The goal of breast reconstruction is to restore the shape, appearance, symmetry, and size of one or both breasts after cancer removal. Types of cancer removal include mastectomy (surgery to remove breast tissue from one or both breasts) and lumpectomy (surgery to remove cancer from the breast that leaves most of the breast skin and tissue untouched).
If only one breast is affected, reconstruction may involve only that breast. However, a breast lift, breast reduction, or breast augmentation may be necessary for the opposite breast to improve symmetry of both breasts. Symmetry includes size, shape, and position of the breasts.
Breast reconstruction often involves multiple procedures performed over time. Reconstruction can be done (or started) at the time of the mastectomy. This is called immediate reconstruction. Reconstruction can also be done after the mastectomy incisions have healed and breast cancer therapy is completed. This is called delayed reconstruction and can happen months or years after the mastectomy.
Types of Reconstruction
There are three types of breast reconstruction: implant-based reconstruction, flap reconstruction, and oncoplasty. Implant-based reconstruction uses implants to form a new breast mound. Flap reconstruction uses the patient’s own tissue from another part of the body to create a new breast. Flap reconstruction is also called autologous reconstruction.
- Tissue Expander. During surgery, an elastic silicone rubber tissue expander is placed under the skin of the chest. Over four to six months, the expander is filled with sterile saline during appointments with your surgeon. As the expander fills, the overlying tissues expand. When the expander is filled, it will be removed and replaced with a breast implant.
- TRAM Flap. A transverse rectus abdominis myocutaneous (TRAM) flap uses tissue and muscle from the abdomen to reconstruct the breast.
- DIEP Flap. A deep inferior epigastric perforator (DEIP) flap is similar to the TRAM reconstruction, but the DIEP flap doesn’t use muscle.
- Latissimus Flap. This reconstruction uses muscle and tissue from the upper back. An implant may also be used to ensure that the reconstructed breast is symmetrical.
- Other Types of Flap Reconstruction. Like a Latissimus Flap reconstruction, other types of flap surgery use tissue from other parts of the body. This may be from the abdomen, upper hip, or buttocks (instead of the upper back). The reconstructed breast can be made from the tissue alone or an implant.
A newer reconstruction technique is oncoplasty, which combines plastic surgery and surgical oncology. Both can be completed during the same surgery. When surgical oncology is required to remove cancer that will change the shape of the breast, the remaining tissue is sculpted to restore the breast. The opposite breast will be modified to preserve symmetry.
There are many benefits to oncoplasty. It allows for a larger amount of tissue to be removed and for breast symmetry to be retained. Oncoplasty requires only one surgery instead of separate oncology and reconstruction procedures.
Finding a Surgeon
If one of these reconstruction methods is right for you, you’ll need to find an experienced, board-certified plastic surgeon. These surgeons have taken an extra step beyond their required education and training to seek out board certification.
Questions for Your Surgeon
Once you’ve selected a surgeon, it’s important to prepare for your consultation. An important part of the consultation is asking questions. Here is a list of questions to help start the conversation with your surgeon.
- How many years of plastic surgery training have you had?
- Am I a good candidate for reconstruction?
- Which type of reconstruction do you recommend?
- What are the risks and benefits of each kind of reconstruction?
- If my reconstruction requires a breast implant, how long will it last?
- What type of implant do you recommend?
- What will be expected of me to get the best results?
- How long of a recovery period can I expect? What kind of help will I need during my recovery?
- What kinds of changes can I expect aging to have on my reconstructed breasts?
Ready to Find the Right Breast Reconstruction Surgeon?
Dr. Madry offers several kinds of breast reconstruction, and we will help you find the one that best suits your unique situation during your consultation. Consultations are often covered by insurance. If you’re ready to restore your breasts to their pre-cancer look and build your confidence, schedule a consultation today to find out which is right for you.