When should I see a plastic surgeon about breast reconstruction?
You can see a plastic surgeon about reconstruction at any time that you are considering treatment that includes the possibility of surgery to remove a breast. It is also possible to see a plastic surgeon after you have begun or even completed treatment for breast disease. Some options are best if carried out with cooperation between the surgeon who removes the breast and the surgeon who will begin reconstruction at the time of removal of the breast.
When does breast reconstruction normally start?
Breast reconstruction, for those women who desire it, frequently begins at the time of mastectomy. Each woman optimally will have discussed the options before surgery with the plastic surgeon. Ideally the cancer surgeon and reconstructive surgeon have made a coordinated plan for her treatment. In the appropriate patient the two main choices are between using her own tissue for reconstruction or using implants. Frequently implant reconstruction is two stages started with an expander at the time of mastectomy. Rarely, and generally only in very small breasts, a permanent implant is sometimes placed at the time of the mastectomy. Most commonly the permanent implant is placed at a second procedure.
What is my risk for breast cancer?
Recent data suggests that all women have about a one in nine chance of developing breast cancer. Although family genetics can be a significant risk most breast cancer occurs in women who have no family history of breast cancer. Some genetic conditions have a greater than 90% risk of developing breast cancer. Breast cancer risk assessment is available through the Breast Clinic and takes into account multiple factors when estimating your personal risk. You will also receive recommendations about breast cancer screening or some information about options for treatment of a high risk for breast cancer. If you, your mother, maternal grandmother, maternal aunts, or sisters have breast cancer this may affect your risk for breast cancer.
If I have my mastectomy first and heal from that can I still have reconstruction?
Yes, you can still have breast reconstruction. Breast reconstruction is very individualized and options are tailored to different factors such as whether you had radiation therapy, how much skin was saved and you own desires about using your own tissue, whether you have enough tissue to transfer or using implants to take the place of the missing breast tissue. Your plastic surgeon will help you with your decision.
Can I still start breast reconstruction at the time of mastectomy if I have a high likelihood of needing radiation therapy after surgery?
This is an area of controversy. Some reconstructive surgeons will place a tissue expander at the time of the initial mastectomy and others will not. Recent experience with tissue matrix suggests that some patients may still have successful staged reconstruction with implants at a higher success rate than the data from years ago before tissue matrix was available. There is believed to be a higher complication rate for implant reconstruction when radiation treatment is needed, but no longer is it completely out of the question. Your surgeon will help you with this decision.
What are the basic options for breast reconstruction?
The two big choices are between using your own tissue and using implants for reconstruction. Many patients have a strong preference for one of these choices. There are factors that may make one of those a better choice for you or possibly exclude the option. Some patients are so thin that there is not enough of their own tissue to reconstruct the breast. Sometimes a combination of the patient’s own tissue plus an implant is optimal.
What is a TRAM?
TRAM stands for Transverse Rectus Abdominus Myocutaneous which describes taking the lower tummy attached to the muscle that makes up half of the “six pack” to provide circulation and bringing that up in to the mastectomy site under the nearby skin and fat to make a new breast. Some describe it as getting a “tummy tuck” and using that lower tummy to make a breast. The area where the muscle is taken from needs to be repaired, often with mesh to try to prevent a bulge in the tummy.
What are SIEP and DIEP flaps?
Superficial and Deep Inferior Epigastric arteries can supply reliable areas of skin and fat that can be moved to the breast position and using microsurgical techniques to restore circulation to the tissue by hooking up the arteries and veins to ones in the chest area. Depending upon the patient’s anatomy one may entirely spare the abdominal muscle or certainly limit the amount of muscle that is needed for the breast reconstruction.
What is the Lattissimus Dorsi flap?
The Latissimus Dorsi is a large muscle on your back that can be used with or without skin from the back to help with breast reconstruction. Unless the breast is very small an implant is usually used with the Latissimus Dorsi flap for breast reconstruction.
What is a tissue Matrix (like Alloderm)?
Tissue matrix is usually formerly from a living being but processed to remove all cells but still provide a framework for the patient’s blood vessels to grow into and become the patient’s own live tissue. This has been helpful in many areas of reconstruction and particularly in breast reconstruction.
What is a tissue expander?
A tissue expander is a temporary breast implant that is filled over weeks to months to bring the breast pocket safely to the appropriate size and shape for the permanent implant. The implant is usually filled through an injection with a needle into a port underneath the skin that may be part of the implant.
Why can’t you just put a permanent implant in at the time of the procedure?
The skin of the breast after mastectomy is delicate and has very limited circulation that improves over time. Stressing it with too large an implant risks almost certain failure and loss of the skin. The expander allows judgment in how much fluid to add.
Why are some results so spectacular and others are not?
There are many factors that affect the appearance of a breast reconstruction. Certain breast shapes are easier to reconstruct than others. Some women have undergone radiation for treatment of the cancer, some mastectomies have been done preventively and have had no lymph dissection surgery, both factors affect the outcome. Some women begin reconstruction at the time of mastectomy and much of the skin and sometimes the nipple can be spared. All women have different skin and tissue characteristics. Our age changes our appearance as well as how we scar. All of these factors and more affect how the breasts will look.
What are my choices for permanent implants?
Two basic choices are saline filled and silicone gel filled. Both are FDA approved and each has its advantages and disadvantages. There are different kinds of both implants and your surgeon will help you choose what is appropriate for you.