What is Breast Reconstruction?

Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.

Enhancing your appearance with Breast Reconstruction

Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.

The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life. Although surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed.

What happens during breast reconstruction surgery?

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – Flap techniques reposition a woman’s own muscle, fat and skin to create or cover the breast mound.

Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion.

A TRAM flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.

Alternatively, your surgeon may choose the DIEP or SGAP flap techniques which do not use muscle but transport tissue to the chest from the abdomen or buttock.

 
 

A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.

 
 
 

Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.

 
 
 
 

Step 3 – Tissue expansion stretches healthy skin to provide coverage for a breast implant.

Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process.

It requires many office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin.

A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.

Step 4 – Surgical placement of a breast implant creates a breast mound.

A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction.

Your surgeon will help you decide what is best for you. Reconstruction with an implant alone usually requires tissue expansion.

Step 5 – Grafting and other specialized techniques create a nipple and areola.

Breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola

Breast Reconstruction Surgery – Procedure Steps

1. Anesthesia

Patients receive medications designed to keep them asleep during their breast reconstruction surgery.

2. Dr. Thomassen Will Perform a Flap Technique to Reposition Muscle, Fat and Skin or Place a Tissue Expander

Many times, radiation therapy and/or the surgical removal of the breasts leaves an inadequate amount of tissue on the woman’s chest wall. Insufficient tissue makes covering and supporting the breast implant impossible; therefore, the expansion of tissue or a flap technique is almost always necessary.

In Fort Lauderdale, the following flap techniques can be used to cover or create the breast mound:

  • A Free TRAM Flap refers to a procedure where Dr. Thomassen excises skin, fat, muscle and blood vessels from the wall of the lower abdomen and then moves it up to the patient’s chest. Dr. Thomassen takes care to reattach the blood vessels using microsurgery techniques.
  • A Muscle-Sparing Free TRAM Flap refers to a procedure where Dr. Thomassen only uses a portion of the rectus abdominis muscle to create the flap.
  • A Pedicled TRAM Flap involves moving the patient’s fat, blood vessels, skin and muscle from the wall of the lower abdomen to the chest: These tissues remain attached to their original blood supply. Dr. Thomassen gently moves these tissues beneath the patient’s skin from her abdomen to her chest. It may take longer to recover from a pedicled TRAM flap than it will to recover from a muscle-sparing free TRAM flap procedure because it requires the use of a larger portion of the rectus abdominis muscle.
  • SGAP or DIEP Flap Techniques do not use muscle: Instead, the tissue is transported from the patient’s buttock or abdomen.

A tissue expansion can be used to stretch healthy skin:

  • Although reconstructing the breast via tissue expansion offers an easier recovery for women in Fort Lauderdale than the recovery experienced following a flap procedure, the reconstruction process itself is lengthier. Breast reconstruction through tissue expansion requires numerous visits to Thomassen Plastic Surgery in Fort Lauderdale. These visits occur over a period of 4 to 6 months. During these visits, a previously placed expander is slowly filled via an internal valve; thus, promoting skin expansion.

If the expander itself is not meant to serve as the implant, a second surgical procedure is necessary.

3. Implant Placement

Patients who want reconstruction with just an implant will need to have tissue expansion techniques performed prior to their breast reconstruction surgery. Once tissue expansion is complete, a breast implant can be used an alternative to flap techniques in the creation of the breast mound. Furthermore, an implant can be used in addition to the flap technique.

4. Dr. Thomassen Uses Specialized Techniques and Grafting to Create the Patient a Nipple and Areola

To complete the breast reconstruction procedure, Dr. Thomassen uses a variety of techniques to reconstruct the nipple and areola.

5. Recovering from a Breast Reconstruction Procedure

Following the surgery, bandages and/or gauze is applied to the incisions. Patients also receive a support bra or elastic bandage to reduce swelling and support their reconstructed breasts. Dr. Thomassen may place a small tube just beneath the skin to drain extra fluid and blood. Patients may also receive a pain pump.

All patients receive specific instructions that relate to their particular surgery. These instructions include information about medications, follow-up appointments and symptoms that indicate the patient needs to seek medical attention.

Results

It takes several weeks for inflammation to decrease and the breasts’ shape and position to improve. As time passes, many women will experience the return of some breast sensation, scar lines will become less visible; however, they will never disappear completely.

If you have had a mastectomy and are interested in learning more about the breast reconstruction procedures that are available in Fort Lauderdale, contact Thomassen Plastic Surgery today.