The DIEP flap procedure has rapidly become the “gold standard” in breast reconstruction today. While not every woman is a candidate for DIEP flap surgery, many are turned away when in fact they needn’t be. The most common areas of confusion include:
1) Previous Abdominal Surgery
While some types of previous abdominal surgery can make the DIEP flap procedure impossible to perform, most of the time previous abdominal surgery really isn’t an issue.
Many women these days have had a previous c-section or hysterectomy. It is possible for these procedures to cause damage to the blood vessels needed for DIEP flap surgery, but this is rare. A previous c-section, hysterectomy, or tubal ligation is not a contra-indication to having the procedure.
If your surgeon is worried about potential damage from previous surgery then certain tests can be performed to examine the anatomy more closely. This can include a simple doppler ultrasound exam in the office or a more involved test like a CT angiogram.
So which previous surgeries DO cause a problem? Women that have had a previous TRAM flap, tummy tuck or very extensive abdominal wall surgeries (like complex repairs of huge hernias) cannot have a DIEP or SIEA flap reconstruction because the lower tummy tissue that is needed has already been removed, disconnected or moved around.
While previous abdominal surgeries may not prevent DIEP flap reconstruction, women that have had multiple previous abdominal procedures are at increased risk of abdominal complications like bulging and even hernia after DIEP flap surgery when compared to women that have never had prior abdominal surgery.
2) An Umbilical Hernia
It is very unlikely that an umbilical hernia would prevent DIEP flap surgery. Most umbilical hernias are small. A very large umbilical hernia can make the surgery harder but even this is not usually a contra-indication to having the procedure.
3) Previous Chest Radiation
One of the most important things for the reconstructive surgeon to achieve is to replace the damaged, firm irradiated tissue with normal, healthy, soft tissue. If the irradiated tissue is not healthy enough to be used as part of the reconstruction (as is the case in many instances), it will be removed and replaced by the healthy (DIEP) tissue.
I have visited with a fair number of patients who have previously been told they are not candidates for DIEP flap reconstruction because they received chest radiation after their mastectomy. I do not share this opinion.
Most of the time this advice seems to stem from fear that the radiation may have caused damage to the internal mammary vessels in the chest. These are the blood vessels that are usually used to connect the DIEP flap to the chest. In reality it is exceptionally rare for us to find these blood vessels are damaged and cannot be used.
4) Not the Right Amount of Tissue
You don’t need to be overweight to be a candidate for a DIEP flap. What matters is the distribution of the fat. We have performed DIEP flaps on smaller breast, thin women with a BMI (body mass index) of 20 (and even less) because the fat that they did have was “in all the right places”. Having said that, there is an upper limit beyond which the risks of surgery outweigh the benefits - At PRMA we set an upper BMI limit of 40 as we have found that performing the procedure on women with BMIs greater than this significantly increases the rates of complications (especially wound healing problems).
I’ve spoken to several ladies recently who have had the same misconception about DIEP flap surgery. They were scared they were “too skinny”. The truth of the matter is that you don’t need to be overweight to be a candidate for DIEP flap surgery. What matters is the distribution of the fat that you do have. Unfortunately that can’t be determined over the phone. Sometimes it can’t even be determined by emailing pictures.
I can say that we have successfully performed DIEP flap reconstructions on women with BMI’s of 20 and even less. In instances where the reconstruction ends up too small, many women are candidates for autologous fat grafting. This involves liposuction of fat from another part of the body, purifying this fat, and then re-injecting it into the reconstructed breast for additional volume.
We used to occasionally place a breast implant under the DIEP flap in women who needed more volume. Unfortunately the patient is then exposed to the risks of breast implants like capsular contracture (hardening of the implant and breast) and even deformity.
Fat is not free of issues either though - some of it can become reabsorbed or form little pea-sized areas of hardening (fat necrosis), especially if the fat grafting is not performed in a meticulous way. There were fears for a while that the injected fat could cause calcifications on a mammogram that could look like or even mask a new breast cancer. Several studies have since proven that fat grafting is safe though some plastic surgeons are still reluctant to perform the procedure because of these previous fears. Even though fat grafting may not be 100% predictable, it has served our patients very well and we now prefer it to implants in these situations.
If you’d like to know for sure whether you’re a candidate for a DIEP flap please visit with an experienced DIEP surgeon. It’s the only way to really be sure.
