Plastic Surgery- Breast Reconstruction

Breast reconstruction is probably the most common set of procedures people think of when you say reconstructive surgery. With 1 in 8 women being diagnosed with breast cancer, it’s no wonder why! Breast reconstruction specialists reconstruct the breast after breast cancer. Most people know about implant based reconstruction, but there are so many more ways to reconstruct a breast! Let’s go through a few.

The first option- do absolutely nothing. Patients can, for a variety of reasons opt to do absolutely nothing. She may have a lumpectomy or mastectomy and opt for no reconstruction. That’s ok! It should always be an option as reconstruction has the potential to increase surgical time, risk of infection, and recovery time. There are whole groups of women who choose this option, like the women of Flat and Fabulous. It is always important that this option is given to patients, as breast reconstruction is not a requirement.

Oncoplastic reductions- If a patient only needs a lumpectomy/partial mastectomy, she may be a candidate for a breast reduction at the same time. This allows the remaining breast tissue to be rearranged and lifted, hopefully concealing the defect left behind by the lumpectomy. This is one of my favorite procedures- breast conserving surgery has great benefits including the potential for preserving nipple sensation while avoiding the risks of implants or flap surgery.

Tissue Expanders/Implants– Also known as alloplastic reconstruction, this form of reconstruction uses an artificial implant to reconstruct the breast after a mastectomy. It can be done all in one surgery at the time of a mastectomy (direct to implant), in a two stage procedure (tissue expander first, then implant), or in even more stages if needed.

Flaps- A flap refers to using the patient’s own tissue to reconstruct another part of the body. A pedicled flap means that tissue remains attached to its own blood supply and does not require microsurgery to connect blood vessels. Pedicled flaps include latissimus (from the back) and TRAM (from the abdomen) flaps.

Free flaps, on the other hand, take tissue from a remote part of the body such as the abdomen, thigh, or buttocks to reconstruct the breast. The tissue is taken with a named blood supply (artery and vein), and reattached under a microscope to blood vessels in the chest (usually the internal mammary). The most common approach is the deep inferior epigastric artery (DIEP) flap. Which has the added bonus of a free tummy tuck- but buyer beware… this isn’t a cosmetic tummy tuck and the priority is always making a new breast first!

Breast reconstruction is an ENORMOUS topic so this barely scratches the surface of what can be offered to a patient with breast cancer. Breast reconstruction makes up the majority of my practice and is near and dear to my heart- drop any questions in the comments!

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