Breast cancer is one of the most common reasons causing women to undergo tumor resection by lumpectomy (removal of tumor) or mastectomy (removal of breast). Women will have one or both breasts removed. If you are considering a mastectomy or have previously undergone a mastectomy, it is helpful to talk to a Plastic Surgeon to determine your reconstructive options. Often times the first stage of reconstruction can be performed at the same time as the mastectomy procedure, or may need to be delayed depending on whether radiation is needed right away or not. Dr. Brown will work closely with the team of doctors made up by your surgical oncologist, medical oncologist, and radiation oncologist to help plan the type of reconstruction that is best for you. Reconstruction typically restores a sense of wholeness and helps patients continue with their lives. It will not restore you breasts to their original look or feel, but will leave you with an illusion of a breast mound.
However, breast reconstruction is not for everyone. It requires more than one operation that may take up to a year to complete. Some women choose not to undergo reconstruction and are very comfortable with their decision. For those women who prefer restoration of the breasts, several good techniques are currently available. There are a variety of operations that may be performed that can be divided into two main categories: procedures that borrow your own tissue from one part of the body, or strictly implant based reconstruction with saline or silicone implants.
How do I know what procedure is right for me? - At your initial consultation, Dr. Brown will discuss all the options with you. This will be a lengthy discussion lasting 30-60 minutes. It is our goal that no one leaves after a breast reconstruction consultation with doubts or unanswered questions. The procedure that you choose will be based on your desires and goals, lifestyle, overall health, body type, and what the oncologic team feels is the safest course of action for you.
Surgery & Incisions
If you have an implant based reconstruction we will use the same mastectomy incisions made by your surgical oncologist to remove the breast whether it is at the same time as your mastectomy (immediate reconstruction), or weeks, months, to years later (delayed reconstruction). If we use your own tissues for reconstruction you will have additional scars that Dr. Brown will discuss with you at your consultation.
What does an implant/expander reconstruction involve? - An implant/expander reconstruction can be performed after a mastectomy. This technique is usually a two-step process. The first stage involves placing a tissue expander underneath the pectoralis (chest) muscle. The expander is gradually inflated like a balloon by filling it with saline. This is done weekly in the office starting several weeks after all wounds have had time to heal. Once the skin has been adequately expanded over 6-8 weeks, a second surgery is planned. The second stage involves removal of the expander and replacement it with a permanent implant (saline or silicone). It is important to know if you will be having radiation this second stage will not be performed for a minimum of 6 months after the end of radiation is completed. This is because your skin needs time to recover from the damage that radiation causes to the blood supply and the elasticity of your skin.
Breast Reconstructive Options
What does using my own tissue involve? - If you choose to use your own tissue there are two main regions of the body that offer excellent reconstructive options, the abdomen and the back tissue. These two flaps are called the Latissimus Dorsi muscle flap and the Trans-Rectus Abdominus muscle flap (TRAM). There are many variations to the TRAM flap that Dr. Brown will discuss with you.
Latissimus Dorsi Muscle Flap: The Latissimus Dorsi muscle flap procedure borrows skin and muscle from the back, and leaves a scar where the skin was removed. Every attempt is made to hide the scar within the bra line. Sometimes the Latissimus Dorsi muscle flap can be combined with an implant if necessary.
TRAM (Trans-rectus abdominus muscle) flaps: The TRAM flap is created from lower abdominal tissue and muscle similar to a tummy tuck procedure. It is usually obtained from the skin and fat which would normally be discarded in a conventional "tummy tuck". However, the muscle is used to give this tissue blood supply that it needs to survive and will be used in the reconstruction. In this manner the TRAM flap can be delivered to the chest wall while still attached to one of the abdominal wall muscles. These muscles allow blood flow into the tissue so it remains healthy and alive.
How long does the surgery take? - The length of surgery is highly variable depending on which flap is used and if one or both breasts are being reconstructed. In addition to the time it takes the breast surgeon to perform his or her part, the reconstruction can take anywhere from an additional 1-3 hours (for an implant/expander reconstruction) or to 6 hours for a more complicated reconstruction such as a TRAM flap. Dr. Brown will have a better estimate of the length of the procedure after your initial consultation.