How Do They Reconstruct a Breast after a Mastectomy?
If you and your Breast Surgeon make the decision to have a total mastectomy, you will be referred to a Plastics and Reconstructive Surgeon to learn about the reconstructive process. Reconstruction can be done at the same time of the mastectomy, as an immediate reconstruction, or delayed after oncologic treatment is complete. Breast reconstructive surgery involves two primary methods: implant-based or autologous reconstruction.
Types of Breast Reconstruction Procedures
- Implant-Based Reconstruction
Implant reconstruction uses an implant to rebuild the breast mound. The implants are primarily made of either saline or silicone gel and come in a variety of sizes.
The reconstruction can be done in one surgery, known as direct-to-implant reconstruction; however, the majority of cases are done in stages. At the time of the first surgery, a tissue expander is placed. The expander is filled to the desired size in the office and then later exchanged for the final implant at another surgery.
Implants can be a good option for some patients, but they do require “maintenance,” as they are not lifetime devices. This usually requires a future surgery to replace the implant (approximately every 10 to 15 years).
- Autologous Reconstruction
Autologous or flap surgery means using one’s own skin and fat tissue to reconstruct the breast mound. This tissue is removed from the donor site and transplanted to the breast. Several donor sites are available for tissue transfer, including the abdomen (DIEP flap), thighs (PAP flap), or buttocks (SGAP or IGAP flap).
Historically, patients underwent a TRAM flap, which involved harvesting the abdominal muscles in addition to the skin and fat. As surgical techniques have evolved, we have transitioned to muscle sparing techniques like the DIEP flap, which avoids the abdominal morbidity common to the prior TRAM flap procedure.
The abdominal fat has a consistency similar to that of the breast tissue, allowing for a more natural appearing and feeling breast reconstruction, and it does not require any long-term maintenance procedures.
Breast reconstruction can significantly improve a woman’s morale and self-esteem throughout their survivorship journey. Some women view breast reconstruction surgery as a symbolic step to close the cancer chapter and feel whole again.
FAQs
Reconstruction can be done either immediately at the same time as the mastectomy, or it can be delayed until after oncologic treatment (such as chemotherapy or radiation) is complete. Your surgical team will help determine the best timing for your individual situation.
The two primary methods are implant-based reconstruction, which uses saline or silicone implants to rebuild the breast mound, and autologous (flap) reconstruction, which uses your own skin and fat tissue harvested from another part of your body.
In direct-to-implant reconstruction, the final implant is placed in a single surgery. In the more common staged approach, a tissue expander is placed first, gradually filled to the desired size in the office over time, and then exchanged for the permanent implant in a second surgery.
No implants are not lifetime devices and require ongoing maintenance. Patients can typically expect to need a replacement surgery approximately every 10 to 15 years.
Both use abdominal tissue for reconstruction, but the key difference is muscle preservation. The older TRAM flap involved harvesting the abdominal muscles along with the skin and fat, which could lead to significant abdominal complications. The DIEP flap is a muscle-sparing technique that takes only skin and fat, avoiding those complications while still achieving natural results.
Several donor sites are available depending on the patient’s body and preferences, including the abdomen (DIEP flap), thighs (PAP flap), and buttocks (SGAP or IGAP flap). Your reconstructive surgeon will help identify the most suitable option for you.
No — one of the key advantages of autologous reconstruction using your own tissue (such as the DIEP flap) is that it does not require long-term maintenance procedures. The reconstructed breast ages naturally with your body and typically does not need replacement surgery over time.