Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy, lumpectomy or other trauma. Breast reconstruction often involves several procedures performed in stages and can begin either at the time of mastectomy or delayed until a later date. If only one breast is affected, it alone may be reconstructed. Surgery may be recommended on the opposite breast to improve symmetry.
Breast reconstruction generally falls into two categories: Implant based reconstruction Flap based reconstruction, also known as autologous reconstruction.
After mastectomy, a silicone balloon expander is inserted under the skin and muscle of the chest wall. This is called a tissue expander. You will have two drains for 1-3 weeks after surgery. Once drains are removed, we will gradually fill the expander with saline, causing the skin to stretch. When the expander has reached a desired size, we wait 3 months before returning to the operating room and exchanging the expander for an implant through the same incision used previously. The implant may be silicone or saline.
Drains are removed when the fluid output is less than 20ml in 24 hours for at least 1-2 days. Drains are removed between 1 and 3 weeks after mastectomy. We will not begin tissue expansion until the drains have been removed.
Tissue expansion is performed in the office by inserting a small needle into a port within the expander. The port is found with a small magnet. You may feel sore and achy after tissue expansion.
Autologous or Flap-Based Reconstruction: There are many types of autologous reconstruction and Dr. Talbot will determine if you are a candidate. Autologous reconstruction includes:
Transverse Rectus Abdominus Myocutaneous (TRAM) Flap - In this flap, the abdominal muscle, skin and fat is tunneled up to the chest to reconstruct a breast without disrupting the blood supply.
Deep Inferior Epigastric Perforator (DIEP) Flap - In this flap, the skin and fat is detached from the abdominal blood supply through microsurgery and transferred and reconnected to blood vessels at the mastectomy site.
Latissimus Flap - In this flap, the skin, fat and latissimus muscle in your back is tunneled and transferred to the front of the chest wall mastectomy site.
TRAM Flap Reconstruction: In this reconstruction, the abdominal muscle, fat and skin is tunneled to the mastectomy site to create a breast mound using your native tissue. The abdomen is contoured, excess skin and fat within the abdomen is removed and the belly button is relocated, similar to a tummy tuck or abdominoplasty. This results in a hip-to-hip incision in the abdomen, an incision around the belly button and an incision around the reconstructed breaset. The reconstructed breast looks and feels natural and will increased and decrease in size based on your weight.
There will be two drains in the abdomen (one at each side) and a drain within the reconstructed breast. Drains are removed when the fluid output is less than 20ml in 24 hours for at least 1-2 days. Drains are removed between 1 and 3 weeks after surgery.
DIEP Flap Reconstruction: In this reconstruction, the skin and fat is removed from the abdomen and separated from its blood supply. This is transferred to the mastectomy site and blood vessels are reconnected in the breast site with the abdominal skin and fat, creating a breast mound. The blood vessels are connected through microsurgery and requires close monitoring after surgery. With this reconstruction, no muscle is used and there is no loss of abdominal strength. You have the benefit of an abdominoplasty or "tummy tuck" by using skin and fat in the abdomen and will have incisions around the belly button, going from hip-to-hip and around the reconstructed breast mound.
The microsurgery performed to reattach the blood vessels is complex and surgery is 8-12 hours. After surgery, you will be in the iCU overnight to closely monitor the reconstructed breast's blood supply A special probe will be placed, called Vioptix, to monitor the blood supply. On occasion, if the blood vessels clot, we will return urgently to the operating room to correct this problem. Rarely, this can result in the loss of the reconstruction.
There will be two drains in the abdomen (one at each side) and one in the reconstructed breast. Drains are removed when the fluid output is less than 20ml in 24 hours for at least 1-2 days. Drains are removed between 1 and 3 weeks after surgery.
Latissimus Dorsi Flap Reconstruction: In this reconstruction, skin, fat and the latissimus muscle in your back is tunneled and transferred to the front of the chest wall to create a breast mound using your native tissue. This results in an incision along your back and around the reconstructed breast. The reconstructed breast looks and feels like a normal breast. This reconstruction can be a good option when considering future pregnancies or if prior abdominal surgery has been performed. Often, a small implant is recommended with this reconstruction to attain adequate size of the reconstructed breast.
There will be drains in the back and in the reconstructed breast. Drains are removed when the fluid output is less than 20ml in 24 hours for at least 1-2 days. Drains are removed between 1 and 3 weeks after surgery.