Breast Reconstruction

What Is Breast Reconstruction?

The goal of breast reconstruction is to recreate the shape and form of the breast after mastectomy.  This may be accomplished using a breast implant or natural tissues like ‘tissue flaps”—fat and/or muscle taken from another part of the body.  Breast reconstruction is performed by a plastic surgeon. Dr. Holmes works with experienced plastic surgeons to plan the most suitable type of breast reconstruction for each woman. In most cases, breast reconstruction can be started at the time of the mastectomy. This is known as an “immediate reconstruction”. In some cases, the characteristics of the breast cancer require delaying breast reconstruction to a later date, an approach known as “delayed reconstruction.”

The appropriate type and timing of reconstruction are an individual decision, based on the patient’s body size, the amount of preserved breast skin, overall physical health, cancer stage, and desired breast size. Since mastectomy removes most of the nerves of the breast, the skin of the reconstructed breast generally has little or no sensation.

What is tissue flap reconstruction?

Tissue flap reconstruction uses muscle and/or fat from the tummy, back, buttock or thighs to create a natural-looking and naturally feeling breast. The most common tissue flap reconstructions are:

• DIEP (deep inferior epigastric perforator) Flap uses skin, fat, and blood vessels from the abdomen, but no muscle is removed.
• TRAM (transverse rectus abdominis) Flap uses skin and fat from the tummy, but muscle is used.
• LAT (latissimus dorsi muscle) Flap uses skin, fat, and muscle from the back, and this procedure is usually combined with an implant.

What is implant reconstruction?

Saline and silicone implant reconstruction are widely used today for women who do not desire tissue flap reconstruction or do not have enough spare tissue for tissue flap reconstruction.  Depending on personal circumstances and preference, the implant may be placed on top of the pectoralis major chest muscle (called “pre-pectoral”) or underneath the pectoralis major muscle (called “sub-pectoral”).  In either case, the plastic surgeon might first insert a temporary, empty implant called a “tissue expander” that is injected or filled with saline over several weeks until the tissues have been adequately expanded to accommodate a full-size implant.  A tissue expander might also be inserted when radiation is planned after mastectomy or as a temporary means of supporting the skin when a delayed tissue flap reconstruction is planned.

If you have breast cancer in one breast, should you undergo preventive (prophylactic) removal of the opposite (contralateral) breast? 

The need for prophylactic mastectomy is greatest is women diagnosed with a hereditary breast cancer mutation, such as BRCA1 and BRCA2, due to a high lifetime risk of cancer in both breasts. Women with breast cancer may choose prophylactic mastectomy of the opposite, unaffected breast to maintain breast symmetry, to eliminate the need for annual mammograms, and to reduce anxiety about the future risk of cancer.  However, contrary to popular belief, the risk of cancer in the opposite breast of non-mutation is generally relatively low--less than 15% over the next 20 years.  You can calculate your personal risk of contralateral breast cancer (CBC) by visiting the following link: https://cbc-predictor-utd.shinyapps.io/CBCRisk. Contralateral mastectomy is usually covered by insurance.

For more information about breast cancer surgery, including breast reconstruction, visit Dr. Holmes’s YouTube Channel here.