Breast reconstruction is a field of plastic surgery dedicated to restoring the breast shape.
This can be due to congenital problems, accidents or diseases. One of the most common reasons for breast reconstruction is replacing breast tissue that is lost during tumour removal surgery or during prophylactic mastectomy.
The goal of reconstructive procedures is to create breasts that look as symmetrical and as natural as possible.
Is breast reconstruction suitable for me?
Your breast reconstruction journey depends on different considerations, including your surgeon’s recommendation, personal preferences, physical condition and medical needs.
With one in eight women affected by breast cancer during their lifetime1, the field of breast reconstruction shows advancements with new technologies and surgical techniques.
While opting in for breast reconstruction can increase your self-confidence and self-esteem2, you should also consider that not all breast reconstruction procedures are a total success, additional corrective surgeries may be necessary, and the revision rate is higher than in augmentation breast surgery3.
For more information on potential complications of breast reconstruction with implants, see the ‘Risks and complications of an implant’ section.
Breast reconstruction - immediate or delayed?
The choice between immediate or delayed reconstruction is often determined by the need to undergo therapies that may negatively affect the outcome of reconstruction. Considering your medical condition and planned therapy, there are two options for reconstruction plan:
- Immediate breast reconstruction
Performed immediately and during the same surgical procedure for prophylactic mastectomy or a tumour removal. - Delayed breast reconstruction
Can take place from 6 to 12 months and up to several years after mastectomy or lumpectomy surgery, and where applicable also after the radiotherapy or chemotherapy that follow.
Main methods for breast reconstruction
Generally, reconstructive surgical methods can be performed as immediate or delayed reconstruction.
Autologous breast reconstruction:
In autologous reconstruction, the surgeon works with tissue taken from your own body. Generally, there are two types of flap surgeries:
- Pedicled flap surgery, in which the flap remains attached via the blood vessels to its original site at one end. For this type of flap reconstruction, surgeons often use the Latissimus dorsi or LD flap, a flap of muscle and subcutaneous tissue from the back, or the Transverse rectus abdominis musculocutaneous flap or TRAM flap, consisting of muscle and subcutaneous tissue from the abdomen, or the Gracilis flap or PAP (Profunda Artery Perforator) flap from the inner thigh.
- Free-flap surgery is more complex, where the flap is completely removed from the donor site and then micro-surgically reconnected in the breast area. Today, free-flap surgery is a very common procedure. Flaps used for this method are the Deep Inferior Epigastric Perforator flap, or DIEP flap, from the lower abdomen, the Superior or Inferior Gluteal Artery perforator flap – SGAP or IGAP flap - from the gluteal area.
Autologous reconstruction using fat transfer: Only minor defects in the breast can be corrected by using this technique, as the volume of fat obtained is lower than the volume that may be achieved with implants and it is not possible to reconstruct a complete breast. Autologous fat reconstruction might require several follow-up surgeries until the desired shape is achieved, as many of the transplanted cells tend to be destroyed by the body.
Hybrid approach to breast reconstruction:
A hybrid approach is a combination of reconstruction methods. For example autologous reconstruction can often be combined with implants, in cases where the desired aesthetic result of the reconstructed breast cannot be achieved using only the patient’s own tissue. In some cases, fat transfer may also be used for “touch ups”, in the same procedure or in several following procedures, until the aesthetic result is achieved.
Implant-based reconstruction:
Nearly all patients are suitable for immediate reconstruction with breast implants. However, if radiation therapy is necessary following the initial surgery, it may increase the complication rate with breast implants and therefore immediate reconstruction may not be the first choice.
Delayed reconstruction requires several steps. Firstly, the skin must be expanded using a tissue expander. A tissue expander is a special type of temporary implant that is inserted unfilled and is then over the course of several weeks the expander is filled with saline solution via a remote or an integrated valve, to slowly expand the skin until there is enough tissue to insert a permanent implant. Then, the expander is replaced with the permanent implant in the desired size.
Your reconstructive surgeon:
Your surgeon will be able to walk you through the best options for you, considering your treatment plan, your health needs and for the best aesthetic outcome over time.
Sources:
1. American Cancer Society. Breast Cancer Facts & Figures 2017-2018. Atlanta: American Cancer Society, Inc. 2017.
2. Roje et al., Breast reconstruction after mastectomy, Coll Antropol. 2010 Mar;34 Suppl 1:113-23. Trejo-Ochoa et al., Impact on quality of life with breast reconstructive surgery after mastectomy for breast cancer, Ginecol Obstet Mex. 2013 Sep;81(9):510-8.
3. American Cancer Society. Should I get breast reconstruction surgery? Available at https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/should-i-get-breast-reconstruction-surgery.html