Breast Reconstruction Following Mastectomy
Extensive research has shown that surgical reconstruction of the breast following mastectomy can help women regain their sense of wholeness. Not every breast cancer patient requires reconstructive plastic surgery, and some choose not to have it. But for women who opt for reconstruction, it is often an important step in their personal recovery.
Eligibility for breast reconstruction is not limited by age or time. Reconstruction can take place immediately following the cancer surgery (before the patient is out of the OR) or 30 years later. There are reconstructive options for mastectomy and lumpectomy patients. Reconstruction can also be performed to revise a previous reconstructive procedure.
The Breast Cancer Program includes board-certified plastic surgeons who are specially trained in the latest reconstructive techniques. They offer a full range of reconstructive options for women in virtually any situation.
For decades, plastic surgeons have been able to use skin and fat from a patient’s abdomen to create a natural breast reconstruction. However, the traditional approach, TRAM flap, requires the removal of abdominal muscle. This can lead to abdominal complications and significant pain. An advanced reconstruction technique called deep inferior epigastric perforator flap (DIEP Flap) allows many patients to avoid these problems by preserving the abdominal or "core" muscles.
DIEP Flap is offered by a handful of plastic surgeons around the country. During the procedure, the surgeon carefully separates skin, fat and tiny blood vessels (or perforators) from the abdomen without removing any muscle tissue. Next, the tissue flap is transferred to the chest, where the blood vessels are reattached to the vascular system using microsurgical techniques. The surgeon then shapes the transferred tissue to look and feel like a natural breast. In approximately three months, the surgeon performs a second procedure to create a reconstructed nipple.
Because DIEP Flap preserves the patient’s abdominal muscles, the patient recovers faster, experiences fewer complications (such as hernia) and maintains her core abdominal strength.
- Some women are eligible for an alternative procedure known as a superficial inferior epigastric artery flap (SIEA Flap). This procedure uses a system of blood vessels in the fatty layer just under the skin of the abdomen. Because SIEA Flap uses this superficial vascular system, it requires less tissue removal from the abdomen, resulting in faster healing. Physicians determine during surgery whether or not a patient is a candidate for the SIEA approach.
- Women whose abdominal tissue is not suitable for a breast reconstruction may be eligible for a superior gluteal artery perforator flap (SGAP Flap), a microsurgical procedure that uses skin and fat from the upper buttock.
To find out more about breast reconstruction with advanced tissue transfer techniques, please see: Who Is a Candidate for SIEA or DIEP Flap?
Reconstruction using silicone breast implants is an option for many women, including patients who have had a skin-sparing mastectomy. Implant reconstruction can be an important alternative for women who are not good candidates for reconstruction using their own tissue.
For many patients, a temporary expander implant is used to prepare the breast for the permanent implant. During an initial procedure, the expander implant is placed under the chest muscle. Over the course of several office visits, a physician slowly inflates the implant with saline solution, allowing the muscle and skin to expand gradually. Once the correct size is reached, the patient undergoes a second procedure to place a breast implant.
Lumpectomy surgery allows women to preserve their breasts. But when a lumpectomy involves the removal of a significant portion of breast tissue, a noticeable deformity can result. Medical College of Wisconsin plastic surgeons and breast cancer surgeons work together to incorporate cosmetic surgery principles into cancer treatment. For example, surgery to remove a large tumor could incorporate a breast reduction pattern or breast lift pattern. The result is an effective cancer operation with a good cosmetic outcome.