Breast reconstruction involves many decisions and choices, not the least of which is whether breast reconstruction is right for you. Some women feel as though they have lost a part of their femininity following a mastectomy while others don’t feel like dealing with a prosthesis for the rest of their lives. Whatever the reason, the decision is ultimately based on your needs, desires, and expectations. Not every woman facing a mastectomy feels the need for breast reconstruction, but for many it is an essential part of the recovery. Dr. Tiffany McCormack, our highly experienced plastic surgeon, understands that there are many options to choose from once you have determined that breast surgery with reconstruction is right for you. She will spend time discussing the various options available and guide you toward a decision based on your unique situation.
Breast Reconstruction Techniques
Breast reconstruction is accomplished in a variety of ways, including through autologous reconstruction (the use of your own tissue, such as a TRAM flap or latissimus dorsi flap) or implant/expander reconstruction. These options are highlighted below.
TRAM Flap Reconstruction
TRAM (transverse rectus abdominis myocutaneous) flap breast reconstruction uses tissues taken from abdomen to rebuild the breast(s). To perform this procedure, the whole rectus abdominis muscle is tunneled under the skin of the upper abdomen in order to transfer abdominal skin and fat to the chest wall. These tissues are then carefully shaped to create the breast mound(s) for an exceptionally natural-looking, symmetrical appearance.
Latissimus Dorsi Flap Reconstruction
Latissimus dorsi flap reconstruction involves rebuilding the breast(s) using tissues of the latissimus dorsi muscle, which is located just below the shoulder in the upper back. During treatment, an oval-shaped flap of muscle, skin, fat, and blood vessels harvested from the latissimus dorsi muscle is carefully tunneled underneath the skin to the chest wall. When in position, these tissues are meticulously contoured to form a new breast mound. As an added benefit, the relatively short distance between the chest and donor site allows blood vessels in the transferred flap to remain connected to their original blood supply, ultimately promoting long-term tissue survival.
Implant reconstruction refers to rebuilding the breast(s) with silicone or saline breast implants. Depending on how much tissue is removed during the lumpectomy or mastectomy procedure—as well as the size of the implant of choice—a tissue expander may or may not be necessary prior to the placement of implants. When needed, a tissue expander is first used to create a large enough breast pocket to accommodate one’s desired implant. Tissue expanders are available in numerous sizes and shapes to properly match the volume and contour of the selected implant, and they can be placed immediately following mastectomy or at a later point in time. Once an ample breast pocket has been created, the implant can be inserted through small incisions and carefully positioned for an ideal aesthetic.
Ultimately, each breast reconstruction option offers unique advantages and disadvantages for patients. At the time of the consultation, Dr. McCormack will assess your needs, anatomy, and expectations to help guide you toward the best reconstruction for you.
The Breast Reconstruction Process
It is important to remember that any breast reconstruction process will require multiple procedures. The number of surgeries will vary depending on the type of reconstruction you undergo. This is why it is so important that you feel comfortable with the plastic surgeon you choose. You will become involved with multiple physicians during the course your treatment. This may include a general surgeon, medical oncologist, radiation oncologist, and plastic surgeon. Your team will work with you to guide you through the necessary steps toward recovery. We are able to help you network with other patients going through a similar situation and connect you with local support groups.
Breast Reconstruction Recovery
Recovery from breast reconstruction will depend on the specific technique performed, as well as your body’s natural healing process. Generally speaking, the majority of women will notice some swelling, soreness, and/or bruising in the breasts (and donor sites, if autologous reconstruction is performed). These side effects are temporary and should dissipate as time passes. While a significant degree of pain is rare, any discomfort experienced throughout the first few postoperative days can usually be controlled effectively with medication. After about one to two weeks, most patients feel well enough to return to office jobs, school, and/or other non-strenuous daily routines; however, any heavy lifting, intense exercise, or other physical activities should be limited for at least a few weeks to provide ample healing time. Placing strain on treatment areas too soon may have a negative effect on one’s final outcome.
Ultimately, from consultation to recovery and beyond, Dr. McCormack will be available to answer all questions, address any concerns, and provide the necessary support to complete your breast reconstruction journey and feel like yourself once more.