loading
Breast Reconstruction_ Reconstructive Options After Mastectomy

Breast Reconstruction: Reconstructive Options After Mastectomy

Breast Reconstruction_ Reconstructive Options After Mastectomy PRMA Plastic Surgery

What are the breast reconstruction options after a mastectomy? 

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.

Author: Dr. Minas Chrysopoulo

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.

Sign Up for Our Monthly Newsletter

Online Form – Newsletter Signup

Continue Reading

Breast Reconstruction_ Reconstructive Options After Mastectomy

Breast Reconstruction: Reconstructive Options After Mastectomy

Read More

Breast Reconstruction After Mastectomy & Lumpectomy - What Are Your Options PRMA Plastic Surgery

Breast Reconstruction After Mastectomy & Lumpectomy – What Are Your Options?

Breast Reconstruction After Mastectomy & Lumpectomy – What Are Your Options? July 08, 2020 Share on Facebook Twitter Linkedin What are your breast reconstruction options after a lumpectomy or mastectomy?  Breast reconstruction makes women physically whole again after breast cancer. It restores something that nature provided but cancer has taken away. In the US, it is covered […]

Read More

Growing New Breasts from Fat Stem Cells: Fact or Fiction? Is this the Future of Breast Reconstruction

Growing New Breasts from Fat Stem Cells: Fact or Fiction? Is this the Future of Breast Reconstruction July 07, 2020 Share on Facebook Twitter Linkedin Author: Dr. Minas Chrysopoulo Can you grow new breasts from fat stem cells for breast reconstruction after a mastectomy?  A new form of breast reconstruction that allows women to grow […]

Read More

Tammy’s Breast Reconstruction Journey – Part I: My Breast Cancer Diagnosis

Comparison of Abdominal Recovery After SIEA, DIEP, TRAM Flap Breast Reconstruction July 07, 2020 Share on Facebook Twitter Linkedin Author: Tammy Carrington What’s it like being diagnosed with breast cancer? My name is Tammy and I was diagnosed with Ductal Carcinoma In Situ (DCIS) in June 2009. I underwent bilateral mastectomy and immediate reconstruction with […]

Read More

can breast cancer be detected early

Can Breast Cancer Be Detected Early?

Can Breast Cancer Be Detected Early? July 07, 2020 Share on Facebook Twitter Linkedin Can breast cancer be detected early?  Breast Cancer Screening Recommendations from the American Cancer Society Screening refers to tests and exams used to find a disease, such as cancer, in people who do not have any symptoms. The goal of screening […]

Read More

male breast cancer spotlight

CNN Airs News Story on Male Breast Cancer at Camp Lejeune

CNN Airs News Story on Male Breast Cancer at Camp Lejeune July 07, 2020 Share on Facebook Twitter Linkedin Author: Pam Stephan, About.com Guide to Breast Cancer What is male breast cancer? Mike Partain, male breast cancer survivor and former resident of Camp Lejeune, is back in the news again. Tune in to CNN on […]

Read More

how healthcare reform affects breast reconstruction

Breast Cancer Reconstruction & Health Care Reform – What It Means For You

Breast Cancer Reconstruction & Health Care Reform – What It Means For You July 07, 2020 Share on Facebook Twitter Linkedin Author: Dr. Sharon Lacey What does health care reform mean for patients with breast cancer and how will it affect you? Well, it could mean… Even though you or your loved one could benefit […]

Read More

Breast Reconstruction – Breast Cancer Patients Denied Choice After Mastectomy

Breast Reconstruction – Breast Cancer Patients Denied Choice After Mastectomy July 07, 2020 Share on Facebook Twitter Linkedin Author: Dr. Minas Chrysopoulo Are there breast reconstruction options other than implants?  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 […]

Read More

Mammograms and MRI after Breast Reconstruction – Are They Needed?

Mammograms and MRI after Breast Reconstruction – Are They Needed? July 07, 2020 Share on Facebook Twitter Linkedin Author: Dr. Minas Chrysopoulo “Do I still need to have mammograms after my breast reconstruction?” I’m asked this question quite often. Surprisingly, there is no evidence-based consensus on this among breast cancer physicians. Recommendations range from “no need […]

Read More

Is there a Place For Breast Reconstruction in Metastatic Breast Cancer?

Is there a Place For Breast Reconstruction in Metastatic Breast Cancer? July 07, 2020 Share on Facebook Twitter Linkedin Author: Dr. Minas Chrysopoulo Can I still have Breast Reconstruction if I have Metastatic Breast Cancer? Traditional medical opinion states that patients with metastatic breast cancer are not candidates for breast reconstruction. Once metastases are diagnosed […]

Read More

post-img
Prev post

Breast Reconstruction After Mastectomy & Lumpectomy - What Are Your Options?

Next post

Tammy's Breast Reconstruction Journey. Part 2 - Finding My Surgeon

post-img
Subscribe Newsletter