The two most common questions among breast cancer patients considering breast reconstruction are “how much does breast reconstruction cost?” and “will my insurance cover it?”. The good news is that even though breast reconstruction is performed by plastic surgeons, it is NOT considered cosmetic surgery.
If the mastectomy is for breast cancer then the law states it must be covered by insurance. If the mastectomy is covered, the reconstruction will be too. The bad news is that even though insurance covers breast reconstruction, there are still some costs that the patient will be responsible for. Patients much research this ahead of time to limit the risk of a nasty financial surprise down the line.
While the degree of coverage varies based on the insurance plan, there are some things that are pretty standard. Effective June 1, 2010 even Medicaid will provide a benefit for breast surgery to the unaffected breast for symmetry, providing certain criteria are met. Breast reconstruction after prophylactic (preventive) mastectomy is usually covered as long as the patient is deemed to be high risk for breast cancer (significant family history or BRCA gene positive).
Even though insurance companies are mandated to cover reconstruction, breast reconstruction insurance laws do vary by state. The amount each insurance pays can also vary a great deal.
It is important to make sure your surgeon is in-network for your insurance plan if at all possible. This will limit your costs to whatever you’ve agreed to pay under the terms of your insurance plan (such as your deductible, co-pay and out of pocket expense). Using an out-of-network surgeon will likely subject you to other costs such as “balance billing”. This is when the surgeon essentially sets his/her price (just to use an example let’s say $1,000), receives whatever the insurance plan pays (let’s say $600) and then asks the patient to pay the remainder (ie the “balance” of $400). This example is based on relatively small dollar amounts but you can see how this could add up to tens of thousands of dollars of additional bills for a major surgical procedure, and that’s just for the first procedure.
Whether or not you can find an in-network, experienced surgeon depends on the procedure you’ve decided to have. If you’ve decided to have an implant reconstruction then you may have several doctors to choose from. Implant breast reconstruction is technically not as challenging as other options and most plastic surgeons perform the procedure.
On the other hand, if you’re more interested in an advanced reconstructive procedure that not many surgeons offer (like a DIEP flap), you’re likely to have a harder time finding an experienced surgeon to perform your surgery who is in-network. Most patients will unfortunately have to travel for their surgery because of this. Even though this may now add the cost of airfare and hotel stays, these costs are typically significantly less than a “balance bill” from an out-of-network surgeon.
Some breast centers even offer special arrangements to traveling patients such as significantly discounted hotel charges to help ease the financial burden.
After deciding to pursue immediate breast reconstruction I went online and requested information from the PRMA website on a Saturday. By Monday morning Mistie (the nurse) called me back to see what information I needed. She was so kind and nice. She really listened to what I was saying and took my medical information and then verified my insurance. After I gave Mistie my medical information, the ball started rolling in the right direction. Mistie spoke with Dr. Chrysopoulo directly about my case and an appointment was scheduled. Once I met him I had an incredible peace about the whole thing. I knew that I found the right doctor and the right place to have my surgery.
When I arrived for my initial appointment, Dr. Chrysopoulo made me feel at ease immediately. He was kind, compassionate, and knowledgeable. He spoke with complete sincerity and he also had a great sense of humor, which helped to make me smile and made me feel at ease. It was also wonderful getting to meet Mistie in person after talking to her on the phone several times.
I had initially wanted to do reconstruction with implants thinking that my recovery time would be quicker. Dr. Chrysopoulo spoke to me about the pros and cons of implants verses DIEP flap reconstruction. Once it was laid out in front of me, it made complete sense to have the DIEP flap procedure rather than reconstruction with implants. The DIEP procedure would use tissue from my stomach to reconstruct my breasts and Dr. Chrysopoulo would begin the reconstruction as soon as the general surgeon completed the mastectomy - while I was still asleep. I would not have to return for reconstruction surgery later. That sounded great to me.
Dr. Chrysopoulo was preparing me for what might be ahead after surgery by saying that when I woke up, I would feel like I had been hit by an 18-wheeler but it would get better. He said that by a week later I would feel like I had been hit by a mini-van. I knew other women who had breast augmentation who said when they woke up; it felt like they had a Buick parked on their chest, so I knew that there would be pain following such major surgery. I prepared myself for whatever was ahead mentally. (Actually, my personal experience with pain following my surgery was so much less than what I mentally prepared for.)
Dr. Chrysopoulo also told me that my instructions following my surgery would be to basically ?live in a recliner for 3 weeks getting up only to walk?. I knew that walking was going to be a big part of recovery, but that it would be important to take it a little easy as well.
