Breast reconstruction is usually performed for breast cancer patients who have had a mastectomy. In addition, there are patients who require breast reconstruction for other reasons such as for Poland’s Syndrome, other breast asymmetries, and for deformities secondary to previous breast implant complications. Patients who are undergoing treatment for breast cancer should seek consultation with a plastic surgeon in conjunction with their general breast surgeon.
Many times it is easier to perform the mastectomy and reconstruction during the same operative setting. Sometimes, the breast reconstruction is performed at a later time. Reconstructive options can include my preferred method using autologous tissue replacement procedures.
These are operations that use your own tissue for the reconstruction: this includes, using a transverse rectus abdominus myocutaneous(TRAM) flap(muscle and tissue from your abdominal region), Latissimus dorsi muscle flap(tissue from your back) with/without an implant, or a free flap(tissue moved on its own blood supply from another area of the body). Options for free flaps include the free TRAM or better still a deep inferior epigastric artery perforator (DIEP) flap.
The DIEP flap preserves the underlying rectus muscle and only uses the overlying skin and underlying fatty tissue. This helps reduce the risk of a postoperative lower abdominal bulge. If a patient does not have enough lower abdominal tissue to perform a DIEP flap, then a perforator flap from the buttock region can be used. This includes the superior gluteal artery perforator (SGAP) flap or the inferior gluteal artery perforator (IGAP) flap.
These two flaps as well usually do not incorporate any muscle and leave a very acceptable donor site scar in most cases. Sometimes instead, a tissue expander is placed and then a secondary procedure is performed to exchange the tissue expander for a permanent breast implant. The procedure chosen is tailored specifically for each patient. The surgical procedure can take between 2-6 hours and recuperation can vary from 1 week to 3 weeks depending upon the procedure performed.