Reconstructive Surgery

farha breast cancer surgeon reconstructive surgery

 Maeh Farha, MD, FACS, breast surgeon and director of the Breast Center at MedStar Union Memorial

Breast reconstruction is a surgical procedure that restores the appearance of a breast for women who have had their breast removed due to tumors and/or cancer. A plastic surgeon rebuilds the size and shape of the breast using local tissue rearrangement or artificial implants. The nipple and areola can also be reconstructed.

The techniques for achieving excellent post-surgery appearance have greatly improved over the last few years. However, it is important to note that the goal of reconstruction is to restore symmetry of the breasts when clothed—the difference between the reconstructed breast and the unaffected breast will still be seen when unclothed. Reconstruction will also not restore normal sensation.

Of course, this is an optional surgery. If you decide on breast reconstruction, you and your doctors will evaluate the best timing to do so. Breast reconstruction can take place during the mastectomy operation (immediate reconstruction) or at a later date, after other necessary treatments are given (delayed reconstruction).

  • Immediate reconstruction is performed at the same time as the mastectomy. The entire breast is removed, and a new one reconstructed immediately. With immediate reconstruction, the chest tissues are undamaged by radiation therapy or scarring. Also, immediate reconstruction means one fewer surgeries.
  • Delayed reconstruction is performed at a later time. For some women, this may be recommended if radiation is to follow mastectomy, as radiation therapy after breast reconstruction can increase post-surgical complications.

Breast reconstruction includes a variety of advanced surgical procedures that work to restore the breasts, typically after breast cancer and mastectomy. The goal of breast reconstruction is to minimize psychological stress caused by the loss of a breast. There are several different possible techniques, including TRAM flap, free flaps, and prosthetic implants.

Breast Reconstruction with Flaps

Tissue from your own body can be used to recreate the breasts after mastectomy. Because these flap procedures can produce natural-looking results and forgo the use of synthetic implants, there is a growing interest in them among some breast reconstruction patients.

Two basic types of tissue flaps may be used: pedicled flaps, which retain an attachment to the original blood supply, and free flaps, which do not, and involve microsurgery to create a new blood supply.

  • Deep Inferior Epigastric Perforator (DIEP) Flap: The DIEP flap is a breast reconstruction technique that involves transfer of soft tissue from the abdomen to the new breast. The DIEP technique allows reconstruction of the breast without implants and usually without movement of muscle tissue. Skin and fat from the lower abdomen are transferred to the chest wall, along with blood vessels, which are grafted to the new site with microsurgical techniques.
  • Superior Gluteal Artery Perforator (SGAP) Flap: The SGAP flap moves tissue from the buttock and hip area to the new reconstructed breast. Using microsurgery, blood vessels from the perforator flap are then connected to the internal mammary vessels on the chest. The SGAP technique may be appropriate for any mastectomy patient, and is often recommended for those who exhibit defects resulting from previous breast surgery. This procedure provides very acceptable aesthetic contour at the buttock donor site.
  • Superficial Inferior Epigastric Artery (SIEA) Flap: The SIEA flap is an alternative to the DIEP flap, and also involves the transfer of skin and fatty tissue from the abdomen to one or both breasts. The SIEA technique does not harvest abdominal muscle, so it can preserve abdominal strength and contour and minimize downtime after the procedure.
  • Transverse Rectus Abdominus Musculocutaneous (TRAM) Flap: The TRAM flap is a method of breast reconstruction that moves muscle, skin and fat from the abdomen to the new breast. Candidates for TRAM flap include patients who have desire or need their breasts reconstructed with their own tissues but are not good candidates for free-flap reconstruction.

Breast Reconstruction with Expanders

Tissue expanding implants, also known as Becker implants, are often used during breast reconstruction to facilitate recreation of the breast mound. Your plastic surgeon inserts the expander beneath the pectoralis muscle and gradually fills the implant with saline. Once the tissue has stretched to accommodate the desired implant volume, the breast mound can be restored, along with reconstruction of the nipple and areola.

Fat Grafting for Breast Deformities

Fat grafting can improve the cosmetic result of breast reconstruction. During this procedure, fat is taken from elsewhere in the body using a low-pressure liposuction method, which uses a syringe. The fat is washed gently with saline and then injected into contour depressions along the margins of reconstructed breasts. The technique has limitations and risks, but overall it is a safe alternative to more complicated procedures that achieve similar results.

Breast Reconstruction with Implants

Implant breast reconstruction remains one of the most popular techniques available, with a high rate of patient satisfaction. Saline or silicone gel-filled breast implants can be used to recreate the breast mound.

  • Revision Breast Reconstruction: Breast reconstruction is often performed in stages. After the operation is complete, revision procedures can be performed to improve aesthetic appearance or correct unexpected complications.
  • AlloDerm Placement: AlloDerm, a type of acellular dermal matrix, is a biologic material that acts as a soft tissue substitute during breast reconstruction. The material closely resembles normal dermis and integrates nicely with existing tissue. Typically used in expander or implant-based reconstruction, AlloDerm supports and provides coverage of the breast implant.

Learn more about breast reconstructive surgery in the video below: 

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