Breast Reconstruction after Cancer
A variety of breast reconstruction procedures are available from Board Certified Plastic Surgeon, Dr. Steven Goldman
Breast reconstruction refers to the process of recreating a breast following removal of the breast for cancer (mastectomy). There are so many issues involved with breast cancer reconstruction that this a hard topic for patients to research and understand. This webpage contains a large amount of information which we have tried to organize in a way that serves as a useful starting point for patients contemplating breast reconstruction after cancer. Hopefully this information will serve as a foundation that allows a more informed discussion if you meet with a plastic surgeon.
What are the different types of reconstruction?
Some of the basic terms describing different types of breast reconstruction are as follows:
What is implant reconstruction?
Implant reconstruction. The main advantage of implant breast reconstruction after cancer is it does not borrow tissue from any other part of the body, so there is no trauma to the belly, back, or other areas (no donor site morbidity). Implant reconstruction is fast, generally adding an hour or less to the time required for mastectomy. Implant reconstruction requires two stages: the first stage is placement of a tissue expander. A tissue expander is essentially a surgical balloon. This is placed under the chest muscle (the pectoralis muscle). The tissue expander has a metal injection port either built into the front of the balloon (integrated port) or attached to it by a connecting tube (remote port). Usually about two weeks following surgical placement of the tissue expander, inflation is initiated. In the plastic surgeon’s office, saline (the same type of salt water that is administered as intravenous fluid to hospital patients) is injected through the port, into the expander. This is done in the doctor’s office every week or so until the expander has stretched the muscle and skin to adequate size. This is easily achieved with the patient awake, like a regular follow-up visit.
Once the appropriate size is reached, the tissue expander is replaced with a permanent breast implant, like the ones used for cosmetic breast augmentation. Dr. Goldman uses both silicone and saline implants; silicone is used for the majority of breast reconstructions after cancer. This exchange requires anesthesia and is performed in an outpatient surgery center. The procedure generally takes about an hour per breast. Usually it takes 3 – 4 months from the time the tissue expander is inserted until the time the permanent implant is placed.
Tissue Expander vs. Flap, which is best?
How does a patient know whether a tissue expander versus flap is best? If a flap is the best choice for a patient, how does she know which flap to choose? Ultimately, this decision is so complex that it can only be made after consultation with a plastic surgeon. The breast cancer surgeon can also add valuable information. Sometimes more than one visit, or consultation with more than one plastic surgeon, is needed.
Several factors may influence the choice of breast cancer reconstruction:
Some patients will develop a preference for a specific technique prior to consulting with the plastic surgeon because of their own research or the experience of family members or friends who have gone through breast cancer reconstruction treatment. Certain options may be excluded based on medical issues. For instance, obese patients are generally not candidates for use of the lower abdominal tissue for reconstruction (the TRAM flap; please see below) or a patient with severe coronary artery disease (heart disease) may not be a candidate for a long procedure. Radiation, especially for delayed reconstructions, increases the failure rate of tissue expander reconstruction.
A few generalizations are useful although they are, of course, not applicable for every patient:
Dr. Goldman’s preferences for breast reconstruction after cancer.
Every surgeon has different preferences based on his or her training, personal experience, and interpretation of data presented in studies and at national meetings. Some surgeons strongly favor one type of breast reconstruction. Dr. Goldman tries to help his patients decide which option is best for them based on their goals, physical characteristics, and medical history. Dr. Goldman commonly performs implant reconstruction, TRAM flaps, and latissimus flaps. And although he does not perform the DIEP flap, he discusses it with his patients and refers them to a local colleague if appropriate.
Please note that we list these preferences to give you a sense of how we choose the best method of breast cancer reconstruction for each patient, but these are generalizations that may not apply to the subtleties of any given patient’s situation.
Other considerations with this complex topic:
In conclusion, breast reconstruction after cancer is a complex topic. As a patient it can be hard to interpret information, especially when different sources seem so conflicted. The above information will hopefully serve as a useful foundation. Feel free to contact our office by phone (216-514-8899) or email (firstname.lastname@example.org); our friendly and knowledgeable staff are happy to answer any questions.