Breast Reconstruction Surgery

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• QHow has breast cancer reconstructive surgery changed?

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  A Dr. Brian A. Pryor, DO , Surgery, answered on behalf of Mercy Medical Center

  I think breast cancer reconstructive surgery has gone through a lot of different changes over the years. Initially reconstruction wasn’t the focus—historically the focus was treating the cancer itself. As we've gotten better and better at treating the cancer, we've really started addressing the whole person and recreating the breast as a whole. Today, I would say most patients choose some type of breast reconstruction. As technology has advanced, we can create a better aesthetic breast mound, and as implants have changed and gotten better and better, we have better tools to shape and restore the breast shape to what it was before, and sometimes even better aesthetic outcomes than before surgery.

  Trinity Health is a Catholic health care organization that acts in accordance with the Catholic tradition and does not condone or support all practices covered in this site. In case of emergency call 911. This site is educational and not a substitute for professional medical advice, always seek the advice of a qualified healthcare provider.

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• QWhat is breast reconstruction?

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  A Dr. Erik A. Hoy, MD , Plastic Surgery, answered

  Breast reconstruction is the process of rebuilding a breast which is both natural-looking and -feeling through a series of surgical procedures.  This can involve implant-based or autologous (rearranging the patient’s own tissues) reconstructions.  The first phase of the reconstruction can be done at the time of the breast cancer removal (immediate reconstruction), or be performed in a delayed fashion due to patient preference or the need to receive certain cancer treatments prior to reconstructing the breast.  In either case, plastic surgeons attempt to provide a medical and psychological means of dealing with the after-effects of breast cancer surgery.  These factors should be the reasons a patient undergoes breast reconstruction, not due to pressures from family members or peers.  The goal of breast reconstruction is to help restore a patient’s physical appearance and her psychosocial well-being.

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• QWhat does breast reconstruction using my own body tissue involve?

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  A Columbia University Department of Surgery answered

  The 3 most common options for autogenous breast reconstruction are the TRAM flap, DIEP flap, or latissimus flap. The TRAM flap, or transverse rectus abdominis myocutaneous flap, involves removing skin, fat, and muscle from the abdomen and bringing it up to the breast. This can be done in several different ways, involving either rotating the blood supply of the muscle up towards the breast, or cutting the blood vessels of the muscle and attaching them to the blood vessels in the chest area. Your surgeon will determine which is best for you. Many patients like this option since they get a “tummy tuck” with the procedure.
  
  The DIEP flap, or deep inferior epigastric perforator flap, uses skin and fat from the belly, but does not involve cutting any muscle. The benefit of this technique is that there is no abdominal weakness or potential for hernia. This is a more complex technique, in that it involves microsurgery to attach the blood vessels (inferior epigastric perforator) to the blood vessels in the chest.
  
  Finally, the latissimus dorsi flap involves recreating a breast using muscle from the back. This is generally well tolerated, and recovery time is shorter than a reconstruction using abdominal tissue. Since many women don’t have a large back muscle, sometimes this procedure is combined with an implant to give the size, as well as feel of a real breast.

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• QWhat are my options for breast reconstruction after a mastectomy?

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  A Dr. Virginia Chiantella, MD , Surgery, answered on behalf of StoneSprings Hospital Center

  

  Not all women choose to have reconstruction after a mastectomy, but there are many options for those who choose to do so. Learn more from Virginia Chiantella, MD, from StoneSprings Hospital Center in this video.

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• QHow do I care for my incisions after reconstructive breast surgery?

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  A Dr. Brian A. Pryor, DO , Surgery, answered on behalf of Mercy Medical Center

  Each incision is different, but in general, for at least three weeks, you don't really need to do anything to your incisions. Just keep them covered, depending on how they were closed, and then a gentle scar massage after three weeks can be helpful. Silicone scar strips and some creams may help, but you shouldn’t use those for at least three weeks to a month after surgery.
  
  Trinity Health is a Catholic health care organization that acts in accordance with the Catholic tradition and does not condone or support all practices covered in this site. In case of emergency call 911. This site is educational and not a substitute for professional medical advice, always seek the advice of a qualified healthcare provider.
   
• QIs breast reconstruction surgery covered by insurance?

