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Breast Reconstruction Options

The science of breast reconstruction has dramatically improved over the last twenty years. The reasons? Better insurance, and better patient education. If you're considering a breast reconstruction - whether following a mastectomy or for other reasons -- it's important to understand the different options, and what they involve.

What option is best for you? How do you prepare for surgery, and what will the recovery be like?

Implants

The most basic reconstructive option involves the use of an implant. Following removal of the breast, a tissue expander is placed beneath the chest wall muscle and skin. The expander is gradually filled with salt-water over a period of weeks to months, allowing overlying skin to grow and replace the original breast skin. This expander is then replaced at a later date with a permanent implant to achieve symmetry with the opposite breast.

TRAM Flap

Reconstruction can also be performed using tissue from a different area of your body. Flap reconstruction requires additional incisions, so a woman will have more scarring than she would have with an implant. However, results are more natural and the use of an implant may be avoided.

The most popular of the flap reconstruction procedures is the TRAM (Transverse Rectus Abdominis Myocutaneous) flap, which uses muscle, skin, and fat from your abdominal wall to reconstruct the breast mound. Tissue remains attached to its blood supply and is tunneled beneath the chest wall skin where it is arranged to replicate the appearance of your other breast. By removing tissue from your abdominal wall, you essentially undergo a tummy-tuck procedure and awake from surgery with a reconstructed breast and a tighter, flatter abdomen. While this is an excellent option, it is generally reserved for patients with a little extra weight around the middle, and is not a good option if you are excessively thin.

Other procedures incorporate tissue from your back, and in less common cases, "free tissue" is brought from a more remote site--such as your buttocks--removed from its blood supply, and ultimately rejoined to a new blood supply using an operating microscope. While this technique is appropriate for a select group of patients, it is technically demanding and associated with a higher risk of complications.

The Choice is Yours

Both the flap reconstruction and implant procedures achieve excellent results. The real question is, which route do you feel most comfortable with? A decision can be reached after careful consultation with a plastic surgeon. Many women request simultaneous surgery on their other breast-such as a reduction, breast-lift, or augmentation-to improve symmetry with the reconstructed breast.

Preparing For Surgery

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