Breast Reconstruction surgery is also known as reconstructive mammoplasty. It is generally performed following mastectomy or lumpectomy surgery in order to restore the shape, appearance and size of the breast. In reconstituting your breast tissue via reconstructive surgery, many women find that a plastic surgeon is able to help with the psychological trauma of losing one or both breasts following mastectomy.
Depending on the particulars of the individual case at hand, whether it is covered by your provincial healthcare insurance and in addition, the point at which you seek out a consultation with a plastic surgeon; the surgery may be performed either at a regional hospital or at the private clinic of the plastic surgeon. Additionally, the procedure may be performed at the same time as your mastectomy or at a later date. In most cases completion of the reconstruction process will require two or more surgeries. Be sure to ask your oncologist for a referral to a plastic surgeon for a consultation in order to discuss your options.
Although reconstructive surgery can provide a natural-looking bust line, a reconstructed breast will never look or feel the same as the breast that was removed. If only one breast underwent mastectomy, it may be reconstructed alone; however, it may be recommended that you perform a breast lift, breast reduction or breast augmentation on the other breast at the same time in order to ensure good symmetry.
Breast Reconstruction Methods
There are various methods your plastic surgeon may employ in order to reconstruct your breast. Each option has its benefits and drawbacks and can vary in the number of procedures required to complete your reconstruction surgery. The exact technique used by the surgeon will vary based on a patient’s existing breast tissue, their oncologist’s post-operative treatment plan, and the wishes of the patient. Your plastic surgeon will recommend the method of breast reconstruction surgery that will best achieve the results you are looking for within the treatment plan designed by your oncologist.
Implant(s) for Breast Reconstruction
The implant method for breast reconstruction generally uses a two stage process. First, the plastic surgeon will insert a tissue expander (a modified saline implant with a valve) beneath the skin and chest muscle in order to create a pocket where the final breast implant will be located. Over the course of two to six months, during a series of visits, your plastic surgeon will inject a saline filler to gradually expand the breast tissue until it reaches the size required for the final implant. During the second step in the process, the plastic surgeon will remove the tissue expander and replace it with a permanent saline or silicone gel-filled implant.
It is important to note that while implant only reconstruction is possible, mastectomy and radiation therapy can leave insufficient healthy tissue to cover and support a breast implant, as a result it is often necessary to combine implant based reconstruction together with own-tissue reconstruction.
Own-tissue (Autologous) Breast Reconstruction
The own-tissue method for breast reconstruction uses the patient’s own body tissues (muscle, fat, skin) collected from other areas of her body in order to reconstitute a natural tissue breast mound. Autologous breast reconstruction has some advantages and disadvantages when compared with implant based reconstruction. While autologous reconstruction can look and feel more like a natural breast when compared to an implant, the procedures themselves are more invasive and complex and will leave the patient with more extensive scarring.
There are a number of different tissue collection options for own-tissue breast reconstruction; the TRAM flap, latissimus dorsi flap, SAGP and IGAP flap(s), and the TUG flap.
It is important to note that while own-tissue breast reconstruction can sometimes provide enough tissue volume to reconstruct a complete breast mound, it is often used in combination with implant reconstruction.
TRAM Flap (Transverse Rectus Abdominis)
The TRAM flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply (pedicled) and be tunneled up through the chest wall, or be completely detached (free flap), and formed into a breast mound. When using the free abdominal flap technique without harvesting muscle for reconstructing the breast it is called either a DIEP or SIEA flap.
Latissimus Dorsi Flap
The latissimus dorsi flap uses muscle, fat and skin from a woman’s back to reconstruct the breast. The flap is tunneled to the mastectomy site where it is formed into a breast mound. The tissue remains attached to its donor site (pedicled), leaving the blood supply intact.
SGAP & IGAP Flap (Superior & Inferior Gluteal Artery Perforator)
A less common option than the free abdominal flap, the gluteal free flap can be considered when other options are not available or preferred. There are two options when considering a gluteal free flap; the SGAP and the IGAP flap. The difference between the two methods is the SGAP flap is made from skin & fat taken from the upper buttock, while the IGAP flap is made from skin and fat from the lower buttock.