Every woman has a right to breast reconstruction surgery after breast cancer. This has been a federal mandate for some time and insurance companies have to pay for breast reconstruction surgery by law. There is no age limitation for breast reconstruction and there are many different options available.
When the breast reconstruction is performed at the same setting as the mastectomy it is referred to as “immediate” reconstruction. The biggest advantage of immediate reconstruction is that the patient wakes up from the surgery still “whole” and completely avoids having to live without a breast. Other advantages include shorter scars and, generally speaking, a better cosmetic result.
In some instances immediate reconstruction is not recommended or is not possible and the reconstruction is performed several months after the mastectomy. This is called “delayed” reconstruction. Women with more advanced disease are usually not candidates for immediate reconstruction because of the need for radiation therapy after the mastectomy. While some plastic surgeons still perform immediate reconstruction in these cases, most prefer to delay the reconstruction until a later date to allow the tissues to recover.
The most common breast reconstruction procedure performed by American plastic surgeons utilizes implants to restore the breast shape and form. These can be either saline or silicone. Implant reconstruction is typically performed as two separate surgeries. The first involves placing a tissue expander (temporary implant) under the skin and pectoral muscle. This is used to expand the skin to the required size. The expander is later replaced by the permanent implant at a second surgery. A few surgeons prefer using a one-stage approach and place the permanent implant at the same time as the mastectomy. While not all patients are candidates, this is a very attractive option for many women because they avoid the entire tissue expander phase of the reconstruction.
Implant reconstruction can be the best option for some patients. However, reconstruction with expanders and breast implants are associated with more complications than cosmetic breast augmentation. Complications following radiation therapy are also higher with implants compared to reconstructions using the patient’s own tissue.
The Latissimus procedure uses muscle (latissimus dorsi), fat and skin from the back (below the shoulder blade) that is brought around to the chest to create a new breast. Many patients also need an expander or implant to obtain a satisfactory result in terms of size. Patients typically have a scar on their back that can be seen with some low-cut clothing. Women who are very active in sports may notice some strength loss with activities like golf, climbing, or tennis.
Tissue can also be taken from the lower abdomen to create the new breast. The TRAM flap uses the same tissue that is removed by a tummy tuck. This skin and fat is transferred along with variable amounts of the rectus (sit-up) muscle. This tissue can be tunneled under the upper abdominal skin (pedicled TRAM), or disconnected from the body and reconnected to the chest using microsurgery (free TRAM). All forms of TRAM flap can improve the abdominal contour just like a tummy tuck. Unfortunately, women can notice loss of abdominal muscle strength due to the sacrifice of the rectus muscle. There is also a risk of bulging of the tummy and even hernia.
Over the last decade or so, the TRAM has been replaced by the DIEP flap as the new breast reconstruction gold standard. The DIEP provides a natural, warm, soft reconstruction together with an improved abdominal contour, just like the TRAM flap. However, unlike the TRAM, the DIEP flap spares the abdominal muscles completely. The tissue is disconnected from the body completely and reattached at the chest using microsurgery. This makes the post-op recovery easier and also significantly decreases the risk of abdominal bulging and hernia.
There are a handful of other tissue options available for women who are not candidates or prefer to avoid using their abdominal tissue. These include the inner, upper thigh (TUG flap), lower buttock crease (IGAP), and upper buttock (SGAP). The best tissue option will depend on a number of factors, primarily the patient’s body habitus.
Microsurgical breast reconstruction procedures like the DIEP, TUG and GAP flaps are not offered routinely by many American plastic surgeons. There are many reasons for this, primarily the complexity of the surgery and the need for additional training. Unfortunately most patients seeking one of these breast reconstruction options after mastectomy will be forced to travel to specialized centers for their surgery.
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Dr Chrysopoulo and his partners are board certified plastic surgeons specializing in advanced breast reconstruction techniques after mastectomy. All PRMA surgeons are in-network for most US insurance plans. PRMA Plastic Surgery is located in San Antonio, Texas. (800) 692-5565.
After getting over the shock of hearing the C word, I began my quest for knowledge. I went into research mode, reading and devouring everything I could lay my hands on. I literally spent the next 30 days reading and gathering all the information that I could find. I found it almost impossible to sleep (getting maybe 2-3 hours sleep each night) because I knew I needed to gather the information to make the right decision because I have a special needs child who relies on me.
I spoke to many other women both in person and in online in some of the breast cancer forums. I found myself on the PRMA website many times during my search for information and I was impressed with the amount of information there.
