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Bst Recon Album
What is Covered
Devices
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Options In Breast
Reconstruction
| Decisions and choices |
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There are many decisions and many choices involved in the process of
breast reconstruction, but the first and most important is: Is reconstruction right
for you? |
| What is a Mastectomy? |
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When cancer is discovered in a women's breast, the most common form of
treatment is a mastectomy. A mastectomy is the removal of breast tissue due to the
presence of a cancerous or pre-cancerous growth. The amount of tissue removed during
a mastectomy procedure varies. Three of the most common mastectomy procedures are: modified
radical mastectomy, which entails removing the breast, its tissues, the nipple-areola
and the lymph nodes found in the arm pit. This procedure leaves the pectoralis
major, the large muscle located on the chest wall intact. The simple mastectomy
involves the removal of only the breast tissue, and sometimes the lymph nodes. A lumpectomy
is the most conservative surgical procedure. It calls for the removal of only the
tumor itself and the localized swelling, preserving the majority of the breast and its
tissues. Some general surgeons may offer a very conservative procedure when your
Plastic Surgeon is there for immediate reconstruction. In the proper setting a
patient may have a mastectomy through a nipple incision and reconstruction with the use of
a TRAM flap and have only the scar around the nipple. |
| Choosing Reconstruction |
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Today, most women who have mastectomies are good candidates for breast
reconstruction. Following a mastectomy, some women feel a lack of wholeness or a
loss of femininity that breast reconstruction may restore, and some simply don't like the
hassle or worry associated with wearing an external prosthesis. Whatever the reason
for reconstruction, every woman's decision is different and must ultimately be made by
her, based on her needs, desires and expectations. The breast reconstruction
procedure that is best for you will vary depending on the results you desire, your
particular situation, and other physical and mental determinations. Whatever
procedure is decided upon, it's important that you take part in making the necessary
decisions. |
| Reconstruction Options |
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Your first decision regarding reconstruction is whether to have immediate
reconstruction, which is performed at the time of the mastectomy, or delayed
reconstruction, performed weeks, months or years after a mastectomy. The next
important choice is selecting the type of reconstructive procedure you will undergo.
Reconstruction can be performed using a variety of methods: it can be done by
using a women's own body tissue, using medical implants, or by using a combination of the
two methods. |
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Flap Reconstruction
BEFORE
AFTER
Flap reconstruction is a method of reconstruction that uses a women's own tissue from
her back, abdomen or buttocks to create a breast mound. The tissue to be relocated
is called a flap. The flap, depending on where it is taken from, is either tunneled
to the breast area under the skin, allowing it to remain attached to its original location
and retain its blood supply, or it is surgically removed and transferred to the breast
area (free flap transfer technique).
Flap reconstruction is most commonly performed using one of three methods: The
Latissimus Dorsi Flap, in which skin tissue and Latissimus Dorsi muscle are taken form the
back and tunneled below the skin to the breast area to create a breast mound. The
TRAM Flap uses skin tissue and the rectus muscle which is taken from the abdomen and
tunneled to the breast area. The Buttocks Flap method removes skin and tissue from
the buttocks or thigh area and transfers it to the breast area. This method requires
microsurgery to re-attach blood vessels, creating a blood supply for the newly formed
breast mound.
A breast implant can be used in conjunction with any of these techniques if the
transferred tissue does not provide enough mass or produce the desired results.
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Tissue Expansion
BEFORE
AFTER
Another method of breast reconstruction involves the use of a tissue expander and a
breast implant. A tissue expander is a short-term implant that is surgically placed
under the skin and the muscle of the chest and gradually inflated with saline, over a
number of weeks or months, to gently stretch the skin. Once the skin is sufficiently
stretched, another surgery is performed to remove the expander and replace it with a
breast implant.
This secondary surgery for the expander-breast implant exchange can be avoided by using
an implant that can be postoperatively adjusted or a combination type expander/mammary
implant. The fluid volume of postoperatively-adjustable implants can be adjusted
after surgery in a simple office procedure to the desired size. The expander/
mammary implant is both a tissue expander and a breast implant. Its volume can also
be adjusted postoperatively. |
Other Options
Depending upon the type of mastectomy performed, sometimes a breast implant can be
placed without flap reconstruction or the use of a tissue expander. This is possible
only in cases where adequate tissue is left intact and the implant to be placed is
relatively small.
In the case of surgery to a single breast, women with a ptotic or sagging breasts may
choose to have a Mastopexy, or breast lift of the opposite breast. This will help to
achieve symmetry with the reconstructed breast. Small or large-breasted women may
elect to have the opposite breast enlarged or reduced.
Nipple-Areola Reconstruction
Nipple areola reconstruction is part of most breast reconstruction
cases. Once the tissue has settled, we will return to the operating
room to complete the reconstruction with the use of a flap and possible skin
graft. A tattoo may be necessary to match the pigmentation of the
other nipple.
Any reconstructive process will require multiple procedures. Because each patient
and procedure is different, the actual number of surgeries and recovery time will vary.
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