Breast reconstruction is an option for women who have undergone a single or double mastectomy or lumpectomy. It may be performed at the same time as the lumpectomy/mastectomy, or at a later date. The reconstructed breast may be made from the patient’s own tissue, an implant, or both. Most reconstructions will require either a flap technique or a tissue expansion. Fat transfer is now increasingly being used to augment and refine the results of these two main techniques.
This procedure moves muscle, fat and skin from other areas of the body to the chest wall. The tissue may be “tunneled,” which means it remains attached to the blood supply in its original location, or it may be detached and transplanted to the chest. Transplanted tissue is then connected to a new blood supply by microsurgery on the blood vessels. Donor tissue may be taken from the back, abdomen, or buttocks. The donor tissue may be sufficient to form a breast mound, but typically it’s used to support an implant.
While an implant alone may be an option for a woman with small breasts and sufficient chest tissue, most implants will require tissue expansion to prepare the site for an implant. In this procedure, an expander is placed under the skin at the site of the breast to be reconstructed. The expander is then slowly enlarged with injections over a period of several months to stretch the skin and surrounding tissues to create a pocket for the implant. The expander is later removed and replaced with a non-expanding implant.
Following breast reconstruction surgery, an elastic bandage or a surgical bra will minimize swelling and provide support. As healing progresses, the swelling will diminish and the breast’s shape and position will improve. While these procedures creates the shape of a breast, it’s important for patients to understand that the reconstructed breast will not have the same sensation of a natural breast, though it may become more sensitive to touch over time. Patients also have options for recreating the appearance of an areola and nipple.
Reconstruction can also restore a more natural appearance to a breast that has undergone a lumpectomy. Because there are so many variables, reconstruction after lumpectomy may involve filling the affected area with donor tissue or a more extensive procedure such as those described above. In patients who have had a lumpectomy or mastectomy on a single breast, surgery on the natural breast may be a desirable option to provide a symmetrical appearance.