Breast reconstructive surgeon, Dr. Michele Manahan.
In the past ten years, major achievements have been made in breast reconstruction following mastectomy surgery. No longer do women need to face long, jagged scars that impact their self image. Instead, advanced techniques have given plastic surgeons the tools to rebuild a woman’s breast in such a way that her silhouette is once again whole.
Women with breast cancer have two main considerations when considering reconstructive breast surgery—when to have surgery and what type of surgery to have. All of the options below are available to patients who are good candidates and healthy enough for surgery.
Compare the advantages and disadvantages of each option.
When to Have Reconstructive Breast Surgery
Your breast surgeon and the breast plastic and reconstructive surgeon will help you decide which option is best for you:
- Simultaneous breast reconstruction – Women have the option to have immediate reconstruction of their breast(s) at the same time as their mastectomy. This is a reasonable option for patients who do not need breast irradiation.
- Staged breast reconstruction – Many women who require radiation therapy are advised to have staged breast reconstruction instead of simultaneous reconstruction. If radiation is done on a newly reconstructed breast, over time it can alter its cosmetic appearance, making an implant hard, painful, deformed, contracted or even exposed. It may also cause severe fibrosis or shrinkage of the fatty tissue that may have been used in rebuilding the breast.
A tissue expander will be inserted after mastectomy to keep the breast skin that was saved during the skin sparing mastectomy procedure stretched and supple in preparation for the final reconstruction, which will be done several months after radiation is completed.
- Delayed breast reconstruction – A woman may opt for delayed reconstruction if a plastic surgeon was not involved after her mastectomy. Many women did not know their breast reconstruction options at the time of mastectomy. More and more they’re discovering that surgically recreating their breasts is possible and is required to be covered by insurance as a result of a federal law passed in 1998.
Delayed Breast Reconstruction Surgery
Delayed breast reconstruction is an option if a plastic surgeon was not involved at the time of a mastectomy. This animated procedure illustrates the process.
Types of Breast Reconstruction
A woman’s breast can be reconstructed in one of two ways:
- Implants – Implants are made out of silicone or saline or a combination of both, and can be inserted during or after a mastectomy. They are placed underneath the chest muscle versus on top of it, as in the case of breast augmentation.
- Flaps – Flap procedures are done by plastic and reconstructive surgeons who specialize in microsurgery. During flap reconstruction, a breast is created using tissue taken from other parts of the body, such as the abdomen, back, or buttocks, or thighs, which is then transplanted to the chest by reconnecting the blood vessels to new ones in the chest region. Due to the high level of skill required for microsurgery, as well as the equipment and staff needed, these techniques are available only at specialized centers
Most breast centers are still performing flap surgery the "old fashioned" way if they do not have surgeons with these skills. These older procedures (TRAM Flaps and latissimus dorsi flaps) result in the patient sacrificing either her abdominal muscles or her upper back muscles. While those procedures were the best options decades ago, today we know that there is a higher risk of hernia, weakness, abdominal bulging, and limits on physical activity with these older procedures. There are no physical limitations with the more sophisticated procedures performed at our Breast Center.
Experience is Critical for the Best Cosmetic Results
Our plastic and reconstructive surgeons perform the most complex breast reconstruction surgeries and more types of procedures than most breast centers in the region and in some cases, the country.
We perform a high volume of these surgeries and are constantly finding ways to make them even better. Many of our breast plastic and reconstructive surgeons have pioneered or contributed to new, advanced techniques for mastectomy surgery and breast reconstructions. These microvascular reconstructive surgeries allow our surgeons to manage compromised breast tissue that may have been injured by radiation. Preserving as much of the natural look and feel of a woman’s breasts as possible is also of great concern to our surgeons.
Using Fat Grafting for Breast Reconstruction
In addition, we try to give women the look and feel of an actual breast, using creative techniques such as fat grafting, also known as lipofilling or fat transfer. Fat can be taken from another part of your body, possibly the abdomen or somewhere on your buttocks, through liposuction. The fat will be purified and carefully layered within the new breast to create the desired shape. Our surgeons are experienced at these techniques.
State of the Art Surgical Techniques for Better Breast Sensation
Our reconstructive surgeons are using innovative techniques that give patients the best and most natural results. One such technique is the nerve regeneration procedure that enables tissue transplanted from the abdomen to have sensation when sculpted into her newly created breast.
Paying for Reconstruction
Federal and state laws require insurance companies to pay for all or part of the cost of breast reconstruction at any time after removal a patient’s breast tissue. This includes any surgery required on the opposite breast for symmetry. Our staff is experienced in working with all major insurers for these procedures. We will work with you to keep your out-of-pocket expenses to an absolute minimum.
Learn About Reconstructive Breast Surgeries
- Pre-operative blood vessel mapping
- Tissue expanders (staged reconstruction)
- Deep inferior epigastric artery perforator (DIEP) flap
- Superior gluteal artery perforator (SGAP) flap
- Lateral septal gluteal artery perforator (LSGAP) flap
- Superficial inferior epigastric artery (SIEA) flap
- Transverse upper glacilis (TUG) flap
- Transverse rectus abdominis myocutaneous (TRAM) flap
- Oncoplastic surgery