ABOUT BREAST RECONSTRUCTION

Breast Reconstruction for Cancer Rehabilitation

The goal of breast reconstruction after mastectomy or lumpectomy is to restore your self to a sense of being whole. Ideally, a natural breast is created that has a shape, softness and symmetry that is like the original. Although losing all or part of your breast can be a life-altering shock, the loss can be softened with advanced, less invasive, state-of-the-art procedures that restore your breast to its presurgical form.

About Breast Reconstruction Procedures

In the United States, at least 80% of breast reconstructions are performed using tissue expanders and implants. For the patient, there is only one area of scarring - on the breast - and no second surgical site for donor tissue - such as the abdomen. For most plastic surgeons, implant-based breast reconstruction is an easier and faster operation, and one that does not require any specialized training. A breast implant, however, is a foreign body, which often leads to complications over time. According to data from one implant manufacturer, about 50% of implants for breast reconstruction require re-operation in 7 years - most often due to painful capsular contracture, rupture, or infection - but sometimes due to extrusion through the skin, especially in patients who have undergone radiation. 

Over the long term, autologous tissue breast reconstruction - that is, breast reconstruction that uses the body's own tissue - provides the longest lasting results. A University of Michigan study comparing implants and autologous tissue breast reconstruction found that procedure type made no difference in the short term, but over the long term autologous tissue breast reconstruction resulted in significantly higher patient satisfaction. By using the body's own tissue, the restored breast is composed of soft, warm, living tissue, which integrates with your body over time. If you gain or lose weight, your breast will also gain or lose weight - just like any other part of your body. There is no chance of rejection, as there is with an artificial implant, as an autologous tissue breast reconstruction is composed of tissue that is already a part of you.

Originally, the first types of breast reconstruction to use the body's own tissue also sacrificed the muscle. For example, the Transverse Rectus Abdominis Muscle (TRAM) flap uses the skin, fat, and muscle of the abdomen to recreate the breast. Early forms of the TRAM flap were "pedicled" - meaning the abdominal tissue was kept attached to its blood supply on a vascular pedicle, then tunneled under the upper abdomen and through the inframmary fold to create a new breast. A pedicled TRAM removed all the muscle and some of the abdominal fascia above the muscle, so synthetic mesh was often used in place of the muscle and fascia to prevent abdominal hernias, bulge, and weakness.

Later forms of the TRAM flap were "free flaps" - meaning the abdominal tissue was disconnected from its blood supply and then reconnected to a new blood supply in the chest wall under an operative microscope. Not only did the microvascular free TRAM flaps provide better blood supply to the tissue, but newer types of TRAM flaps also allowed for less and less muscle to be sacrificed, which reduced postoperative pain and abdominal morbidity.

Ultimately, plastic surgeons recognized that advanced microsurgical breast reconstruction techniques made it unnecessary to sacrifice any muscle at all. The perforator vessels that traveled through the muscle could be carefully dissected to separate the artery and vein from the muscle and provide safe and reliable blood supply to the overlying tissue. And since the "perforator flaps" and missing breast tissue were both composed of skin and fat - not muscle - the new "perforator flaps" also adhered to an important plastic surgery principle of replacing "like with like."