Breast Reconstruction


Who is a Candidate?

  • If you have had a simple mastectomy, total mastectomy or subcutaneous mastectomy and are missing both breast tissue and some skin.
  • If you have had a modified radical mastectomy and are missing breast tissue.
  • Reconstruction with an expander is usually not appropriate for women who have had a radical mastectomy. Consultation will determine whether expansion of some other type of breast reconstruction will be the most favorable in your particular case.

Intended Result

Cosmetic reconstructive surgery of a breast that looks as normal as possible. A good result makes you look normal in clothes or a bra and reasonably normal without clothes.

Procedure Description

  • Step One: In the first operation an expander is placed under the skin and chest muscles. Saline is injected into the expander over a period of weeks or months via a Afill port. The overlying skin expands and grows with continued expansion. When enough skin is present the expansion process is terminated.
  • Step Two: At the second procedure, the expander is removed and a permanent silicone or saline implant is placed.
  • Possible step three: Nipple areolar reconstruction, if desired, can be completed at a later time. It is possible that adjustment of the pocket where the permanent implant is placed may be appropriate at a future date in order to obtain the best possible result.

Recuperation & Healing

  • Initial discomfort is controlled with oral medication.
  • Sutures are usually removed in 7-21 days.
  • Light activities can be resumed as tolerated. Aerobic activities can be started in about 3 weeks following either the 1st or 2nd stage procedure.

Other Options

Enlarging, reducing, or lifting the opposite breast may be appropriate in order to have the reconstructed breast and the normal breast match.

Insurance Guidelines

These operations are reconstructive and are almost always covered by insurance.

Note

The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.

TRAM Flap Reconstruction

Who is a Candidate?

  • If you have loss of breast tissue and skin following mastectomy —one or both sides.
  • If you have loss of breast tissue only following a subcutaneous mastectomy.
  • If you have a desire for larger breasts (uncommon).

Intended Result

Cosmetic reconstructive surgery of a missing breast (s) or replacement of breast tissue.

Procedure Description

  • A flap of lower abdominal wall fat, muscle (and usually skin), is transferred to the area of missing breast tissue with its own blood supply. In a standard TRAM flap, the blood supply is within the rectus muscle(s) which is left attached at the lower edge of the rib cage. In a Free TRAM, the blood vessels are reconnected to vessels in the axilla. In a Turbo charged TRAM, the muscle is left superiorly, but the inferior vessels are connected in the axilla creating a double blood supply.
  • The abdominal donor site is closed as a tummy tuck, leaving a horizontal scar and a tighter abdomen.
  • An attempt is made to create a “normal” breast mound and shape at the first operation, but subsequent smaller procedures are frequently necessary.
  • Nipple/areolar reconstruction is performed at a later date and is elective.

Recuperation & Healing

  • A TRAM flap breast reconstruction is a major procedure performed in the hospital and requiring at least several days of hospitalization.
  • Ambulation will begin the day after surgery and be reasonably comfortable within 10-14 days.
  • Complete recovery usually takes about 6 weeks.
  • Surgery will probably reduce and possibly eliminate, the ability to breast feed.
  • The abdominal donor site causes the most discomfort during healing.

Other Options

Additional procedures that will enhance the result are enlargement, lifting or reduction of the opposite breast and or nipple areolar reconstruction.

Insurance Guidelines

These operations are reconstructive and are almost always covered by insurance.

Note

The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.