Breast reconstruction is an important part of the post-cancer healing process for many women. Reconstruction can happen during treatment, shortly thereafter, or years down the road. Your health and your personal feelings about reconstruction should be the most important decision-making factors.
Learn more here:
- Advanced, Natural Breast Construction
- Benefits of Breast Reconstruction
- Is Breast Reconstructive Surgery Right For You?
- Types of Breast Reconstructive Surgery
Learn how Donna was given hope after a breast reconstructive procedure called Deep Inferior Epigastric Perforator (DIEP) Flap with Dr. Del Corral, MD.
Advanced, Natural Breast Reconstruction
MedStar Health Cancer Network offers natural breast reconstruction for patients who want to avoid implants or who are not candidates for them. The most common type of breast reconstruction involves saline or silicone implants, but the downside is they typically need to be replaced after a decade or so. This degree of maintenance can seem unappealing to anyone, especially someone who has battled cancer.
As an alternative, natural breast reconstruction is becoming more common and popular after mastectomy. Natural breast reconstruction uses skin and fat from other parts of your body to create breasts with a natural feel. Also known as DIEP Flap (deep inferior epigastric perforator flap), this procedure takes extra skin and fat from the lower abdomen, back and buttocks. The result is permanent and the microvascular technique leaves less scarring and impacts muscle function far less.
The Benefits of Breast Reconstruction
The decision to have breast reconstruction is personal, and the benefits can be as unique as you are. A few common advantages are:
- Balance and Proportions Restored. After a mastectomy, your clothes might not feel or look the same. Your sense of balance changes. Reconstruction brings back the physical proportions you knew before surgery.
- Renewed Confidence and Self-Esteem. The fact that you are alive and thriving matters far more than what you look like. But, for many women, the loss of breasts impacts self-confidence and even the feeling of femininity. Reconstruction can provide an incredible confidence boost.
- A Sense of Normalcy. If you have been through a battle with cancer, your life has been focused on battling cancer for a long time. Restoring your breasts and shape can help orient you to a new normal
Is Breast Reconstructive Surgery Right for You?
Breast reconstruction is something you should do for you, not to fit an idealized image in the media or as a response to pressures by loved ones. You may be a candidate for breast reconstruction if:
- You are healthy and do not have any condition that would compromise your healing.
- You have a healthy attitude about your treatment and what you've been through.
- You understand that a reconstructed breast will not be "perfect." You will have scarring, potentially some asymmetry.
Types of Breast Reconstructive Surgery
Learn more about the types of breast reconstructive surgery below.
Breast Reconstruction with Flaps
Natural breast reconstruction or "flap" procedures are becoming more popular as patients decide synthetic implants are not for them. There are two types of tissue flaps used in breast reconstruction: pedicled flaps, which stay connected to the original blood supply, and free flaps require microsurgery to create a new blood supply.
Deep Inferior Epigastric Perforator (DIEP) Flap: The DIEP flap is a breast reconstruction technique that involves the transfer of soft tissue from the abdomen to the new breast. The DIEP technique allows reconstruction of the breast without implants and usually without movement of muscle tissue. Skin and fat from the lower abdomen are transferred to the chest wall, along with blood vessels, which are grafted to the new site with microsurgical techniques. The results are permanent and, unlike artificial implants, do not require revision after 10-15 years. Click here to view a DIEP Flap Reconstructive Surgery (GRAPHIC CONTENT WARNING) by Gabriel Del Corral, MD.
Superior Gluteal Artery Perforator (SGAP) Flap: The SGAP flap moves tissue from the buttock and hip area to the newly reconstructed breast. Using microsurgery, blood vessels from the perforator flap are then connected to the internal mammary vessels on the chest. The SGAP technique may be appropriate for any mastectomy patient, and is often recommended for those who exhibit defects resulting from previous breast surgery. This procedure provides very acceptable aesthetic contour at the buttock donor site.
Superficial Inferior Epigastric Artery (SIEA) Flap: The SIEA flap is an alternative to the DIEP flap, and also involves the transfer of skin and fatty tissue from the abdomen to one or both breasts. The SIEA technique does not harvest abdominal muscle, so it can preserve abdominal strength and contour and minimize downtime after the procedure.
Transverse Rectus Abdominus Musculocutaneous (TRAM) Flap: The TRAM flap is a method of breast reconstruction that moves muscle, skin, and fat from the abdomen to the new breast. Candidates for TRAM flap include patients who have the desire or need their breasts reconstructed with their own tissues but are not good candidates for free-flap reconstruction.
Surgery During Mastectomy
Of course, this is an optional surgery. If you decide on breast reconstruction, you and your doctors will evaluate the best timing to do so. Breast reconstruction can take place during the mastectomy operation (immediate reconstruction) or at a later date, after other necessary treatments are given (delayed reconstruction).
Immediate reconstruction is performed at the same time as the mastectomy. The entire breast is removed, and a new one reconstructed immediately. With immediate reconstruction, the chest tissues are undamaged by radiation therapy or scarring. Also, immediate reconstruction means one fewer surgeries.
Delayed reconstruction is performed at a later time. For some women, this may be recommended if radiation is to follow mastectomy, as radiation therapy after breast reconstruction can increase post-surgical complications.
Breast reconstruction includes a variety of advanced surgical procedures that work to restore the breasts, typically after breast cancer and mastectomy. The goal of breast reconstruction is to minimize psychological stress caused by the loss of a breast. There are several different possible techniques, including TRAM flap, free flaps, and prosthetic implants.
Breast Reconstruction with Expanders
Tissue expanding implants, also known as Becker implants, are often used during breast reconstruction to facilitate recreation of the breast mound. Your plastic surgeon inserts the expander beneath the pectoralis muscle and gradually fills the implant with saline. Once the tissue has stretched to accommodate the desired implant volume, the breast mound can be restored, along with reconstruction of the nipple and areola.
Fat Grafting for Breast Deformities
Fat grafting can improve the cosmetic result of breast reconstruction. During this procedure, fat is taken from elsewhere in the body using a low-pressure liposuction method, which uses a syringe. The fat is washed gently with saline and then injected into contour depressions along the margins of reconstructed breasts. The technique has limitations and risks, but overall it is a safe alternative to more complicated procedures that achieve similar results.
Breast Reconstruction with Implants
Implant breast reconstruction remains one of the most popular techniques available, with a high rate of patient satisfaction. Saline or silicone gel-filled breast implants can be used to recreate the breast mound.
Revision Breast Reconstruction: Breast reconstruction is often performed in stages. After the operation is complete, revision procedures can be performed to improve aesthetic appearance or correct unexpected complications.
AlloDerm Placement: AlloDerm, a type of acellular dermal matrix, is a biologic material that acts as a soft tissue substitute during breast reconstruction. The material closely resembles normal dermis and integrates nicely with existing tissue. Typically used in expander or implant-based reconstruction, AlloDerm supports and provides coverage of the breast implant.
For a physician referral, please call 1-877-715-HOPE.
MedStar Franklin Square Medical Center
The Harry and Jeanette Weinberg Cancer Institute
9103 Franklin Square Drive
Baltimore, MD 21237
MedStar Good Samaritan Hospital
5601 Loch Raven Boulevard
Baltimore, MD 21239
MedStar Harbor Hospital
The Cancer Center
3001 South Hanover St.
Baltimore, MD 21225
MedStar Union Memorial Hospital
3333 North Calvert St.
Johnston Professional Bldg
Baltimore, MD 21218
Breast Center at MedStar Health Bel Air Medical Campus
Breast Center at Bel Air
12 MedStar Blvd.
Bel Air, MD 21015