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  A Dr. Erik A. Hoy, MD , Plastic Surgery, answered

  Since 1998, Congress has mandated universal insurance coverage for breast reconstruction after removal of breast cancer.  This even includes staged procedures such as the filling of adjustable breast implants or reconstruction of the nipple.  It also covers cases in which a breast lift is required in a normal breast in order to better match a reconstruction on the cancerous breast.  Now, new legislation in New York state will require doctors and healthcare centers to review reconstruction options with patients prior to the resection of their breast cancer.  If the initial center does not perform reconstructions, the patient must be referred to one that does.  These laws help protect a patient's access to reconstructive surgery after breast cancer removal.
  
  

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• QWhat is delayed breast reconstruction for breast cancer patients?

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  A Intermountain Healthcare answered

  Delayed breast reconstruction is recreation of the breast mound at a separate date than the mastectomy.  Immediate reconstruction refers to recreation of the breast mound at the time of mastectomy. 

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• QIs a deep inferior epigastric artery perforator flap (DIEP) done in stages?

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  A Intermountain Healthcare answered

  This depends on what the DIEP is reconstructing. In the case of breast cancer reconstruction, the DIEP flap is usually performed in one stage (ideally at the time of mastectomy) if the patient is not recommended for radiation treatment after mastectomy. It is not uncommon, however, for the reconstructed breast to undergo some adjustments to improve symmetry with the breast or breast reconstruction on the opposite side. Most commonly the reconstruction of other structures associated with the breast, such as nipple reconstruction, are performed at a separate time.
  
  If a woman is likely to undergo radiation after her mastectomy, it may be wise to undergo definitive reconstruction after radiation is complete. In such cases, a tissue expander might be placed at the time of mastectomy to preserve breast skin. Once the radiation treatment is complete and the tissues have recovered, the tissue expander may be removed and the mound replaced with the DIEP flap. In many cases, this improves the overall aesthetic outcome despite the negative effects radiation has upon the chest.
• QWhat is a deep inferior epigastric artery perforator (DIEP) flap procedure?

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  A Intermountain Healthcare answered

  A DIEP is a tissue transfer from the lower abdomen (tissue between the belly button and the pubic region) that spares the underlying abdominal muscles. It is most commonly used in reconstruction of the breast after mastectomy. The donor site is then closed in a manner similar to a "tummy tuck" leaving a low horizontal scar on the abdomen and around the belly button.
  
  The blood vessels that keep this tissue alive are left attached to the harvested DIEP flap. These vessels arise from the deep inferior epigastric vessels, travel through the abdominal muscle, and spread out in the fat and skin over the muscle. (Hence the name of the flap). In order to keep the tissue alive, however, the vessels must be sewn into a recipient vessel at the defect site (using microsurgical techniques) to re-establish flow in and out of the tissues. In the case of breast reconstruction, the most common vessels that the DIEP flap is sewn to are the internal mammary vessels, which run underneath the cartilage between the rib and the sternum (breast bone).
  
  The benefit of the DIEP flap over traditional abdominal flaps (such as the TRAM flap) include sparing of the body's core muscles. Particularly in cases of bilateral breast reconstruction, if both muscles are taken the abdomen is reconstructed with mesh, has a high risk of bulge, and takes away the ability to perform a sit up (when both muscles are gone). A true DIEP will trace the course of the vessel through the muscle, deliver it from the muscle, then leave a functional and viable muscle in place. The goal is to decrease the morbidity (damage) at the donor site while maximizing as much as possible the restoration of the acquired defect. In the case of breast cancer, restoring the form of the breast while diminishing donor site complications can be of high value in a patient already suffering from cancer.
  
  Using excess and unwanted abdominal tissue to reconstruct a breast is an attractive option to many patients. It is important to discuss with a board-certified plastic surgeon trained in these techniques whether your disfigurement can be addressed with a DIEP flap and if you are a candidate for such a procedure.

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• QHow can breast reconstruction help after breast cancer surgery?

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  A NorthShore University HealthSystem answered

  If your breast cancer surgery involves removing the whole breast (mastectomy), you may want to have the breast reconstructed. This can happen at the same time as your cancer surgery, or afterward. A plastic surgeon can insert a saline or silicone implant under the chest muscle, or tissue from another part of your body (such as the back or abdomen) may be used to re-form the breast shape. The areola and nipple are often reconstructed a few months later, after your reconstructed breast has healed, using tissue from your body.

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