The following Breast Reconstruction questions are asked by real people like you. The answers are provided by board-certified doctors or qualified medical providers who meet our exacting standards.

Breast Reconstruction is a surgical technique to recreate a breast or both breasts after mastectomy or lumpectomy. In another word, women who have surgery as part of their breast cancer treatment are the most candidates for breast reconstruction surgery in order to rebuild the shape and appearance of the breast. In fact, the goal of breast reconstruction is to restore the appearance, shape, and size after lumpectomy or mastectomy.

The breast reconstruction process can start at the time of your mastectomy which is called immediate reconstruction or it can be done after mastectomy which is called delayed reconstruction.

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The vertical lift, which is the most popular in our practice, has a scar around the areola and straight down. This mastopexy works well to not only lift but to narrow the breast. This finesse and exacting technique required to do this lift means you need to find a surgeon experienced in its use. It really is the biggest lift for the amount of scar, or biggest bang for your buck.

Some women simply have too much skin for a vertical lift and must have the Wise pattern or anchor shaped scar. The long horizontal component of this scar is the area most likely to produce a thick highly visible scar, but as in all mastopexies, it is a trade-off. More scar, less excess skin, and resulting better breast shape.

This is another example of when looking at post-operative pictures can help define what is possible with your breast with each lift.

There are different types of breast reconstruction which the procedure differs according to the type you may choose. But usually, the breast reconstruction process requires two or more operations depending on the type of breast reconstruction. So, you can expect several appointments during 2-3 months after your initial surgery in order to expand and stretch the skin on your chest in preparation for the implant.

You shouldn’t expect that breast reconstruction re-create the exact look and feel of your natural breast. However, the contour of your new breast may restore a silhouette similar to the appearance of your own breast before lumpectomy or mastectomy.

In order to get prepared for breast reconstruction surgery, you should follow your surgeon’s instructions before surgery which include guidelines on eating and drinking, adjusting current medications, and quitting smoking.

Before going through breast reconstruction, it is good to ask yourself some questions to make sure you are really ready for this surgery.

    • How much is important to rebuild your breast?
    • Can you live with an artificial breast form?
    • Will breast reconstruction help you to gain your confidence and feel whole again?
    • Do you feel good about having more surgery for breast reconstruction after mastectomy or lumpectomy?

There are two major techniques for breast reconstruction including implant reconstruction and flap reconstruction or Autologous. There is a third option combination of implant and flap reconstruction.

Breast reconstruction with breast implants is a complex surgical procedure which will be performed by a plastic surgeon under local or general anesthesia. In this method, the surgeon will insert an artificial implant inside your breast which is filled with saline (salt water) or silicon gel. The good news is that silicone gel implants are considered as a safe option, so there is no need to be worried about that.

Your plastic surgeon places the implant behind or in front of your chest muscle depending on the surgeon’s diagnosis. The implants that are inserted in front of the muscle will be held in place by using a special tissue called an acellular matrix. Your body will replace this tissue with collagen over time.

    • Breast pain
    • Asymmetry means Breasts don’t match each other in size or appearance
    • Implant rupture or deflation
    • Infection
    • Bleeding
    • Poor healing of incisions
    • Increased risk of future breast surgery to replace or remove the breast implant
    • Changes in breast sensation
    • Scar tissue that forms and compresses the implant and breast tissue into a hard, unnatural shape (capsular contracture)
    • Risks associated with anesthesia

It is very important to know that correcting any of these complications may require additional surgery.

You might not be a good candidate for breast implant reconstruction if you need post-mastectomy radiation or need adjuvant radiation therapy to the skin and chest wall after a mastectomy. This is because breast implant reconstruction makes it more difficult to deliver the radiation therapy effectively and the implant may need to be deflated.

Flap reconstruction, also known as Autologous, is the most complex surgical option that uses tissues transplanted from another part of your body. The tissue usually will be taken from your thigh, belly or back.  Flap reconstruction will be performed by a plastic surgeon under general anesthesia.

The best advantage of flap reconstruction, is that the tissue flaps look more natural and act more like natural breast tissue than breast implants. Tissue flaps will change like any other tissue in your body. For example, unlike implant reconstruction, they may get bigger or smaller as you gain or lose weight. In breast implants, if the implant ruptures, it needs to be replaced, while this is not a concern with tissue flaps.

Depending on the tissue taken from which part of the body, there are different types of flap reconstruction including:

abdomen (TRAM flap, DIEP flap, SIEA flap), Back (latissimus dorsi flap), Buttocks (gluteal flap) and Inner thigh (TUG).

You need to discuss your surgeon about the method is best for you based on your body type and your medical and surgical history.

Abdomen flap is one of the popular methods for flap reconstruction which has different procedures including TRAM flap, DIEP flap, SIEA flap. In all these procedures, your surgeon removes tissue from your abdomen.

In TRAM flap procedure, also called transverse rectus abdominis muscle, the tissue including skin, fat and the muscle will be removed from your abdomen.

In DIEP flap procedure, also called deep inferior epigastric perforator, your surgeon removes only skin and fat from your abdomen exactly from the same area as the TRAM flap and most of the abdominal muscle is left in place and minimal muscle tissue is taken to form the new breast mound.

SIEA flap is a variation of the DIEP flap, also called the superficial inferior epigastric artery flap, uses the same abdominal tissue but relies on blood vessels that aren’t as deep within the abdomen. However, this option is not suitable for all women specifically those SIEA blood vessels are not adequate for this type of flap surgery.

Back flap reconstruction, also known as latissimus dorsi flap, is a pedicle flap technique that takes skin, fat and muscle from your upper back. This method is often used with a breast implant to add volume to breast reconstruction. In this procedure, the fat, skin, muscle and blood vessels will be tunneled under your skin from your upper back to the front of your chest. This option is ideal for small and medium-sized breasts, because the amount of skin and other tissue is generally less.

Buttock flap also known as gluteal flap is another option which takes tissue from your buttocks and transplants it to your chest part. A buttock flap is an option for those women who don’t have enough extra tissue in their backs or abdomens for flap reconstruction. In fact, buttock flap is an option for women who cannot or do not wish to use the tummy part because they are thin, have previous incisions or have had a previous tummy tuck.

Inner thigh also called, the transverse upper gracilis (TUG) flap, is a newer option which uses muscle and fatty tissue from the bottom of the buttocks to the inner thigh.

    • Changes in breast sensation
    • Poor wound healing
    • Extended recovery and healing time
    • Prolonged time in surgery and under anesthesia
    • Fluid collection (seroma)
    • Bleeding
    • Infection
    • Loss of sensation at the tissue donor site
    • Tissue death (necrosis) due to insufficient blood supply
    • Abdominal wall hernia or weakness
    • There are some factors that can affect your decision for choosing
    • Type of mastectomy
    • Cancer treatments
    • Patient’s body type

It is very important to take into consideration the above factors when you choose the technique of breast reconstruction as the best option. You need to talk to your healthcare team about the advantages and disadvantages of breast reconstruction and the best technique that is appropriate and ideal for you.

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