I discovered that Dr. Chrysopoulo had written a great deal of information on breast cancer and reconstruction and I read all of it that I could find. He was able to explain things in a way that was easy to understand. I also listened to a one-hour radio interview that he did on breast cancer and reconstruction. He really impressed me with his compassion and he seemed to understand what a difficult and emotional decision that this was for all women. He seemed to get it.
I made the decision to have a bilateral mastectomy because I wanted (and needed) peace of mind and I knew that I would worry every year that I could get it again in my other breast. I decided to take away that risk now. I absolutely did not like the way I felt with this breast cancer diagnosis and I knew that I never wanted to be in this place again and didn’t want to have to have this worry again. The stress, the tears, the fear, and the unknown were traumatic enough, but also coupled with emotional upset? I just wanted to get through this and move on with living my life again. One of my doctors told me that by doing the bilateral mastectomy, it would get me cancer free and keep me that way for a very long time. I needed that kind of peace of mind.
Everything that I read said that when a woman has a mastectomy and wakes up and still has breasts, it is emotionally and psychologically so much better than waking up without breasts. I felt that it would be important for me to have reconstruction immediately following the mastectomy. I didn’t want to wait to have it done later. I also knew that not many places offered immediate reconstruction following mastectomy and I realized as I spoke with other women that not many realized immediate breast reconstruction was even an option. I felt blessed to have found this out.
Despite the increase of breast reconstruction procedures performed after mastectomy in 2008, nearly 70 percent of women who are eligible for the procedure are not informed of the breast reconstructive options available to them, according to a recently published report. Newly released statistics by the American Society of Plastic Surgeons (ASPS) shows there were more than 79,000 breast reconstruction procedures performed in 2008 - a 39 percent increase over 2007. But in spite of this, current research suggests that many breast cancer patients are missing out on a key conversation that should take place at the time of diagnosis.
“Women need to understand all of their options to make an informed decision,” said ASPS President John Canady, MD. “Those who are diagnosed should be immediately referred to a full team of physicians that can provide breast care, and plastic surgeons need to be included as part of that treatment team.”
Taking the position that every woman deserves the right to choose which, if any reconstruction option is best for her after a mastectomy, the ASPS is launching an ongoing effort to bring public awareness to breast reconstruction issues, including education, access, and a team approach. Because early involvement by plastic surgeons and other physicians can allow development of an optimum treatment plan for each individual patient, collaboration amongst specialties is essential. As such, ASPS suggests that primary care, general surgery, radiology, pathology, oncology, gynecology, and plastic surgery be available from the onset of treatment to ensure the greatest possible outcome for the patient.”
It is also important that patients actively participate in their treatment. Though a common misconception, eligible patients should not assume that anyone other than a board-certified plastic surgeon affiliated with an accredited facility is qualified to perform breast reconstruction after mastectomy. While technology has made breast cancer diagnosis, treatment, and reconstruction better than ever, it does not negate the need for medical expertise within each specific area of care.
Among the factors contributing to patient awareness and understanding, specific education regarding the options for breast reconstruction is often lacking. Therefore, in the coming months, ASPS will reach out to women through a variety of materials, ranging from information cards and online videos, to an ad campaign featured online and in the waiting-room publication produced by the American College of Obstetricians and Gynecologists.
“We know that there are many issues surrounding breast reconstruction and that addressing them all will take time, but this is a very important first step,” said Dr. Canady. “Our goal is to make sure that those women who are not getting breast reconstruction are doing so of their own accord and not because they are uneducated or uninformed about their options.”
The ideal breast reconstruction technique is one which allows reconstruction of a “natural”, warm, soft breast with the least impact on the patient’s body. While breast reconstruction with stem cells may not be too far off, until it becomes a reality we are limited to using the patient’s own tissue to achieve these goals. As discussed in the previous posts in this breast reconstruction series, until fairly recently the only “tissue reconstruction” options involved sacrificing muscle. This made recovery from the surgery difficult and painful, not to mention the risk of long-term muscle function loss and weakness.
Perforator flap techniques use skin and fat from various parts of the body. All muscles are preserved. Since no muscle is sacrificed recovery is much easier and muscle strength and function are preserved long-term. The downside to these procedures is that they are technically much more demanding than other breast reconstruction techniques and require microsurgical expertise. For this reason they are not offered by many plastic surgeons and patients must be prepared to travel when choosing these procedures.
