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Reconstruction Overview

This section outlines the many options available and information about reconstructing breasts following mastectomy.

Types of reconstruction

Types of reconstruction

Breast reconstruction utilizes implants or your own tissue to replace breast tissue that is removed during mastectomy. There are many different reconstruction methods—learning about your options and comparing the length of surgery, recovery and availability of each will help you make the right decision. It is advisable to consult with a few plastic surgeons, because not all surgeons perform all procedures, and often, they recommend only the techniques they perform.

Most reconstruction involves two or more operations over several months. The initial surgery forms the breast mounds (breasts without nipples). A later shorter revision surgery refines the shape and size of the new breasts and adds nipples. Tattooing around the nipples simulates the areolas and completes the process.  With unilateral reconstruction, the opposite healthy breast may be modified at this time for better symmetry. If you have nipple-sparing mastectomy, you are a candidate for a simpler “one-step” reconstruction with breast implants, which completes the entire reconstruction in a single operation.

Breast reconstruction with implants

Breast implants have an exterior silicone shell and are filled with either saline or silicone gel. About 80% of all breast reconstructions are done with implants, mostly using silicone-filled devices that impart a softness and more natural feel than saline implants. Implants are available in a variety of shapes, sizes and profiles (projection). Your surgeon will select implants that best fit your chest anatomy and your desired size.

Implant reconstruction can be done as a one- or two-step surgical process.

  • Expander-to-implant reconstruction: A temporary tissue expander is placed into a pocket under the chest muscle and gradually inflated over a few weeks—during several quick visits to a plastic surgeon’s office or with a patient-controlled device at home. Expansion stretches the chest skin and muscle until the pocket is large enough to fit the desired implant; a second shorter surgery is then performed to replace the expanders with an implant.
  • Direct-to-implant reconstruction completes reconstruction in a single operation. The implant is placed over or under the chest muscle, secured into place with an acellular dermal matrix (a supportive tissue substitute material made from collagen), eliminating the need for expansion. Not all surgeons perform direct-to-implant reconstruction.

Breast reconstruction with tissue flaps

After mastectomy, your breast tissue can also be replaced with excess fat and skin taken from your tummy, hips, back, buttocks or thighs. Some of these tissue flap techniques also use muscle, but more sophisticated procedures use only fat and skin.

All tissue flaps need a healthy blood supply to survive in the chest. Flaps are categorized by the way the blood supply is harvested:

  • Attached flaps of tissue and muscle are tunneled under the skin from the back or abdomen to the chest.  One end of the blood vessel remains attached at the donor site to provide blood supply to the new breast.
  • Free flaps require microsurgical skills to disconnect the blood supply from the donor site and reattach it to blood vessels in the chest. A small amount of the surrounding muscle, including the blood vessel within, is also removed.
  • Perforator flaps are more sophisticated microsurgical procedures that remove the flap and its blood vessels without removing any of the muscle.

Immediate vs. delayed reconstruction

Reconstruction can be done almost anytime after mastectomy.

“Immediate reconstruction” is performed at the same time as the mastectomy. Breast tissue is removed, but most of the breast skin is preserved and incisions are less visible.
You enter and exit the operating room in the same way: with full breasts.

“Delayed reconstruction” can be performed weeks, months, or even years after mastectomy—treatment may delay reconstruction, or a woman who does not want immediate reconstruction may later change her mind. If you do not have immediate reconstruction, your breast tissue and most of your breast skin will be removed during mastectomy. You’ll have a long incision across your chest. If you have reconstruction later, the scar will be reopened and an expander/implant or tissue flap will be inserted to create a new breast. Very good results can be achieved with delayed reconstruction, but the mastectomy scar, which fades in time, remains on the new breast.

Updated 04/20/2018

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