Breast Health Program


Following skin sparing mastectomy, breast reconstruction often begins during the same surgical operation. One form of reconstruction uses breast implants to reconstruct the breast mound. If there is adequate skin after the mastectomy, the implants can be inserted immediately. If there is not enough skin to create a breast of the desired size, a temporary tissue expander can be placed to stretch the skin over a few weeks to months. The implants are most often placed behind the muscle to recreate the breast mound. The surgery is well tolerated and adds moderate additional surgical time. If radiation therapy is anticipated, reconstruction may be delayed allowing for the treatment. The implant type will be determined by your reconstructive surgeon.

Immediate implant placement

Your breast surgeon and reconstructive surgeon will determine if you are a candidate for placement of permanent implants at the time of your mastectomy.

Several factors determine whether this is possible, including:

  • Type of cancer.
  • Size of your native breast.
  • Looseness of your skin.
  • Desired size of your reconstructed breast.
  • Potential for radiation therapy.

Tissue expanders

For many women, tissue expanders are required to stretch the skin to achieve the desired cosmetic results after mastectomy. When there is a discrepancy in size of the breasts, radiation therapy is indicated or a larger breast mound post mastectomy is desired, then expanders may be required.

Several factors determine whether this is possible, including:

  • Small native breasts.
  • Desire for larger reconstructed breasts.
  • Radiation therapy planned.
  • Delayed reconstruction.

Nipple areola reconstruction

Nipple areola reconstruction is completed at a later stage regardless of the type of reconstruction chosen. The areola nipple complex creation surgery is an outpatient procedure and the final touch is tattooing of the areola complex.

Risks of implant reconstruction

  • Skin necrosis
  • Infection
  • Hematoma/seroma
  • Asymmetry
  • Capsular contracture
  • Implant extrusion
  • Deflation
  • Rupture
  • Pain
  • Delayed wound healing

Tissue reconstruction

A muscle flap can be utilized to recreate the breast and is an excellent alternative to implant reconstruction.

Free flap reconstruction – A free flap means the tissue is surgically removed from where it was attached and the blood vessels are then reattached to the vessels on the chest wall. The flaps can come from the latissimus (back) muscle, the rectus (abdomen) muscle and the gluteal (buttock) muscle. Free flap reconstruction has an increased risk of the flap dying or becoming compromised due to the microscopic vascular connection and the surgery time will be longer than in implant reconstruction.

DIEP flap –The DIEP, or deep inferior epigastric perforator, flap uses the same skin island as the TRAM flap (below) but preserves all the rectus muscle and anterior rectus fascia, potentially reducing the risk for abdominal wall weakness and subsequent hernia formation or lower abdominal bulge. The skin island in the DIEP flap is based on one or more perforating branches off the deep inferior epigastric artery and vein.

Latissimus flap – The latissimus muscle from the back can be used in conjunction with a small implant. The surgery is longer than implant alone, but is an excellent choice to reconstruct a previously radiated breast or chest wall.

TRAM flap – The trans rectus abdominis myocutaneous, or TRAM, flap uses the lower abdominal skin, muscle and fat to recreate the breast. The skin, fat and muscle are disconnected from the lower portion of the abdomen and then a tunnel is made under the upper abdomen and is attached to the chest where the breast previously resided. The flap remains attached to its original blood supply. This procedure adds four to five hours to the surgery and adds significant postoperative recovery time for the patient. Patients who smoke, have midline lower abdominal incisions, are morbidly obese or have other health issues may not be candidates for this reconstruction.

SIEA –Superficial Inferior Epigastric Artery, SIEA, flap was described as the true abdominoplasty flap for breast reconstruction. It is based on the superficial inferior epigastric vessels, which arise from the common femoral vessels and course through the subcutaneous tissues. The harvest of this flap does not violate the anterior abdominal wall fascia or musculature and as a result, patients experience less post-operative pain, quicker recovery and no chance of hernia formation. Unfortunately, clinical experience has shown that the superficial inferior epigastric vessels are either absent or too small to adequately perfuse a free flap transfer of abdominal tissue in the majority of patients. These vessels are only adequate for use in approximately 20 to 30 percent of patients and are smaller than the deep inferior epigastric vessel system with less blood volume flow as a result.

Nipple areolar reconstruction is completed at a later stage regardless of the type of reconstruction that is chosen. The areolar nipple complex surgery is outpatient procedure and the final touch is tattooing of the areolar complex.


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