The decision to have breast reconstruction after a mastectomy is a personal choice. There are many factors which contribute to this decision and they include both the medical and surgical aspects such as diagnosis, chemotherapy or radiation therapy, as well as the psychosocial factors of emotional well-being, a sense of self, and a desire to feel ‘whole again.’
Recreating a breast after mastectomy can be accomplished by placing a temporary tissue expander under the skin and chest muscle. The tissue expander has a tiny valve into which a salt-water solution can be injected in order to stretch the skin over time. After the tissue expander is fully expanded to its desired volume, another procedure is required to exchange this for a permanent saline or gel-filled implant.
In select patients, this procedure is possible. Direct to implant reconstruction eliminates the need for placement of an expander. An implant may be placed under the muscle at the time of mastectomy.
Another method for reconstructing the breast is to use your own tissue. One type of autologous tissue reconstruction is a microsurgical transfer called a free flap procedure. The transferred flap can come from a patient’s abdomen, inner thigh or buttocks depending on available tissue and patient preference. In the free flap procedure, the tissue is completely disconnected from the donor site and reattached at the chest. Since the surgeon often needs to use an operating microscope to sew together small blood vessels from the flap to blood vessels at the chest (microsurgery), an expert surgical team is required. This is available through the Margie Petersen Breast Center.
The most common site of tissue used is the lower abdomen. The tissue removed is done in such a way as to preserve muscle function and results in an appearance similar to that of a “tummy tuck.” This procedure is commonly called a DIEP or DIEAP (Deep Inferior Epigastric Perforator or Deep Inferior Epigastric Artery Perforator) flap reconstruction.
Another method of reconstruction using your own tissue is a latissimus dorsi flap. In this procedure, skin, fat and muscle from your back is used and moved to the front of your chest, usually to cover an implant or tissue expander.
For those who have had the nipple and areola removed at the time of mastectomy, reconstruction of the nipple and areola is possible. Several techniques are available and would be discussed with the plastic surgeon and your breast surgeon.