The DIEP flap is the latest evolution of the TRAM flap (discussed in Part II) and represents today’s gold standard in breast reconstruction. The DIEP flap procedure is similar to the TRAM flap but only requires the removal of skin and fat. NO MUSCLE is sacrificed. The blood vessels required to keep the tissue alive lay just beneath the abdominal muscle. Therefore, a small incision is made in the abdominal muscle in order to dissect the vessels and microsurgery is required to reattach the blood vessels to the chest area.
Even though an incision is made in the abdominal muscle NO abdominal muscle is removed or transferred to the breast in the DIEP flap procedure. As a result, patients do not have to sacrifice their abdominal strength and they experience less pain and a much quicker recovery. The risk of abdominal bulging and hernia is also very small.
The DIEP flap was first described in the early 1990’s but has remained much less popular than the TRAM flap among plastic surgeons, presumably because of the increased complexity and difficulty of the procedure compared to the TRAM.
So the advantages of the DIEP flap are multiple: it uses living tissue to recreate a breast that often looks and feels like a normal breast; abdominal strength is not affected; the risk of bulging or hernias is significantly reduced; and, like the TRAM flap, the patient benefits from a simultaneous “tummy-tuck”.
The DIEP flap is a very technically demanding operation but the benefits are tremendous for the patient, especially when performed at the same time as a skin-sparing mastectomy.
The SIEA flap procedure is very similar to the DIEP flap procedure. The main difference between the SIEA and DIEP is the artery used for blood flow supply to the reconstructed breast. The SIEA arteries are generally found in the fatty tissue just below skin.
As in the DIEP the SIEA flap reconstruction does not sacrifice the abdominal muscle and only uses the patient’s skin and fat to reconstruct the breast. While the SIEA flap procedure is similar to the DIEP it is used less frequently since less than 20% of patients have the anatomy required to allow this procedure.
Women who do not have an adequate amount of abdominal tissue for reconstruction may be eligible for the GAP flap. This procedure uses excess skin and fat from the gluteal or buttock region. Fat and skin from either the upper or lower buttock region can be used and microsurgically transplanted to the chest.
Once again, no muscle is sacrificed. Incisions can generally be hidden by most underwear. If a patient requires a bilateral reconstruction with GAP flaps most surgeons prefer to only perform one side at a time. It is important to discuss this possibility with your surgeon.
Advantages of the GAP flap include: a scar that is generally hidden with underwear or swimsuits, and no loss of muscle function or strength.
Other Breast Reconstruction Options:
TUG (Transverse Upper Gracilis) Flap
Like the GAP flap, the TUG flap is an option in cases where there is not enough lower abdominal tissue to reconstruct the breast(s). The TUG procedure uses the upper part of the inner thigh; skin, fat and a small amount of muscle are disconnected and transferred to the chest to create the new breast. The patient benefits from a simultaneous inner thigh lift. Once again, this procedure is not widely available due to its complexity and need for microsurgical expertise.
It is important to realize that whichever method of reconstruction is used, the vast majority of women will require 2 or even 3 procedures for the optimal cosmetic result. Each procedure is typically separated by several weeks. The entire reconstructive process, regardless of the method of reconstruction, can therefore take several months to complete. However, breast reconstruction does NOT typically complicate or delay cancer treatment such as chemotherapy.
With all this in mind and also remembering the superior cosmetic results associated with immediate breast reconstruction (reconstruction performed at the same time as mastectomy), it is recommended that women discuss their reconstructive options with a plastic surgeon specializing in breast reconstruction before undergoing mastectomy whenever possible.
Women interested in breast reconstruction after mastectomy have several reconstruction options to choose from. In Part I of this series we discussed tissue expanders, breast implants and Alloderm.
Though implant reconstruction remains the most common method of breast reconstruction in the US, many women are now steering away from this option, opting instead to use their own tissue for more “natural” results. Muscle flaps have, until fairly recently, been the only choice available for these tissue reconstructions. The most commonly offered muscle flaps are the latissimus and TRAM flap procedures.
The latissimus procedure uses muscle from the back of the shoulder blade which is brought around to the breast mound to help create a new breast. During the procedure a section of skin, fat and muscle is detached from the back and brought to the breast area.
Many patients also need a tissue expander placed under the muscle flap in order to obtain a satisfactory result. The expander is replaced by a permanent implant at a second procedure down the line.
