Although in the early days of mastectomy surgery a woman was forced to bear her deformity for the rest of her life, today, there are many wonderful breast reconstruction after mastectomy options that are available to most patients. Recent studies have found that a patient’s satisfaction as she journeys through breast cancer surgery is greatly enhanced when she understands her reconstruction options before her cancer surgery. Another study, unfortunately, has shown that despite this, a large percentage of mastectomy patients in this country are not offered or do not receive good, informative information to help her make appropriate decisions about her cancer care.
After most mastectomies, immediate reconstruction is possible. This means a patient undergoes anesthesia for her mastectomy and has her reconstruction performed at the same time so that when she awakens, she has a new breast or at least the first stage of her reconstruction already completed.
In some cases, plans for other therapies like radiation may lead to selection of delayed reconstruction. This means a patient will have her mastectomy performed with subsequent simple closure of the chest skin. After she has finished other therapies or passes through a period of observation, she can undergo breast reconstruction in a separate surgery.
Breasts can be reconstructed in two principal ways: with the patient’s own tissue borrowed from another area of her body or with an artificial implant.
The most common site for borrowing tissue for this purpose is the abdomen. We commonly perform this using a perforator flap called a DIEP flap. This is different from a TRAM flap, which uses the same tissue but with more destruction of the rectus abdominis muscle. Other flaps can come from the inner thigh (TUG), posterior thigh (PAP), or buttocks (SGAP or IGAP).
When a patient chooses to undergo implant reconstruction, this is usually performed in two steps. In a small subset of patients, the first step can be skipped and final reconstruction achieved with only one surgery. At the first step, a tissue expander is placed below the pectoralis major (chest) muscle with a small amount of saline (IV fluid) inside the implant. A special material called ADM is sometimes used to help maintain an aesthetic position of the implant over time. This implant is then slowly expanded by injection of additional saline over the course of several outpatient office visits. The second step of this process involves an outpatient surgery where the expander is removed and the final breast implant is placed in the expanded pocket.
On some occasions, a tissue flap that involves using the latisimus dorsi muscle, fat, and skin from the back is brought around to the front of the chest with an implant underneath it. Although very common in the past, we no longer use this technique except in special circumstances.
Your surgeon, your experience, your support:
It is very important to us that your experience be as pleasant and informative as it can be. Patients should seek experienced plastic surgeons for their breast reconstructions. We specialize in breast reconstruction and have performed hundreds of reconstructions using both free tissue and implant type surgeries. We try to educate our patients extensively during their initial consultation, and we encourage them to bring a friend to help process the information we share.
Although as your surgeon, we try very hard to be supportive and helpful, still every breast cancer patient needs a support network. Support can come from spouses/partners, parents, children, friends, neighbors, religious leaders, and other breast cancer survivors. Excellent organizations also exist in Austin and throughout the nation to help women along this difficult journey. We are happy to discuss these resources with our patients. No woman should have to walk this road alone.
What You Need To Know About Breast Reconstruction After Mastectomy – Christine Fisher MD