Know Your Breast Reconstruction Options
Any woman facing mastectomy because of breast cancer has the right to have breast reconstruction. Breast reconstruction is not a cosmetic surgery procedure and is covered by insurance plans as long as the mastectomy is covered. There are many reconstructive options to choose from.
When the breast reconstruction is performed at the same setting as the mastectomy it is referred to as “immediate” reconstruction. The biggest advantage of immediate reconstruction is that the patient wakes up from the surgery still “whole” and completely avoids having to live without a breast. Other advantages include shorter scars and, generally speaking, a better cosmetic result.
“Delayed” reconstruction generally takes place after the mastectomy has healed. Many times patients required to undergo radiation following their mastectomies are advised to delay reconstructive surgery in order to achieve the best results. It is common to wait several months after the last radiation therapy session before proceeding with reconstruction to allow the soft tissues to recover completely from the radiotherapy.
Tissue expander reconstruction is the most common method of breast reconstruction in the United States. Most plastic surgeons perform this as a two-stage procedure. The expander is used to stretch the skin envelope and create the size of breast the patient and plastic surgeon desire. The expander is replaced by a permanent breast implant (saline or silicone) at a separate procedure some time later. Some patients are candidates for one-step implant reconstruction (without expanders): a permanent breast implant is inserted immediately without going through the whole expansion process. In the one-step implant reconstruction the implant is completely covered by the pectoralis muscle and an acellular dermal graft (like Alloderm or FlexHD). These grafts are cadaveric tissue implants that provide support and increase the amount of padding over the implant.
Implant reconstruction is completely different to cosmetic breast augmentation with implants. Since there is a lot less tissue padding over the implant (it is removed by the mastectomy), the risk of developing implant-related problems like hardening is much higher in mastectomy patients. Implant reconstructions generally speaking also do not do as well as tissue reconstructions in the setting of radiation.
The Latissimus procedure uses muscle (latissimus dorsi), fat and skin from the back (below the shoulder blade) that is brought around to the chest to create a new breast. Many patients also need an expander or implant to obtain a satisfactory result in terms of size. Patients typically have a scar on their back that can be seen with some low-cut clothing. Women who are very active in sports may notice some strength loss with activities like golf, climbing, or tennis.
TRAM flap surgery is a common procedure that uses skin, fat and varying amounts of the sit-up muscle (rectus abdominis) from the lower abdomen. The tissue (or flap) is then relocated to the chest to create the new breast. This procedure also results in a tightening of the lower abdomen, or a “tummy tuck”. Unfortunately, sacrifice of all or part of the abdominal muscle can result in bulging (or “pooching”) of the abdomen and even a hernia.
DIEP flap breast reconstruction has replaced the TRAM flap as today’s gold standard in breast reconstruction. The DIEP flap uses only skin and fat. This is disconnected from the lower abdomen and reconnected to the chest area using microsurgery to create a new breast. Since all the abdominal muscles are saved, patients do not have to sacrifice their abdominal strength. They also experience less pain and have a quicker recovery than TRAM patients. The risk of abdominal bulging and hernia is also very small. The SIEA flap is a variation of the DIEP flap. It is associated with an even easier recovery and a 0% hernia risk but requires specific anatomy which not all patients have. Like the TRAM, the DIEP and SIEA procedures also provide a simultaneous tummy tuck.
Women who do not have enough abdominal tissue for reconstruction may be eligible for the GAP (buttock) or TUG (upper inner thigh) flap procedures. The resulting scars are generally easily hidden by most underwear.
Unfortunately, advanced microsurgical procedures like the DIEP, TUG and GAP procedures are complex, require extra training and generally are not well reimbursed. For these reasons, they are not routinely offered by plastic surgeons in this country and most patients have to travel to centers specializing in these breast reconstruction surgery options.
Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction, particularly DIEP breast reconstruction surgery. In-network for most US insurance plans. PRMA Plastic Surgery, San Antonio, Texas. (800) 692-5565.
Tagged with: breast cancer • Breast Cancer Articles • breast cancer reconstruction • breast implants • breast reconstruction • breast reconstruction surgery • diep flap • health • mastectomy • medicine • plastic surgery • reconstructive breast surgery • tram flap
Filed under: Breast Cancer Articles
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I agree with your suggestion there is no harm in attempting such.
Just as women can be self-conscious about their looks and difficulties all of their own. Surgeons understand that these difficulties can cause self-esteem issues, an inability to exercise, difficulty with posture, backache and unwanted attention.They are working hard in the same field for many years to find many new things which are easy and can make their patients feel comfortable and easy goo satisfied customer after the surgery.