Breast reconstruction can be performed in patients at the time of total or partial mastectomy, following previous total or partial mastectomy, previous mastectomy, or for congenital defects or differences in size or shape. The approaches used include techniques that use only the patient's own tissue or those that use a breast implant device. Most techniques are applicable whether a patient is considering reconstruction at the time of mastectomy or at a later date.
On occasion a patient will have adequate skin following mastectomy to allow for simply a breast implant to be immediately inserted for reconstruction. This is an unusual circumstance. More commonly, one of the approaches described below or a tissue expander is placed. A tissue expander is a special type of breast implant that is placed beneath the muscles of the chest wall and is then inflated over a series of about six sessions spaced one to two weeks apart. The space that is created is then used for placement of a permanent implant. This process occurs over several months.
The TRAM flap, which uses a large piece of lower abdominal wall fat and skin attached to a piece of rectus abdominis muscle, is the most popular approach for breast reconstruction at the time of mastectomy. This approach provides tissue that most closely resembles the breast tissue removed in terms of consistency and texture, and can offer an improvement in abdominal wall contour as an added bonus. Alternative tissue techniques can be based on flaps from the back (latissimus dorsi), the buttock, or side of the thigh.
The latissimus dorsi muscle of the back can be used with a breast implant as a reliable alternative for immediate breast reconstruction at the time of mastectomy. The muscle can be used with a piece of skin attached to allow for replacement of the nipple areolar complex skin island that is removed with the breast at the time of mastectomy. This provides a loose muscle sling that can allow for improved protection, texture, and appearance for an underlying breast implant used to provide volume and shape.
The nipple is reconstructed about two months following breast mound reconstruction, or about one month after any chemotherapy and/or radiation treatments are completed. Medical tattooing is used to provide color to the reconstructed nipple and areola.
What follows are examples of patients who have allowed us to share their preoperative and postoperative photographs with you. These are examples of typical outcomes, but may not represent your preoperative situation or postoperative result.