TUG Flap (Transverse Upper Gracilis)
Similar to the IGAP flap, the TUG flap uses fat, and skin harvested from the upper thigh, however it differs in that it also includes muscle harvested from the same location. The TUG flap is a less common option for those requiring reconstruction and for whom a free TRAM flap is not an option.
Breast Reconstruction Surgery
Breast reconstruction surgery generally requires two or more surgeries. Depending on the method of reconstruction employed, whether it is covered by your provincial healthcare insurance plan, as well as whether it is being performed at the same time as the mastectomy; the surgery may be performed either at a regional hospital or at the private clinic of the plastic surgeon.
The majority of breast reconstruction procedures are done as outpatient surgery, however, some may require a hospital stay for the initial procedure (particularly if it is done in conjunction with the initial mastectomy).
Breast reconstruction surgery is performed while the patient is under general anesthesia, however for some procedures (tissue expansion injections) local anesthetic may be employed.
Procedural steps
1 – Anesthesia: breast reconstruction surgery is performed while the patient is under general anesthesia, however for some procedures (tissue expansion injections) local anesthetic may be employed.
2 – Own-tissue reconstruction (if necessary): based on the particulars of the case and in consultation with the patient, the plastic surgeon will harvest the donor tissue from the selected site and graft it to the breast tissue, ensuring a healthy blood supply to prevent necrosis.
3 – Tissue expansion (if necessary): based on the particulars of the case and in consultation with the patient, the plastic surgeon will insert a tissue expander (a modified saline implant with a valve) beneath the skin and chest muscle in order to create a pocket where the final breast implant will be located. Over the course of two to six months, during a series of visits, your plastic surgeon will inject a saline filler to gradually expand the breast tissue until it reaches the size required for the final implant.
4 – Breast implant (if necessary): as a compliment or alternative to own-tissue reconstruction, the plastic surgeon will remove the tissue expander and replace it with a saline or silicone breast implant in the pocket created during the expansion process.
5 – Nipple reconstruction (optional/if necessary): breast reconstruction is completed through a variety of techniques that visually reconstruct the nipple and areola.
Recovery After Breast Reconstruction Surgery
Recovery following breast reconstruction will vary depending on the procedure(s) performed. Generally speaking, the recovery period for implant-only based reconstruction will be shorter, and will require around 1-2 weeks off work to rest and heal at home. While you will still be able to move about the house and participate in light activities, it’s important to carefully follow your plastic surgeons’ directions for self-care after surgery.
Own-tissue reconstruction (including combination surgery), which requires surgery in two or more areas, are physically more demanding and recuperation varies depending on which flap procedure(s) are performed. Typically, there will be a recovery period of a few days at the hospital followed by an extended recovery period at home (4-6 weeks).
Additionally, upper body exercise is discouraged until your chest muscles have fully healed. You will also likely need to wear a soft surgical bra or compression bandage to aid in healing for several weeks after surgery. The healing process will continue for 6 months to a year following surgery.
At your follow-up appointments, your plastic surgeon will gradually clear you to resume specific activities and transition to regular bras.
Breast Reconstruction Considerations
While breast reconstruction surgery has been shown to improve the self-esteem and emotional well-being of women who have had to undergo mastectomy or lumpectomy. It is important to remember that a reconstructed breast will never look or feel the same as the breast that was removed.
As a fairly common plastic surgery procedure, significant complications from breast reconstruction are relatively infrequent. However, no surgery is completely free from risk. Some of the possible complications include numbness in the breast and/or donor site (as applicable), hernia, necrosis, fatty cysts, bleeding, blood clots, infection, loss of the flap, scarring (capsular contracture) and reactions to anesthesia.
Be sure to speak with your plastic surgeon about the benefits and limitations associated with reconstructive surgery, and ensure that you fully understand the procedures and their related complications.