Breast Cancer - Reconstruction

One of the treatment options with breast cancer is a mastectomy, or removal of the breast. Depending on risk factors and genetic issues, some women have both breasts removed. Reconstruction is the rebuilding of one or both breasts. Reconstruction cannot completely replace a lost breast, but some women decide to have it done either at the time of the mastectomy, which is immediate reconstruction or at a later date, known as delayed reconstruction. It is a very personal decision that is usually based on how the patient feels about their body and breasts. Some women chose to have no reconstruction and use what is called a breast form.

One type of reconstruction makes use of synthetic implants. They can be either silicone filled or saline filled. Sometimes a temporary expander will be used if the implant is too large to insert under the skin and muscle of the chest wall. When an expander is used, it is injected every few weeks with a small amount of saline to gently stretch the skin and muscle to the size of the implant, at which time the actual implant will be inserted. This usually takes three to six months.

The other type of reconstruction makes use of the patient's own tissue. The tissue is transfered from another part of the body and consists of skin, muscle and fat - a myo-cutaneous flap, or just a flap. This is a fairly extensive procedure and not without a degree of risk. It is painful, both where the tissue is taken from and at the breast area, but it also provides the most natural looking results. The three different types of flap are the TRAM flap, which uses the abdominal muscles, the LAT flap, which uses the muscle from the upper back, and a Free Flap, which can be from the abdominal area or buttocks.

The TRAM flap involves cutting into the abs. The muscle, fat and skin are removed and pulled up to the breast area. The blood vessels are kept intact during the procedure. The flap is shaped into the form of the breast. Usually a good match to the other breast can be made and no implant is required in addition to the flap. The patient receives a tummy tuck as part of the deal, but runs the risk of developing a hernia from where the flap was removed.

A LAT flap follows the same procedure, using the latissimus dorsi muscle instead. The flap is pulled through a temporary tunnel, which is created under the skin from the back to the breast area. Because of the smaller size of the flap, an implant is usually added to make the breast larger.

The Free flap is the most technical of the three and involved the disruption of the blood supply to the flap during surgery. For this reason, you must have a surgeon that is skilled in microsurgery.

Another part of the reconstruction process involves nipple and areola recreation. In this procedure, a piece of skin is removed from another part of the body, the abdomen, leg or breast itself and shaped into a nipple. After it has healed, an areola is tattooed around the reconstructed nipple.

The reconstruction decision is a very personal one and since it involves surgery times of up to 4-5 hours under anesthesia, it's not one to be taken lightly.