Breast Reconstruction Techniques
At Belcara Health, our breast surgery expert Dr. Michael Cohen is experienced in a variety of breast reconstruction techniques that help you enjoy a beautifully recreated breast contour.
WHAT DETERMINES THE BREAST RECONSTRUCTION TECHNIQUE USED?
During your personalized consultation, our surgeons will work closely with you to choose a reconstruction technique that will best work for you. This decision will be impacted by a variety of factors surrounding your health and your desired outcome, including:
- Your medical history, current weight, and overall health
- The details of your cancer treatment
- The timeline of surgery (will it be performed at the same time as mastectomy?)
- How much natural tissue remains after mastectomy
- The breast size and appearance you want after surgery
- Whether or not you want breast implants
Ultimately, the chosen technique for your breast reconstruction will be the one that is will best achieve a beautiful, symmetrical, and natural result safely. Your surgeon will stay in communication with you and work directly with your cancer treatment time throughout the entire process so you can feel confident you are receiving the highest level of patient care.
TISSUE EXPANDER/IMPLANT RECONSTRUCTION
Tissue expansion is a popular technique for breast reconstruction that involves two main steps. After mastectomy, your surgeon will place a temporary implant to slowly stretch your skin and chest muscles over the course several weeks or months to make space for a permanent breast implants.
While this tissue expander is in, you will visit our office periodically to have your surgeon inject a sterile saline solution into the expander to fill it and help in stretching. Once there is enough room, you will have your expander replaced with permanent implants during a second procedure.
Expanders that are designed to be left in place permanently may be an option. Your surgeon will overview all of your choices, including the types of breast implants, during your consultation.
Tissue expansion with implants is generally the least invasive choice for reconstruction because it typically does not require taking tissue from other areas of your body. Recovery and healing also typically takes less time for this method. If you have had radiation treatment, breast implants are typically not recommended and you may benefit from another technique.
FLAP RECONSTRUCTION (WITHOUT IMPLANTS)
A Flap reconstruction technique utilizes tissue from other parts of your body, such as the abdomen, buttocks, back or thighs, to reconstruct your new breast mound. Our Baltimore breast specialists used a variety of different flap techniques. The option that will work best for you depends on your unique medical and physical circumstances, in addition to your aesthetic preferences.
Latissimus Dorsi Flap
The Latissimus Dorsi Flap technique has been in use since the 1970s was the standard for many years. With this option, we bring skin and muscle from the latissimus dorsi muscle to your chest to recreate your breast. In some cases, we may also place an implant to enhance your results. While not as many patients pick this option today, it’s a less complex procedure than some of the more advanced flap methods and it takes less time to perform. This technique, however, will result in a visible scar and can impact your ability to perform certain activities that use your back muscles, like swimming or skiing.
The TRAM Flap technique takes skin, fatty tissue, and muscle from your lower abdomen to rebuild your breast. Through an incision on your lower abdomen, the muscle is channeled upwards into the chest while still attached to its original blood supply. The removed skin is then grafted onto the breast to finish the reconstruction. A TRAM flap can produce remarkable symmetry without using a breast implant, with the added benefit of a firmer, smoother tummy. It’s important to note that this is a complex procedure that has additional risks associated with prolonged anesthesia. You will also spend more time in recovery and may experience loss of muscle strength in the future.
The advanced DIEP Flap method uses vascular microsurgery to provide the needed blood supply to grafted tissues. This surgical subspecialty harvests tissue with its small blood vessels in tact and reattaches them to the small blood vessels on the chest during the grafting process.
A DIEP Flap is like a TRAM Flap, but it does not remove any muscle. Your surgeon will take skin and fat, along with the small blood vessels that connect them to the rectus abdominis muscle, and channel them up to the breast area. He will then use microsurgery to connect the blood vessels to those on the chest so the grafted skin will survive.
Generally, a DIEP Flap provides the same benefits as a TRAM Flap without interfering as much with your stomach muscles. It is often performed at the same time as mastectomy. However, this surgery does require a plastic surgeon with specific training and skill in microsurgery and may not be an option if you do not have enough abdominal fat or skin to build the new breast.
If you want to learn more about these breast reconstruction methods, we encourage you to schedule a personal consultation with Dr. Cohen. During your appointment, he will answer your questions and help you fully understand your options.
Thank you so much for your dedicated, professional care and support during my recent surgeries to restore my body after a mastectomy. The cosmetic result is outstanding! Your surgical skills have brought me a long way from that numbing day when I first heard “I am sorry, but you have cancer.” I am grateful that there are professionals and administrative staff like those in your office who are selfless and generous in providing patient care.