Breast reconstruction is a surgical procedure commonly performed after a mastectomy to offer patients psychological and aesthetic benefits when recovering from breast cancer. This procedure allows many women to fully return to the life they enjoyed before being diagnosed with breast cancer, with barely any signs of the disease remaining.
The most commonly performed breast reconstruction procedure is done with implant placement, which uses a saline-filled implant to replace lost breast tissue and restore the appearance of the breasts.
Tissue Expander Procedure
Breast reconstruction with tissue expanders is a multi-stage procedure that gradually expands the remaining natural breast tissue to create a pocket for the implant, eliminating the need for a flap or skin graft to cover the implant. During the first procedure, the tissue expander is placed on the chest wall and filled partially with saline. After an initial healing period, the expansion process begins by inserting more fluid into the device at regular intervals. After expansion, patients may experience discomfort for up to 24 hours, which can be managed with over-the-counter medications.
Once the expansion process is complete, the implant is placed during a second procedure. The tissue expander is removed and replaced with a breast implant. The entire process usually takes four to six months to complete.
TRAM and Latissimus Dorsi Flaps
After tissue expanders, muscle flaps are the next most common form of reconstruction. This method takes muscles, usually from the abdomen (TRAM) or back (Latissimus), to recreate a breast. During the transverse rectus abdominis myocutaneous (TRAM) flap reconstructive procedure, an incision will be made in the abdomen to lift layers of skin, fat, muscle and blood vessels. These tissues may then be cut from the body and reattached to create a flap or a tunnel is created under the skin to relocate the tissue to the breast area. The breast mound is then carefully reshaped with these tissues.
Breast reconstruction with a TRAM flap often takes four to five hours to perform and requires a hospital stay of three to five days. Patients will likely experience abdominal pain and tightness for several weeks, and it may take a few months to return to full activity. However, TRAM flap breast reconstruction is able to produce a breast that looks and feels natural, and provides the added benefit of a flatter abdomen from the tummy tuck procedure.
The latissimus dorsi (LD) flap has been used successfully since the 1970s. Composed of soft tissue, this type of flap often enhances an implant reconstruction to produce breasts that look and feel more natural. During an LD flap reconstruction, a muscle flap is taken from the back and moved through a tunnel to the front of the chest. The LD flap receives its blood supply from the thoracodorsal artery, which remains attached after surgery to ensure proper blood flow. The procedure usually takes two to three hours to perform, and patients remain in the hospital for one to three days.
Since this procedure requires two different surgical sites, recovery is longer than other reconstructive surgeries. There will be scarring in the breast area and back, although the back incision can be made horizontally and then efficiently concealed with a bra strap. Patients will likely need to rest at home for three to six weeks. It is especially important to avoid heavy lifting and strenuous activity during the healing process.
Oncoplastic Lumpectomy Reconstruction
If a patient requires a large lumpectomy that will significantly alter the shape of the breast, a reconstruction procedure will be recommended. The surgeon will treat the procedure somewhat like a breast reduction or breast lift, in that he or she will be removing tissue and maintaining proportion in both breasts. Once the malignancy has been removed, the breast is reshaped and the nipple aligned, the surgeon will move on to the other breast to remove a similar quantity of tissue and shape it symmetrically. Lumpectomy reconstruction allows a patient to obtain all necessary breast work in one procedure with a typical total recovery time of six weeks.
Lumpectomy/Partial Mastectomy vs. Mastectomy
Also called a wide excision biopsy, a breast-conserving lumpectomy extracts an entire cancerous lump from the breast along with a thin margin of healthy tissue surrounding it. This ensures that all traces of malignant tissue are removed. Lumpectomy is typically recommended in place of mastectomy for women whose cancers are small and/or localized. Lumpectomy leaves more healthy tissue intact for less invasive reconstructive needs.
Radiation therapy is usually administered after surgery to ensure complete removal. Since natural tissue remains in the breast after this procedure, patients remain at risk for recurrence and should continue to be screened on a regular basis for breast cancer.