What is Breast Reconstruction?
The diagnosis of breast cancer can have a huge impact in both your life and those around you. After undergoing curative mastectomy, there are many changes that occur both physical and emotional. Plastic surgeons are uniquely qualified to return a portion of your femininity back.
The results of breast reconstruction after mastectomy or lumpectomy can achieve a natural appearance. However, the reconstructed breast may never look or feel exactly the same as the natural breast. The goal is to return your sense of the female form.
Most Common Types of Reconstruction
- The most common techniques for breast reconstruction is a staged procedure. There is usually at least 3 surgical procedures needed for completion and timeline is in conjunction with the medical treatment for breast cancer.
- A staged technique for breast reconstruction using tissue expanders followed by placement of permanent breast implants (silicone or saline – for further details see section below).
- The first stage involves the placement of a tissue expander device under the pectoralis muscle of the chest. As the pectoralis muscle may not fully cover the implant, the use of acellular dermal matrix (Alloderm, Stratice, Flex HD, or Dermamatrix). Several weeks after the placement of the expander, sterile saline is then added until the desired size is reached.
- After the expansion is completed, the expander is removed and a breast implant is placed.
- The last stage is the recreation of nipples. And after the healing process tattoo can be performed for a more natural look to the breast.
- A TRAM Flap (Transverse Rectus Abdominus Myocutaneous Flap) is when the abdominal skin, fat and muscle are used to reconstruct the breast.
- Latissumus Dorsi Flap surgery uses the muscle from your back along with skin to recreate some of the contour of the breast. The muscle maybe lacking some of the needed bulk to give a sufficient breast and the use of a tissue expander followed by implant placement would be required.
Implant Types (After Tissue Expansion is Complete)
- Saline-filled breast implants are filled with sterile salt water. They may be prefilled at a predetermined size or filled at the time of surgery to allow for minor modifications in implant size.
- Structured saline-filled breast implants are filled with sterile salt water, but contain a structure inside so they behave as if filled with soft, elastic silicone gel. This structure enables them to hold their shape better than traditional saline implants. Approved by the FDA and Health Canada in 2014, these implants have been available since 2015.
- Silicone gel-filled breast implants are filled with soft, elastic gel and are available in a variety of shapes. All silicone gel breast implants are pre-filled and may require a longer incision for implant placement.
- Cohesive gel silicone gel-filled breast implants, also known as “gummy bear” or “form stable” implants, are filled with a cohesive gel, made of cross-linked molecules of silicone, which makes them a bit thicker and firmer than traditional silicone gel implants. This enables them to hold their shape better. Approved by the FDA for use in the United States in 2012, these implants have been available in much of the world since 1992.