Breast Reconstruction is an operation that is commonly performed to rebuild a breast, which is most often performed on a woman. This type of surgery involves using autologous tissue or a prosthetic material to construct a more natural-looking breast. This often includes the reformation of a natural-looking areola and nipple. This cosmetic surgery procedure involves the use of implants or relocated flaps of the patient’s own tissue.
The type of breast reconstruction that is most suitable for one’s situation will depend on the following:
* The amount of tissue that has already been removed from the breast
* The healthiness of the tissue at the site of the operation
* If you’ve had radiotherapy or not to the area of the breast or chest wall
* Your type of body build and overall general health
* The lifestyle you live and what you desire to happen afterwards
The primary part of this cosmetic procedure can often be carried out immediately following the mastectomy. As with many other cosmetic plastic surgeries, those with significant medical comorbidities (high blood pressure, obese, diabetes) individuals who smoke are often higher-risk candidates. Plastic Surgeons may choose to perform a delayed breast reconstruction surgery in order to decrease this risk. The patients that are expected to receive external beam radiation as part of their adjuvant treatment are typically considered for delayed autologous reconstruction due to significantly higher complication rates with tissue expander-implant techniques in those certain patients.
Breast reconstruction is a pretty large undertaking, and will usually take multiple operations to fully complete. Sometimes these follow-up surgeries are spread out over a span of weeks or months, which is determined on a case by case scenario. If a breast implant is used, the individual runs the same risks and complications as those who use them for breast augmentation but will have higher rates of capsular contracture (tightening or hardening of the scar tissue around the implant) and revisional surgeries.
There are a variety of breast reconstruction procedures, but the two most common are:
1. Tissue Expander – Breast implants. This is the most common technique used by cosmetic plastic surgeons worldwide. The trusted surgeon inserts a tissue expander, a temporary silastic implant, beneath the pectoralis major muscle of the chest wall and periodically, over weeks or months, injects a saline solution to slowly expand the overlaying tissue. Once the expander has reached an acceptable size for the patient, it may be removed and replaced with a more permanent breast implant. Reconstruction of the areola and nipple are performed in a separate operation after the skin has stretched to its final size.
2. Flap reconstruction is the second most common breast reconstruction procedure, which uses tissue from other parts of the patient’s own body, such as the back, buttocks, thigh, or abdomen. This procedure may be performed by leaving the donor tissue connected to the original site in order to retain its blood supply (the vessels are tunneled beneath the skin surface to the new site) or it may be cut off and new blood supply may then be connected to it.
* The latissimus dorsi muscle flap is the donor tissue available on the back. It is a large flat muscle, which can be used without a significant loss of function for the person. It can be moved into the breast defect still attached to its blood supply under the person’s arm pit (axilla). A latissimus flap is most often used to recruit soft-tissue coverage over an underlying implant. Enough volume can be recruited occasionally to reconstruct small breasts without an implant.
* The abdominal flap for breast reconstruction is the TRAM flap or its technically distinct variants the DIEP/SIEP flaps. Both the use of the abdominal tissue between the umbilicus and the pubis. The DIEP and free-TRAM flaps require an advanced microsurgical technique and are less common as a result of this. Both of these can provide enough tissue to reconstruct large breasts. The contour of the lower abdomen is reliably improved by using these procedures, which remove the same tissue as an Abdominoplasty (tummy tuck.) TRAM flap procedures may weaken the abdominal muscles, but are usually tolerated by most patients. To prevent muscle weakness and incisional hernias, the portion of the abdominal wall exposed by reflection of the rectus abdominis muscle can be strengthened by a piece of surgical mesh placed over the defect and sutured in place. The DIEP (deep inferior epigastric perforator flap) and SIEP (superficial inferior epigastric perforator flap) require precise dissection of small perforating vessels through the rectus muscle, and purport the advantage of less weakening of the abdominal wall.
Recovery from implant-based breast reconstruction is generally faster than with flap-based breast reconstructions, but both may take at least three to six weeks to recover from and both require follow-up surgeries in order to construct a new areola and nipple. All recipients of these cosmetic operations should refrain from strenuous sports, overhead lifting and sexual activity during the recovery period, which typically runs three to six weeks. TRAM flap patients can show abdominal muscle weakness on EMG studies, but clinically most of the patients can return to normal activities after recovery.
If you are considering a breast reconstruction, we suggest you click on one or more of the links below to connect with a qualified cosmetic plastic surgeon about your situation in more detail…
