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.
Breast Reconstruction Techniques
For decades, plastic surgeons have been able to use skin and fat from a patient’s abdomen to create a natural breast reconstruction.
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.
John LoGiudice, MD, board-certified Froedtert & MCW plastic surgeon, is among a relatively few number of surgeons in the United States who perform DIEP Flap and SIEA Flap breast reconstruction surgery routinely.
Plastic surgeons have used the TRAM Flap, or Transverse Rectus Abdominis Myocutaneous Flap, for more than 20 years, transferring extra tissue from the abdomen to the breast, sometimes taking one entire rectus abdominis muscle with the flap, and sometimes taking only a part of the muscle.
The DIEP Flap, or deep inferior epigastric perforator flap, represents the evolution of the TRAM technique and the current state of the art in breast reconstruction. The DIEP Flap is a microsurgical technique that involves precisely separating the skin, soft tissue and tiny blood vessels, or perforators, from the abdomen without removing any of the abdominal muscles. DIEP Flap is offered by a handful of plastic surgeons around the country.
The blood vessels are matched to supplying vessels at the mastectomy site, and a new breast is formed. Three months later, a new nipple is reconstructed, and finally tattooing of the nipple completes the reconstruction. 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.
The tissue taken to create a new breast using the DIEP Flap is virtually the same as that taken for a cosmetic tummy tuck or abdominoplasty. In fact, the narrow incision at the bikini line used for the DIEP Flap is identical to that made for a tummy tuck.
The SIEA Flap, or Superficial Inferior Epigastric Artery Flap, is similar to the DIEP Flap technique in that it uses skin and fatty tissue from the abdomen to replace the skin and soft tissue removed in a mastectomy.
The SIEA, however, relies on a distinctive blood supply and requires less tissue removal from the abdomen. The SIEA Flap depends on the tiny vessels of the superficial vascular system in the fatty layer just below the skin of abdomen. About 20 percent of women have these types of superficial arteries. Women who do not have adequate superficial blood vessels are not candidates for this procedure. The decision about which procedure to use — DIEP Flap or SIEA Flap — is made during surgery. Because less tissue is removed, the abdomen generally heals faster than with the DIEP Flap procedure.
As with the DIEP Flap procedure, the SIEA Flap preserves the abdominal muscle and leaves a thin scar and a flat belly, similar to a tummy tuck. Three months after surgery, a new nipple is reconstructed, and finally tattooing of the nipple completes the reconstruction.
The superior gluteal artery perforator flap (SGAP Flap) uses skin and fat from the upper buttock for women whose abdominal tissue is not suitable for a breast reconstruction.
Implant Breast Reconstruction
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.