Breast Reconstruction

John T. Nguyen, MD, FICS Plastic and Reconstructive Surgery

John T. Nguyen, MD, FICS
Plastic and Reconstructive Surgery

Breast reconstruction is one or more operations performed to restore all components of the breast of women who have undergone mastectomy or removal of the entire breast. Breast reconstruction after mastectomy has evolved over the last century to become an integral component in the therapy for many women with breast cancer. A complete breast reconstruction includes recreating the breast mound, the nipple and areola complex so that the breasts are symmetric with regard to pigmentation, shape, size, projection and position.

The Goals of Breast Reconstruction:

  • To provide permanent breast contour.
  • To make the breasts look balanced.
  • To give the convenience of not requiring an external prosthesis.

Breast Reconstruction Can Be Performed Using:

  • Artificial material (a silicone shell filled with either silicone gel or saline) placed under the skin.
  • The woman’s own tissues (skin,muscle, fat) from another part of the body (flap reconstruction).
  • Pedicled flap: In this type of flap reconstruction, the tissues remain connected to the area of the body from which they are taken. Specifically, the blood supply to the transplanted tissues is not interrupted.
  • Free flap: In this type of flap reconstruction, the tissues are cut off from the original area and grafted to the chest, and a new blood supply is created for the grafted tissues.
  • A combination of artificial material and the woman’s own tissues.

Timing of Breast Reconstruction: Immediate Versus Delayed

Immediate breast reconstruction is reconstruction that is performed at the same time as the mastectomy. Delayed breast reconstruction is reconstruction that is performed weeks, months or years after the mastectomy.

Surgeons differ in their opinions about when breast reconstruction should be performed. If radiation therapy needs to be administered after mastectomy, then breast reconstruction is generally delayed until the skin in the treated area has healed. Excellent results can usually be achieved by either immediate breast reconstruction or delayed breast reconstruction.

Reconstruction Using Implants

Implants are designed to recreate the original breast shape and contour. A breast implant is a silicone shell filled with either silicone gel or saline. A tissue expander or balloon is inserted beneath the skin and chest muscle either during the mastectomy procedure or at a later operation. The surgeon periodically injects saline into the balloon to gradually fill it over several weeks or months so that the overlying skin can expand. After the skin over the breast area has stretched enough, the tissue expander is removed in a second operation and a permanent breast implant is inserted.  Some women do not require tissue expansion before receiving an implant; for these women, the surgeon inserts an implant directly.

Flap Reconstruction

Flap reconstruction is a reconstructive surgery in which a flap of skin and fat with or without muscle is transplanted from a part of the body, such as the lower abdomen, back, thigh or buttock, to the chest area, where it is shaped to form a new breast mound. Like the implant surgery, this operation can be performed at the same time as the mastectomy, or it can be delayed.

Advantages of Flap Reconstruction:

  • May eliminate the use of foreign material in the body.
  • Reconstructed breast usually looks and feels more natural.
  • Will last the woman’s life span.
  • When successful, requires minimal touch-up or redo operations throughout a woman’s lifetime.

Disadvantages of  Flap Reconstruction:

  • Increased complexity and length of the surgery.
  • May require a longer recovery period if muscle is included in the reconstruction.
  • Additional donor site scars.

Some women may require an implant, in addition to the flap reconstruction, for recreating the breast. If flap reconstruction is the selected option for reconstructive surgery, then the surgeon must decide from which part of the body the required tissues are taken. The tissues for breast reconstruction can be taken from the back, abdomen, buttock or thigh.

Reconstruction of the Nipple and Areola

Once the breast mound has been reconstructed, the nipple and areola (pigmented area around the nipple) can be recreated approximately two to three months after the first breast reconstructive surgery. A nipple can be created using skin from the inner thigh, behind the ear, reconstructed breast or labia.

The skin can be tattooed to match the other nipple and areola. The reconstructed nipple and areola have very little sensation.  Women who decide not to have nipple and areola reconstruction performed can consider the option of nipple prosthesis.