Breast reconstruction is for mastectomy patients, who may choose to undergo breast reconstruction surgery immediately or at a later time. Because a number of choices are involved, some patients prefer to delay the decision while others prefer to complete all their surgeries at once. Regardless of when it is completed, many women experience a sense of restored wholeness as a result of this procedure.
There are three techniques used for breast reconstruction:
- Tissue Expansion. This technique is similar to that used for breast
implants. The surgeon inserts a silicone "balloon" into the breast beneath
the chest muscle. Either during the surgery or later, the balloon is filled
with a saline solution. Over a period of weeks or months, more saline solution
is added while the surrounding skin and muscle is given time to stretch and
accommodate the implant. When the desired size is reached, an outpatient surgery
replaces the temporary implant with a more permanent one.
- Breast Implant. For women with smaller breasts, a permanent implant
can be inserted immediately into the breast without tissue expansion. Again,
a silicone outer shell is filled with saline solution until the desired size
- Flap Reconstruction. Flap procedures use the patient's own tissue
to rebuild the breast. The surgery is more extensive and takes longer to recover
from than the other procedures, but there is no foreign body implanted and
no potential for an allergic reaction. Three flap procedures are most commonly
- Latissimus Flap. The latissimus dorsi muscle runs across the back
from the spinal column and upper hip to the arm just below the shoulder.
The muscle is large in size and obtains its blood supply from the arm, making
it a convenient choice for breast reconstruction surgery. Essentially, the
surgeon tunnels through to the front of the chest and pulls the needed skin
and fat to the front.
- TRAM Flap. TRAM stands for transverse rectus abdominis mycutaneous,
the flat muscle group that runs from the rib cage to the pubic bone in the
front of the body. Again, this muscle group's close proximity to the breasts
and plentiful blood supply make it a good choice for this surgery. The surgeon
cuts the muscle above the pubic bone and tunnels the needed skin, fat and
tissue to the chest wall.
- Free Flap. In some cases, a surgeon may opt to use skin and fat that
is supplied by a single artery and vein from a remote area, such as the
buttocks or lateral thigh. In these cases, the tissue is completely removed
from the body and reattached to the chest. At times, this technique is
applied to a TRAM flap.
Breast reconstruction surgery is major surgery and requires inpatient hospitalization for 2 to 5 days. Drains are usually inserted to help remove excess fluid over the first 2 to 3 days. Stitches are removed in 7 to 10 days. While patients are encouraged to get up and move in the first 24 to 48 hours, recovery from breast reconstruction surgery can be slow. Patients are back to normal activity in 3 to 4 weeks, but overhead lifting and strenuous activities are limited for up to 6 weeks. Scars from incisions are permanent, but are generally located where they can be concealed. They do fade over time. Breast reconstruction cannot restore normal nipple or breast sensation, but some feeling may return in time.