Types of Surgery: Breast Reconstruction

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The Abramson Cancer Center of the University of Pennsylvania
Last Modified: January 22, 2002

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About Breast Reconstruction Surgery

Rena Rowan Breast CenterBreast reconstruction surgery is performed to reshape a woman's breast following mastectomy. Most women have many questions and concerns about reconstruction surgery. This "Helpful Facts" sheet is designed to give you basic information about breast reconstruction surgery. More detailed information can be provided by your doctor or nurse.

Breast reconstruction surgery is performed to reshape a woman's breast following mastectomy. Most women have many questions and concerns about reconstruction surgery. This "Helpful Facts" sheet is designed to give you basic information about breast reconstruction surgery. More detailed information can be provided by your doctor or nurse.

Is breast reconstructive surgery right for me?
Women elect reconstructive surgery for a wide variety of reasons. They include: enhancing body image and self-esteem; improving body posture and balance; increasing comfort in clothing; and eliminating the need to wear a breast prosthesis. Following breast reconstruction women are often more comfortable in bras, bathing suits, and evening ware. They may also be more comfortable performing activities such as swimming and exercising.

Women who elect to not have reconstructive surgery do so for such reasons as a desire to avoid additional surgery, or conflicting medical problems. It is important to get the guidance of your whole medical team - including your medical oncologist, surgical oncologist, radiation oncologist, and counselor - as well as the plastic surgeon, so that you can make the decision that is right for you.

Can reconstruction be done at the same time as a mastectomy?
Breast reconstruction is usually done at the same time as mastectomy. For this reason it is important to meet with a plastic surgeon before the mastectomy is performed. The breast surgeon and plastic surgeon will then coordinate your care. Some advantages of "immediate reconstruction" include:

  • Having a breast immediately after mastectomy
  • Fewer operations
  • Fewer scars
  • Reconstruction can also be done months or years post-mastectomy. Some reasons for delaying reconstructive surgery include:
  • Tumor type and extent of breast cancer
  • Need for additional cancer therapy
  • Personal preference

What will the reconstructed breast look like and how will it feel?
Reconstructive surgery can create an improved breast shape. However it will not produce an exact replica of your breast prior to mastectomy. The reconstructed breast may also be less sensitive to touch. The ultimate result will depend upon the type of breast reconstruction performed and one's natural shape.

What are the different types of breast reconstruction surgery?
There are various approaches to reconstructive surgery. Your plastic surgeon will recommend an approach depending on your preferences, body shape and prior and future treatments.

Type

What is it?

Advantages

Things to Consider

Implant Reconstruction

 

Breast reconstruction with an implant usually occurs as a two-stage process, starting with the placement of a breast tissue expander, which is replaced several months later with a breast implant. 

 

 

Stage 1: Tissue Expansion

To create a breast shaped space for the breast implant, tissue expander is placed under the chest tissue.  The tissue expander is a balloon like device.  It is inserted unfilled and over time saline is injected (weekly or biweekly) in the doctor?s office through a side port until the appropriate size is achieved.  The tissue expander creates a new breast shaped pocket for the breast implant. 

 

Stage 2: Placing the Breast Implant (implant exchange).

The tissue expander is removed and the breast implant is placed in the pocket. 

 

·        Simplest and most convenient form of reconstruction

·        One hour procedure

·        Need to replace implant every 10-15 years

·        Concern about silicone safety

·        Formation of a ?capsule? or layer of scar tissue around the implant

·        Firm breast appearance and no change in size over time

·        One to two days hospital stay

·        Multiple visits to doctors office

 

TRAM Flap

(Transverse Rectus Abdominis Musculocutaneous flap)

 

 

 

Excess abdominal tissue is moved to the chest area by sliding it under the skin.

·        Flattened abdomen (?tummy tuck?)

·        Able to match natural breast size and shape

·        Breast size and shape will change with weight changes

·        Four hour procedure

·        Four to six day hospital stay

·        Four to six week recovery

·        Abdominal scar

·        Weak abdominal muscle

·        Can only be performed once

Latissimus Dorsi Muscle Flap

Muscle from back is moved to chest area. Useful if not a candidate for a Tram Flap, requires skin coverage for an implant or chest wall is taut from radiation therapy.

 

·        Some breast droop

·        Two to four hour surgery

·        Two to three days hospital stay

·        Four to six week recovery

·        Back scar

·        May require implant and/or expander usage for larger breast size

Nipple Areola Reconstruction

 

 

Nipple is formed from skin and fat of reconstructed breast.

Grafting skin from inner thigh to the reconstructed breast forms areola (colored skin around nipple). Tattooing is used to add more color to the areola.

·        Natural look to the reconstructed breast

·        Outpatient procedure

 

·        Inner thigh scar

·        Additional surgery

What is a skin-sparing mastectomy?
A skin-sparing mastectomy is often used with immediate breast reconstruction. An incision is made around the areola and the nipple and areola are removed. The breast tissue is then removed through this opening. The plastic surgeon then replaces the removed breast tissue with an implant or "flap" tissue. This procedure results in fewer scars and saves more of the breast tissue to ensure a more natural-shaped reconstructed breast.

What about my other breast?
If needed, the unaffected breast may be "augmented" (made bigger) or "reduced" (made smaller) to equal the size of the reconstructed breast.

What are the risks of reconstructive surgery?
As with any surgery, there is the risk of bleeding and infection. Poor wound healing can be a significant problem for patients who smoke, have diabetes and/or high blood pressure or have had radiation therapy to the chest wall. Fluid or blood can accumulate near the incision and require drainage following surgery. Numbness can occur due nerve damage with the incision. As with other surgical procedures, there are risks associated with anesthesia which will be discussed with you.



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