Breast Reconstruction

Breast reconstruction is a surgical procedure designed to restore the size, shape and appearance of the breast after a mastectomy (removal of the breast due to cancer).  There are several techniques explained here that are designed to meet the individual goals and physical needs of each patient.

When is Breast Reconstruction Performed?

Ideally, breast reconstruction is discussed with your breast surgeon and Dr. Maddali, and planned prior to the mastectomy. The best time to undergo reconstructive breast surgery is at the same time as the mastectomy. At that time, the chest wall is normal and undamaged from radiation or scarring.

However, some patients do not undergo breast reconstruction at the same time as the mastectomy for various reasons - medical or personal.  If radiation in the chest is needed post-mastectomy, breast reconstruction is usually delayed until after radiation treatment is completed.

Breast Reconstruction Procedures

There are two general options for breast reconstruction. One method is to use a breast implant and the other is to use your own tissue. Dr. Maddali will discuss the options available to you and help you make a decision appropriate for your needs.

Using Breast Implants for Breast Reconstruction

A saline or silicone gel implant is used to mold a new breast shape. If your skin and chest wall tissues are tight and flat, this may be done in multiple stages, wherein a tissue expander is placed beneath the skin and chest muscle. This expander is filled with saline, which creates a new cavity over time. Once the cavity reaches the correct size, the tissue expander is replaced with a standard implant.

Most patients who choose to have a breast implant reconstruction undergo this sequence of procedures. Some patients may be candidates for immediate implant placement after mastectomy. Dr. Maddali will discuss your mastectomy procedure in detail with your breast surgeon and determine if you may be a candidate.

Free Flap breast reconstruction

Autologous Tissue Flap Breast Reconstruction
The basic idea of a tissue flap is to take your own skin, fat, and sometimes muscle from one area of the body and use them to reconstruct a new breast. There are four primary methods for a tissue flap procedure:

• A TRAM (transverse rectus abdominis muscle) flap uses the lower abdomen, between the waist and pubic bone as a donor site. In terms of the tissue removed, The TRAM flap procedure is very similar to a tummy tuck. There is typically enough skin, fat, and blood vessels to reconstruct a breast. One abdominal rectus muscle (one side of the “six-pack”) must be removed, however, to form the base of the breast mound.
• A latissimus dorsi flap uses the upper back as the donor site. The latissimus dorsi muscle from the back is tunneled under the skin to the front of the chest. This creates a convenient pocket that can be filled with an implant to add fullness to the reconstructed breast.
• A DIEP (deep inferior epigastric artery perforator) flap is similar to a TRAM flap except that it doesn’t involve the sacrifice of an abdominal muscle. Instead, blood vessels are carefully dissected out of the abdominal muscle and then reconnected to new blood vessels in the chest wall with the use of a microscope.
• An SGAP (superior gluteal artery perforator) flap is similar to the DIEP flap. It is an ideal option for women who are very thin or for some other reason cannot spare tissue from the lower abdomen. Instead, the buttocks are used as the donor site.

Nipple and areola reconstruction is an optional secondary surgery following breast reconstruction. If necessary, nipple and areola reconstruction will be done three to four months following breast reconstruction to allow time for healing. Like the tissue flaps, donor skin from your body is typically used to reconstruct the nipple and areola.

The areola is tattooed using permanent makeup to make it look very similar to the intact breast. This last step is very crucial and completes the sequence of breast reconstruction.

Recovery After Breast Reconstruction

Recovery time will vary depending on the procedure you choose. With implants, you are likely to feel fatigue and soreness for one to two weeks after your breast reconstruction. If you choose a tissue flap, recovery typically takes longer. Most candidates can completely return to normal activities in as little as three to four weeks with an implant, or six to eight weeks after a tissue flap procedure.

It is normal to have decreased sensation around the breast after your operation. Some of this numbness may resolve with time. Due to various factors like tissue swelling, your new breast tissue may not completely heal for up to a year. Scars will start out as pink or red, but will certainly fade with time.

To learn more about breast reconstruction in San Francisco, contact the plastic surgery office of Sirish Maddali MD.