Patients will have a scar on their back shoulder region that can sometimes be seen through a tank top, swimsuit or sundress. The upper back can be numb or sore for a few following this procedure until the nerves grow back and the incisions are completely healed.
Women who are very active in sports should know that this procedure can reduce ability to participate in activities like golf, climbing, swimming, or tennis.
The TRAM flap was the first procedure to describe use of one of the rectus abdominis muscles (sit-up muscles) for breast reconstruction. This procedure begins with an incision from hip to hip rather like a “tummy-tuck”.
A “flap” of skin, fat and one of the patient’s abdominal muscles is typically tunneled under the skin to the chest to create a new breast. This is known as a pedicled TRAM flap. Recovery from the TRAM flap procedure can be difficult and painful and there is a risk of abdominal bulging (or “pooching”) and even hernia. Long-term, the patient has to adapt to the loss of some abdominal strength (up to 20%) which most active patients will notice.
In cases where both breasts are being reconstructed, both abdominal muscles are sacrificed and transferred to the chest (one for each breast). The loss of abdominal strength in these situations is far greater and very significant.
Over the years and with the introduction of microsurgery, the procedure has evolved several times with each modification preserving more and more abdominal muscle. This has made postoperative recovery a little easier and has decreased the potential for abdominal complications somewhat.
The latest evolution in breast reconstruction is “perforator flap surgery”. These techniques use skin and fat from various parts of the body. Since no muscle is sacrificed recovery is much easier and muscle strength and function are preserved long-term. These techniques will be discussed in Part III of this breast reconstruction series.
This post is the first of a 3-part series on reconstructive breast surgery discussing the reconstructive options available to women facing mastectomy for breast cancer.
Every woman has a right to breast reconstruction. This has now actually become a federal mandate and insurance companies have to cover all types of breast reconstruction by law. Having said that it is also important to remember that it?s not up to the health insurance to decide which reconstruction a woman receives. That?s determined by the patient and her surgeons.
Breast reconstruction is not a form of cosmetic surgery ? it restores something that nature has provided but cancer has taken away. There is also no age limit ? as long as there are no medical conditions making the surgery unsafe and the breast cancer is diagnosed at an early enough stage, most women are candidates for the surgery.
Breast reconstruction can be performed as an ?immediate? or ?delayed? procedure. As the term implies, immediate reconstruction is performed immediately after the mastectomy while the patient is still under anesthesia. Once the general surgeon has completed the mastectomy the plastic surgeon begins creating the new breast. Advantages of this approach include the option of preserving most of the breast skin (?skin-sparing mastectomy?) and a shorter scar. The patient also wakes up ?complete? and avoids the experience of a flat chest. Immediate reconstruction provides the best cosmetic results.
Delayed reconstruction generally takes place several months following mastectomy. Patients required to undergo radiation after mastectomy may be advised to delay reconstruction in order to achieve the best results. This delay may last several months in order to allow the tissues to recover as much as possible from the radiotherapy.
There are several reconstructive options, ranging from breast implants to ?autologous? techniques using the patient’s own tissue to recreate a more ?natural?, warm, soft breast. The nipple and areola can also be restored.
This is the most common method of reconstructive breast surgery currently being used in the United States. Most surgeons perform this is a two-stage procedure. The tissue expander is essentially a temporary breast implant which can be placed either at the same time as the mastectomy or after the mastectomy has healed. The expander is used to stretch the skin envelope and recreate the size of breast the patient wants. The expander is ultimately replaced by a permanent implant (saline or silicone) at a separate procedure several months later.
Some patients undergoing immediate breast reconstruction are candidates for one-step breast implant reconstruction whereby a permanent implant is inserted at the time of the mastectomy and the patient avoids going through the whole expansion process. In the one-step implant reconstruction the implant is completely covered by the pectoralis muscle and Alloderm (a cadaveric acellular dermal graft). This is specially treated skin from a cadaver that is used to provide a sling and coverage of the lower part of the implant.
Two types of implants are available to patients: saline and silicone. There are many opinions regarding both types of implants and it is advised that you speak with your surgeon as to which implant would be best for you. Patients who undergo implant reconstruction should be aware that their breast implants may need to be replaced at a future date.
Implant reconstruction can be the best option for some patients. However, tissue expanders and implants can be fraught with complications long-term, particularly if the patient has had or is going to have radiation therapy as part of her cancer treatments. For these reasons, many surgeons and patients prefer autologous reconstruction, i.e. reconstruction using the patient’s own tissue taken from another part of the body. These will be discussed in upcoming posts.
