is similar to the DIEP flap but varying amounts of muscle are taken as well as skin and fat. These operations also require hospitalization and have a recovery period similar to the TRAM method of reconstruction.
Patient Education
You may be instructed to wear an elastic bandage or support bra after your procedure to aid in minimizing swelling while supporting your reconstructed breast. Your physician may insert a thin tube under the skin near your surgical site to drain excess blood or fluid. This tube will be monitored for drainage output and removed during one of your follow-up office visits. Your physician will work with you to prescribe pain medication following your procedure to assure you are comfortable.
Much information will be given to you during your first visit. Dr. Bergman, Dr. R. Brown and Dr. Sinha and his/her experienced staff will be available to answer your questions to help you decide which treatment option would be best for you. Dr. Bergman, Dr. R. Brown and Dr. Sinha will consider all of your treatment modalities as well as your physical stature and personal goals when developing your personalized plan of care. Involvement of your physician team and loved ones is important in providing you care and support during your treatment and recovery process. Your plastic surgeon will see you at regular intervals during your recovery to monitor your progress, answer your questions and provide you with support.