There are many ways a breast can be reconstructed, and the choice is best made with careful consideration regarding your lifestyle and what your expectations are. There is also the choice to not reconstruct, and many women choose this as well. The following is a brief overview of reconstructive surgery.
For more detailed information please visit the following websites that answer all your questions breastreconstructionmatters.com and breastreconstruction.org.
Should you choose NOT to reconstruct, another breast cancer survivor has started a site for women who opt out of reconstruction. She covers everything you need to know. Please visit breastfree.org for more options and choices available for you.
An implant is a two-step procedure. First a tissue expander is inserted followed by the implant at a later date. An implant requires the tissue expander to create a pocket for the implant to be placed. It is placed behind the pectoral muscle. It is an empty sac that has a metal port connected to it. After your initial healing you will visit your doctor’s office for “fills”. The doctor or nurse accesses that port by locating it with a magnet. When they have found the access point they fill the expander with saline solution in small increments stretching the skin. There is some discomfort in this procedure, there will be a feeling of tightness in the chest area. But over the counter pain relievers are all that is usually required.
When the plastic surgeon is satisfied with the amount of room he now has under the skin and muscle you will then go in for your “exchange” surgery. This means, exchanging the temporary expander with your permanent implant. You will have to decide on Saline Implants or Silicone Implants. Silicone implants are back on the market again. The FDA reversed their decision to remove them because they did exhaustive studies and found that there are no health risks to a woman, other than scarring, that are caused by silicone. The scarring can also occur with saline implants as well. It is a surgical risk one must take into consideration when deciding on what reconstructive option is best for you.
There is a new product called AlloDerm. This is made from donor tissue that has been stripped of all its DNA. When implanted under the breast pocket it heals as part of a woman’s own tissue, taking on her DNA. It strengthens the skin making it possible for even previously radiated skin able to support an implant. Not all doctors are up to date on its uses, but as its success stories grow, more and more reconstructive surgeons will learn how to use AlloDerm, and as a result, more women will have more options in breast reconstruction.
(Transverse Rectus Abdominis Myocutaeous)
This is popular because you get an instant tummy tuck with it. The results are very natural looking and feeling breasts. Abdominal muscle, excess tissue, and a main blood vessel are slid up your torso, over your rib cage, and put in place of your breast on your chest wall. You will have two surgical sites when you are through and both need time to heal. You must be aware that you will be on the operating table for a very long time. All these factors and your current state of health should be considered.
(Deep Inferior Epigastric Perforator)
There is another procedure that actually takes even longer to perform than the Tram Flap and it is known as the DIEP (Deep Inferior Epigastric Perforator) procedure . Only a board certified reconstructive surgeon, who is experienced in micro vascular surgery, should perform this. For in this procedure, also known as the “Free TRAM”, “Free Flap”, etc., the fat and micro vascular tissue are removed from the abdomen, leaving the rectus muscle in place. The surgeon then attaches the tissue to the area where the breast was removed and reconnects each blood vessel.
When factoring in all the details of what you are willing to undergo, one of the most important decisions is the physician who will perform it. He should have done several hundred. Ask to see photographs and if possible ask for patient recommendations. AND ask for his success and failure rate of transplanted tissue.
The TRAM cannot be performed if you do not have enough of a belly to work with. Meaning, if you are thin in your abdomen and store your fat in your butt, the TRAM isn’t for you, but the GLUTEAL would be.
Gluteal flap procedure is a DIEP, or Free Flap procedure where your excess skin and muscle from your buttocks are used to make the breast. The cut is made just below the bikini line on the buttocks and the skin is removed. After you have healed, a ‘revision’ is done where the surgeon goes back to the area and lifts it, creating a new and better looking butt. Putting cosmetics aside, this is micro vascular surgery, for the safety of your health as well as the overall cosmetic outcome of the procedure, you need only the best and most experienced doctors performing it.
TUG (Transverse Upper Gracilis)
The TUG is a fairly new procedure with remarkable results. The flap is taken from the upper thigh with part or all of the gracilis muscle. This muscle provides a more natural contour when the breast is created. As a bonus, the patient gets a thigh lift as part of this surgery. This surgery is ideal for women who do not have enough abdominal fat to create a breast/breasts, or if they do not want to lose abdominal muscle. By contrast, the loss of the gracilis muscle is not missed as the abdominal muscles are.
The LAT Flap
(Latissimus dorsi flap)
This option takes the muscle and excess skin from your upper back just around the bend of your shoulder blade and it is tunneled around your torso under your arm and into place. There is no need to remove any blood vessels because of the proximity of the area used, so they are just shifted along with the rest of the tissue and muscle. This procedure probably has the highest success rate of all the “flaps” because there is less to reconnect.
Note: Even though these procedures create new breasts, it is often necessary to also require an implant to fill the area out.
(As mentioned above, please see breastfree.org)
There are several types of prosthesis you can get. First, after your surgery, your skin will be tender. You will need to get a post-surgical prosthesis. Then you can be fitted for a permanent one. There are all styles and types from silicone to fiberfill. Find a good mastectomy boutique where they can help you with each decision. The nurses in your breast surgeon’s office will be able to recommend a good one to you.
They even have special prosthesis made for swimming. So if you like to swim, you don’t have to give that up, and you don’t have to ruin your good prosthesis with chlorine from a pool.
REMEMBER: THEY ARE COVERED UNDER INSURANCE