Reconstruction is surgery performed to recreate the appearance of a breast in women who have had a mastectomy. Breast reconstruction may be done during the mastectomy or at a later time. If you are thinking about reconstructive surgery, talk to your doctor about all the options so you can choose the best one for you.
Reconstruction options
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Breast implant. Placing a breast implant involves the least amount of surgery, compared to other types of breast reconstruction. For most women, this is done in two steps. First, the skin and muscle that remain after mastectomy are stretched over a period of two to three months. This is done with a tissue expander that is placed under the chest muscle at the time of mastectomy. The tissue expander is increasingly enlarged until the skin and soft tissue can hold the breast implant. Then, in a second operation, the expander is replaced with a breast implant.
Occasionally, breast implants can move or be associated with painful scar tissue. This may require additional surgery to correct the problem. Radiation therapy to the breast implant area increases the risk of complications, including infection and painful scar tissue. Occasionally, implants leak fluid.
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TRAM flap. TRAM is short for transverse rectus abdominis muscle — a muscle located in the abdominal wall. In a TRAM flap reconstruction, a section of skin, fat, and muscle is repositioned from the abdominal wall to the breast area and the navel (belly button) is reconstructed. The tissue is shaped into a natural-looking breast and sewn into place. This is the most popular type of reconstruction. When a TRAM flap is not possible, a muscle from the back may be used (latissimus dorsi flap).
This procedure results in a hip-to-hip abdominal scar, at the level of the navel (belly button). You will not have sensation in the reconstructed breast or breasts, because most of the nerves to the skin are removed during surgery.
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Latissimus dorsi flap. Latissimus dorsi is a back muscle located just below the shoulder blade. In this type of reconstruction, skin, fat, and latissimus dorsi tissue are moved from the back to the breast area, leaving as many blood vessels as possible intact. The procedure is very similar to the TRAM flap, but it is used mainly for women with small to medium breasts because there is much less tissue in the back than in the abdomen that can be used to create the new breast.
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Nipple reconstruction. A reconstructed breast has no nipple, but you have a range of choices to address the issue. You may choose not to have nipple replacement, or you can choose to have nipple reconstruction surgery. Talk to your doctor about which option might be right for you.
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Prostheses. Also called breast forms, prostheses are a nonsurgical option for recreating the shape of your breast or breasts when you are wearing clothes. Breast prostheses fit inside a bra or come preinstalled in clothing, including swimsuits and lingerie. They come in a variety of shapes, sizes, and materials, such as silicone gel, foam, or fiberfill.
