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Breast reconstruction
Below are several procedures that may be used to re-create a breast mound following mastectomy:
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Reconstruction with implants: An implant is a silicone shell filled with saline (saltwater) solution or silicone gel. It is placed under the skin and muscle of the chest to create a breast mound. Silicone-gel-filled implants are under review by the Food and Drug Administration but may be used for patients undergoing reconstruction following mastectomy. Reconstructing a breast with an implant can take nine months to a year. Usually, the first step is to place a balloonlike device called a tissue expander under the skin and muscle of the chest. This is done at the time of the mastectomy. The expander slowly stretches the skin and chest muscle at the breast site to accommodate the implant. The patient then receives serial injections of saline, usually once a week, into the expander on an outpatient basis until the desired breast volume is achieved. This volume is greater than the reconstructed breast will be. The breast is left overexpanded for one to six months to help create a more natural appearance after implantation. After the expansion, the expander is reduced to the correct size to accommodate the implant. The expander is then removed and a permanent implant is put in place. In general, an implant makes the breast firmer than a natural breast.
TRAM flap surgery: One way to reconstruct the breast after a mastectomy is to use the transverse rectus abdominis mycutaneous (TRAM) flap procedure, which takes skin and fat from the abdomen. Sometimes surgeons leave the tissue connected to its own blood supply and pull it under the skin into position on the chest. Alternatively, the tissue may be moved to the chest and attached to different blood vessels. While this operation offers a bonus--a trimmer abdomen--it affects the abdominal muscle and can result in a loss of muscle tone. A variation of the operation has been developed that leaves much of the muscle intact. It is also possible to reconstruct the breast using tissue from the upper back in a similar procedure known as the latissimus flap.
DIEP flap surgery: The deep inferior epigastric perforator (DIEP) flap procedure is another option for women who would like a breast mound present immediately after their mastectomy and reconstruction with their own tissues. The DIEP is a small branch of a major artery. To be a good candidate for this procedure the patient must have an adequate supply of blood to the skin and fatty tissue. If so, no muscle needs to be taken, and muscle function is maintained. The DIEP procedure has several benefits: 1. A faster recovery period than traditional TRAM flap surgery; 2. No loss of abdominal muscle tone; 3. The "effect" of a tummy tuck because excess tissue is removed from the abdomen to reconstruct the breast. This procedure carries the risk of tissue death, or losing the flap.
SIEA surgery: This procedure involves the superficial inferior epigastric artery (SIEA), which is found in the lower abdominal area. The major benefit of this surgery is that the muscle is left intact; only skin and fat are removed, so muscle function is preserved. The blood supply must be reconnected, which means that there is a risk of tissue death, or losing the flap, at the time of surgery or within the first few days. The biggest factor in determining the likelihood of flap loss is the experience of the surgeon. Inadequate size of the patient's arteries often prevents the SIEA flap from being performed.
Nipple and areola reconstruction: The process of surgically re-creating a nipple and areola (the darker-colored skin around the nipple) begins about six to eight weeks after the implant has been put in place or reconstruction using a woman's own tissues has taken place. The surgeon creates a slight mound of tissue from skin. A tattoo may be applied to color the nipple and to create an areola. Both of these procedures are done on an outpatient basis.
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