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When mastectomy or lumpectomy is performed to treat breast cancer by removing one or both breasts, the effect of the surgery can be disfiguring and traumatic for women and their spouses. Many breast cancer survivors who have undergone surgery to remove cancerous breast tissue seek breast reconstruction surgery to restore the appearance of their breasts and sense of femininity.
About Breast Reconstruction
Breast Reconstruction After Mastectomy
Rebuilding your breasts after breast cancer treatment
Breast reconstruction surgery may be performed at the same time as or any time after mastectomy - whether it’s weeks, months or years. However, it is often advisable for patients to wait until all incidences of breast cancer have been successfully treated and resolved before pursuing additional surgery. The decision of when to undergo breast reconstruction is one Dr. Motlagh and your cancer treatment team can help you make depending on your unique needs.
Know that when you decide to pursue breast reconstruction, you have several options. These options include breast implants or tissue expanders and a variety of flap techniques for breast reconstruction, including TRAM flap and free flap (DIEP flap) procedures.
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Breast Implants and Tissue Expanders
Implant reconstruction and tissue expansion
Standard breast augmentation surgery using saline breast implants, silicone breast implants or gummy bear breast implants may be performed as a means of one-step breast reconstruction that does not require multiple procedures unless a tissue expander saline implant is used.
Tissue expanders are only needed to gradually re-inflate the breast pocket in patients who have completely healed from mastectomy long before breast reconstruction is attempted.
To assist with breast implantation after mastectomy, Alloderm, a tissue matrix composed of donated human skin, is commonly used in breast reconstruction to provide a foundation for tissue regeneration. This helps new natural tissues to grow surrounding the breast implants and will help reconstructed breasts achieve a more natural appearance over time.
Most plastic surgeons do not favor this method of breast reconstruction because results typically do not look as natural as the results that can be achieved with other reconstructive breast procedures, but for patients who are not candidates for or do not wish to pursue a flap breast reconstruction procedure, breast implants may certainly be a suitable reconstruction option.
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Flap Breast Reconstruction
Flap surgery to rebuild breasts
Flap breast reconstruction, regardless of the technique, basically refers to transferring tissue from one area of your body to the chest in order to reconstruct your breasts without implants or tissue expanders.
The main differences between each of the most popular flap procedures—TRAM flap and free flap (DIEP flap)—are twofold:
- TRAM flap surgery involves removing skin, fat, blood vessels and muscle from the abdominal donor site, whereas free flap surgery does not remove muscle from the abdomen.
- Free flap, or DIEP flap, surgery involves blood vessel microsurgery to attach donor tissue blood vessels to the chest, whereas TRAM flap surgery simply leaves the abdominal blood vessels attached to the donor tissue when moving it up to the chest.
TRAM flap surgery may also be performed as a free flap procedure. In this case, it is very similar to the DIEP flap procedure in that blood vessel microsurgery is performed instead of leaving attached and tunneling donor tissue blood vessels up to the chest. However, a small amount of abdominal muscle is still removed with free TRAM flap surgery, which is not done with DIEP flap surgery.
Both flap breast reconstruction surgeries can produce a very natural-looking result that will last much longer than breast implants; however, flap surgery is more extensive and takes much longer than breast implant surgery, and therefore may be riskier.
Instead of focusing on the nuances of each flap surgical technique used for breast reconstruction, choose a Tyler breast reconstruction surgeon who has the skill and experience needed to recommend the technique that will provide you with the best possible results.
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Nipple Reconstruction
Re-creating your nipples and areolas
Many patients do not realize that the nipple and areola are composed of breast tissue and may need to be removed if breast cancer occurs. Thus, breast reconstruction procedures oftentimes include surgery to restore the nipples, as well as the application of permanent makeup or cosmetic tattooing to restore a realistic tone to the skin of the reconstructed nipple and areola.
Nipple reconstruction is typically performed about 8-10 weeks after breast reconstruction procedures are complete.
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Breast Reconstruction Scars
Setting realistic expectations for scarring
Flap surgeries will cause the most scarring after breast reconstruction, as these procedures require tissue to be removed from elsewhere on the body before they are applied to the breast. Breast implants and tissue expanders are the least invasive and result in the least amount of scarring.
Incision scars will of course be present on the breasts and nipples after mastectomy or lumpectomy, and oftentimes these same incisions can be used for breast reconstruction. For flap breast reconstruction procedures, scars may also be located on the abdomen and occasionally the back or buttocks, depending from which donor sites are used to collect tissue.
Tram flap breast reconstruction scars
 
Scars are inevitable part of any surgical procedure, and it is very uncommon for a mastectomy patient to regret having breast reconstructive surgery to correct disfigurement following whole or partial removal of one or both breasts, despite some scarring.
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Breast Reconstruction Recovery
After your breast reconstruction surgery
After breast reconstruction, most patients will need 1-2 weeks to recover from the procedure, during which time tiredness, soreness and discomfort will need to be managed with medication. The initial recovery period may be longer in cases where reconstructive surgery is performed in conjunction with other procedures, including mastectomy, lumpectomy or areola and nipple restoration.
Stitches can generally be removed within 7-10 days following breast reconstruction surgery, and patients can expect to achieve full recovery about 1-2 months after each breast reconstruction procedure.
Breast reconstruction surgery generally involves a series of at least 3-4 procedures performed weeks to several months apart, and each procedure will entail a recovery period.
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