The choices available for breast reconstruction can be very confusing and often daunting for patients. This can undoubtedly add stress to an already difficult situation.
As a plastic surgeon, it is my duty to help you navigate through your choices and make a decision that you are most comfortable with.
- Breast reconstruction is elective surgery and you may choose to pursue this option at any time.
- Health insurance companies are mandated by federal law to provide coverage for post-mastectomy breast reconstruction (Women’s Health and Cancer Rights Act (WHCRA) of 1999).
Breast Reconstruction Options
The options for breast reconstruction can be divided into breast implant (silicone) reconstruction or autologous (your own natural tissue) reconstruction. For most candidates, both types of reconstruction typically involve multiple stages in order to complete the process. Generally speaking, these stages include the reconstruction of the initial breast mound and nipple/areola reconstruction.
The number of stages involved depends on the clinical scenario, as well as the type of reconstruction used. Revisions are also performed as needed between the aforementioned stages in order to produce the best aesthetic result.
Types of Reconstruction
The following descriptions provide a general overview of the types of breast reconstruction available. They are not intended to be applicable to all clinical scenarios, as there are a number of differing and extenuating circumstances that can alter an individual’s reconstructive plan.
Breast Implant Reconstruction
Implant based reconstruction involves the use of silicone gel-filled implant devices to reconstruct the breast mound. Most commonly, this type of reconstruction is performed in several stages: insertion of a tissue expander, gradual inflation of the expander to the desired size, and eventual replacement of the expander for a permanent silicone implant.
- Acellular Dermal Matrices (a sheet-like material that provides additional coverage): At times, an individual’s anatomy prevents adequate chest muscle coverage of the tissue expander in the first stage of reconstruction. In this case, a sheet like material known as an acellular dermal matrix (i.e. Alloderm) may be used to provide additional coverage and support of the expander and subsequent implant. This material is eventually incorporated into your body and nearly functions like your own tissues. Nipple/areola reconstruction can usually proceed after 3‐4 months if desired.
Autologous Breast Reconstruction
Autologous breast reconstruction allows a patient to use her own tissue to reconstruct her breast(s). The result can be a very natural reconstruction that looks and feels like the original breast. The tissue used in autologous breast reconstruction can be taken from a number of safe and proven areas of the body, including the back, abdomen, inner thigh and buttock. Autologous breast reconstruction can be divided into two main categories: pedicled flaps and microvascular free flaps.
- Pedicled Flaps: In pedicled flaps, the native blood supply is left intact and is mobilized just enough to be able to move the tissue it supplies to the chest wall.
- Microvascular free flaps: In contrast to pedicled flaps, where the blood vessels supplying the tissue remain intact and connected to the patient at all times, in free flap surgery, the blood vessels supplying the tissue are disconnected from the patient’s body (hence the term free flap). These vessels are then reconnected to vessels in the chest wall to reconstruct the breast mound. This is an advanced type of reconstructive surgery and requires a higher level of training and technical skill to perform.
- Perforator flap surgery (Free flap surgery): In this advanced free-flap technique, the blood vessel(s) (i.e., perforator) supplying the tissue to be used is/are isolated and dissected free of the surrounding tissues. In essence, only the skin and fat are harvested and the muscle which the perforator travels through is preserved.
Discussing Your Options
If you have any questions, please feel free to contact my office and schedule an appointment. I will be more than happy to address any concerns and answer all your questions regarding this difficult decision.