Breast reconstruction is a surgical procedure performed for women who had mastectomy. Mastectomy is surgical procedure that removes the entire breast and surrounding tissues to prevent breast cancers.
The surgery is performed to rebuild the lost breast so that it matches the symmetry of the opposite breast. The surgery may involve implant reconstruction, your own tissues (tissue flap), or a combination of the two. After the breast tissue is reconstructed, later surgery may be required to reconstruct the nipple and the areola, dark area surrounding the nipple.
Breast is an important feature of a woman’s physical characteristics that symbolizes a woman’s femininity. Women who lost their breast after mastectomy consider breast reconstruction because they want to feel feminine again by having their breast restore. The scar from mastectomy can be a constant reminder of breast cancer and by having the breast restore allow women to move on to lead a normal lives before mastectomy.
Implant Reconstruction Procedures
There are two types of breast implants, saline-filled implants and silicone-gel-filled implants. Saline-filled implant is a silicone pouch filled with saline liquid which is most commonly used. Silicone-gel-filled implant is a silicone pouch filled with silicone. There are two types of implant reconstruction procedures and these include one-stage immediate reconstruction and two-stage reconstruction (immediate or delayed).
One –stage immediate reconstruction is performed at the time of mastectomy. Surgical procedure to remove the breast tissues is performed by the surgeon, once the breast tissues is removed breast implant is performed by plastic surgeon to rebuild the lost breast. The benefit from one-stage immediate reconstruction allows women to recover from both surgeries at the same time.
Two-stage reconstruction can be immediate or delayed. Two-stage immediate reconstruction can be performed if radiation therapy is not required after mastectomy. Breast reconstruction is delayed if radiation therapy is required after mastectomy. Radiation therapy given after when the breast has been reconstructed can cause many problems.
Two-stage reconstruction is performed when the chest area is flat with insufficient loose skin. The process involves the use of tissue expander, a balloon shape device that is place under the chest muscle. The tissue expander is injected with saline liquid causing it to expand, and the skin over the tissue expander stretches overtime to form breast contour. The procedure takes several months to stretch the skin and once the skin has been stretched enough, a second surgery is performed to remove the expander and the implant is put in place.
Breast Reconstruction Using Your Own Tissues
Implant reconstruction is not ideal for everyone because some patients who are left with very thin skin and lost major muscle in the chest area after mastectomy may not be a good candidate. When a patient lost excess tissues in the chest area, tissue expansion become impossible with the use of tissue expander.
The alternate option of breast reconstruction is using the patient’s own tissues also known as tissue flap surgery. This type of procedure involves surgically removing tissues from one part of the body and moving it to the chest area. The tissues may be taken from the abdomen, upper back, or buttocks to reconstruct the breast. Individual who have diabetes and smokers are not a good candidate for tissue flap surgery.
There are two types of tissue flap surgery and these include TRAM (transverse rectus abdominis muscle) flap and latissimus dorsi flap. TRAM flap procedure remove tissues from the abdomen and latissimus dorsi flap procedure remove tissues from the upper back.
TRAM Flap Procedures
TRAM flap procedures involve removing a portion of skin, fat, and muscle from the abdomen and transferred to chest area to form a new breast. This operation leaves 2 scars on surgical site, one on the abdomen where the tissues is removed and one on the chest area where the new breast is reconstructed. TRAM procedures can reduce strength in the abdomen and is not ideal for individual who had “tummy tuck” from previous surgery. There are two types of TRAM flap procedures, the pedicle flap and free flap.
• In pedicle flap, the flap remains attached to its blood supply and reconstructed on the chest area by tunneling it under the skin.
• In free flap, the flap is detached from its original blood supply and reattached to the blood vessels in the chest area. This procedure takes longer than pedicle flap because it requires the use of microsurgery to connect the flap to the blood vessels in the chest area.
Latissimus Dorsi Flap Procedures
Latissimus flap procedure involves removing a portion of skin, fat, and muscle from the upper back and tunnel to the chest area to form a new breast. This procedure may be used in combination with implants. Latissimus flap alone can provide enough bulk for women with smaller breast size. For women with larger breast size, Latissimus flap is used in combination with implants to provide the extra bulk. This operation leaves 2 scars on surgical site, one on the upper back where the tissues is removed and one on the chest area where the new breast is reconstructed.
Gluteal Flap Procedures
Gluteal flap procedure involves removing a portion of skin, fat, and muscle from the buttocks and transferred to the chest area to form a new breast. This is a free flap procedure with longer operating time and requires the use of microsurgery to connect the flap to the blood vessels in the chest area. This is an alternate breast reconstruction option for women that do not prefer the TRAM flap or latissimus flap procedures.
Nipple and areola reconstruction is performed after when breast reconstruction is completed. Nipple reconstruction can be performed with flap reconstruction or graft reconstruction. Flap reconstruction is procedure in which skin and fat tissues surrounding the new nipple is removed to construct new nipple. Flap reconstruction can leave scars on the breast surrounding the new nipple.
Graft reconstruction is procedure in which nipple grafts is harvested from the opposite nipple, the labia, and the earlobe. The new nipple is reconstructed from harvested nipple grafts. Graft reconstruction can leave scars on the breast surrounding the new nipple. The site from where the nipple grafts is harvested can also leave behind scars.
reconstruction is performed after the new nipple has been
reconstructed. Areola can be reconstructed by tattooing or graft
reconstruction. Tattooing is a general process used to create areola
with color matching the opposite breast. Graft reconstruction involves
harvesting skin from inner thigh and inner gluteal area which is used to
reconstruct new areola. Some patients that are going through breast
reduction, the extra portion of the areola that is been removed can be
used to reconstruct new areola for the new breast.
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