Breast reconstruction is a surgical procedure commonly performed after a mastectomy to offer patients psychological and aesthetic benefits when recovering from breast cancer. This procedure allows many women to fully return to the life they enjoyed before a breast cancer diagnosis, almost no signs of the disease remaining. Although the treatment of cancer is the main focus for both patient and doctor, restoring your appearance after breast cancer can often help ensure a complete recovery of body and mind.
For many women, breasts are an important symbol of femininity that helps define their self-confidence and body image. The emotional effects of an altered appearance can be as psychologically damaging as the initial cancer diagnosis. Breast reconstruction serves to restore a woman’s body to its original condition after the treatment of breast cancer. There are several different techniques available for breast reconstruction depending on the each patient’s individual condition and their desired results.
The most common breast reconstruction procedures involve implant placement, which may be performed during a single or multi-stage procedure, depending on the amount of skin and tissue left in the breast area after a mastectomy.
Direct to implant breast reconstruction is one of the simplest and most effective techniques available for women after undergoing a mastectomy. This one-step solution places an implant in the treated area immediately after mastectomy surgery without the need for a flap, graft or tissue expander. This allows patients to experience immediate re-creation of the breast mound, and is often considered emotionally beneficial. This procedure is performed similar to a breast augmentation.
Breast reconstruction with tissue expanders is a multi-stage procedure that gradually expands the remaining natural breast tissue to create a pocket for the implant, eliminating the need for a flap or skin graft to cover the implant. During the first procedure, the tissue expander is placed on the chest wall and filled partially with saline. After an initial healing period, the expansion process begins by inserting more and more fluid into the device at regular intervals. Once a sufficient pocket has been created, the implant is inserted and the expander removed.
The transverse rectus abdominus myocutaneous (TRAM) flap is the most commonly performed reconstructive flap used to recreate the breast mound or enhance the appearance and feel of breasts that were reconstructed using implants. During the TRAM flap reconstructive procedure, an incision will be made in the abdomen to lift layers of skin, fat, muscle and blood vessels. These tissues may then be cut from the body and then reattached with microsurgery to create a free flap, or and a tunnel is created under the skin to relocate the targeted tissue to the breast area for a pedicle flap. The breast mound is then carefully reshaped with these tissues.
Breast reconstruction with a TRAM flap often takes four to five hours to perform and requires a hospital stay of three to five days. Patients will likely experience abdominal pain and tightness for several weeks, and it may take a few months to return to full activity. Regardless of the lengthy recovery, TRAM flap breast reconstruction is able to produce a breast that looks and feels natural, as well as the added benefits of a flatter abdomen from the tummy tuck procedure.
Composed of soft tissue, the latissimus dorsi (LD) flap often enhances an implant reconstruction to produce breasts that look and feel more natural. During an LD flap reconstruction, a muscle flap (and attached skin, if needed) is taken from the back and moved through a tunnel to the front of the chest. The LD flap receives its blood supply from the thoracodorsal artery, which remains attached after surgery to ensure proper blood flow to the flap. LD flap breast reconstruction usually takes two to three hours to perform, and patients will need to stay in the hospital for one to three days.
Since this procedure requires two different surgical sites, recovery is longer than other reconstructive procedures. Patients will likely need to rest at home for three to six weeks in order to allow the treated areas to heal. For women with small breasts, the LD flap can sometimes be used as the sole means of reconstruction with no need for an implant.
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Coco (6’1” 280 lbs) is a MTF transgender patient. 800 cc silicone gummy implants with areolar tightening to further transition.
Maricruz (4’11” 120 lbs) is a small-framed woman who recently had breast augmentation using 600 cc silicone implants by another surgeon and presented to me about 3 weeks post-op with exposed left breast implant. She will be undergoing breast implant exchange to smaller implants that are more appropriate for her body size.
Sheri (5’5” 138 lbs) had saline breast implants in place for about 25 years with capsular contracture on Right side and will be undergoing Breast Implant exchange with Removal of old saline implants, correction of capsular contracture on Right, and placement of new 400 cc silicone gummy implants.
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