 It is easy to get lost in the details and volumes of information on breast reconstruction, however, when things are broken down into their simplest terms, there are only 2 ways to reconstruct the breast.
Breast Implants - With breast implants a surgeon is able to form a breast mound by using an implantable prosthesis. Breast implants are filled with saline (salt water) or silicone gel. The sacs are placed under your skin behind your chest muscle. Implants generally work well for the cosmetic breast augmentation patient because the tissue over the implant is healthy and relatively thick. Breast reconstruction with implants is very different from breast augmentation because the skin over the implant is left very thin following mastectomy. To compensate for this, the implants are placed “under the muscle” meaning under the pectoralis muscle. Since this muscle usually only covers the upper 1/2 of the implant, Alloderm™ is used or the latissimus muscle (latissimus flap) is brought from the back to complete the pocket. The incision required for latissimus transfer is placed across the back and is typically visible in swimwear, low cut evening gowns, etc. Implants are prosthetic devices and are subject to wear and tear. Most patients require re-operation at some point to address problems with their implants including leakage, deflation, infection, extrusion through the skin, capsular contracture (becoming hard), pain, and/or desire for size alteration. Implants are not considered lifetime devices. In fact, in 2002 a total of 59,292 women had breast implants removed, 15,785 of whom were reconstruction patients. If you have had radiation therapy as a part of your treatment or radiation is likely for you following mastectomy, breast implants are often regarded as a poor choice. Radiation treatments make the breasts much more prone to harden after implant placement. As a result, most recommend reconstruction with your own body’s tissue after radiation. Your Own Body’s Tissue (“Flaps”)
The surgical transfer of skin, muscle, and fat from one part of the body to the breast area allows for use of your own body’s tissue to restore your breast. There are a number of methods to accomplish this transfer and all are generally referred to as “flaps”. Once the tissue is collected, it is then shaped to form a new breast mound. An important consideration for our patients is the effect of the tissue collection at the donor site. The TRAM flap, developed in the late 1970’s, allows for use of excess fat in the lower abdomen to reconstruct the breast. The problem with the TRAM flap is that it removes the muscle of the abdominal wall and almost always requires the use of implanted mesh. The effect of this muscle sacrifice in the abdomen is permanent. The resultant weakness can lead to hernia formation and/or bulging in the abdomen since it has been stripped of its supporting muscle tissue. The Lat Flap cuts away the largest muscle in the back and uses it to rebuild the breast. This procedure usually requires placement of an implant at the same time to provide adequate volume. Sacrifice of the latissimus muscle produces permanent weakness and an unattractive donor site scar. The DIEP flap employs skin and fatty tissue in the abdomen to restore the breast. The result in the abdomen is much like a tummy tuck in that the abdominal contour is often improved significantly as well. In contrast to the TRAM flap, the DIEP procedure does not sacrifice the muscles of the abdominal wall. This preserves the abdominal strength and avoids the need for implanted mesh. The GAP flap procedure allows for reconstruction using your own body’s tissue when there is inadequate abdominal fat to restore your breast to its proper size and shape. For the woman who is thin or athletic, the breast may be reconstructed with tissue borrowed from the gluteal area. Skin and fatty tissue are collected from the buttocks/hip region without sacrificing underlying muscles. As with the DIEP procedure, the tissue is then sculpted into the new breast mound. The DIEP and GAP allow for creation of a breast that is warm and living and is your's for life. These procedures allow for creation of a breast that is warm and living and once healed, yours for life. The preservation of muscle tissue and associated function, while still providing restoration with living tissue, represents a significant advancement in breast reconstruction. With over 15 years of combined experience and thousands of successful breast reconstructions, our Center has pioneered efforts to refine these techniques into methods that now represents the state-of-the art choice in breast reconstruction. |
