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What reconstruction techniques are available after breast cancer surgery?

There are a lot of breast reconstruction techniques—probably a good 10 options. The two biggest categories are autologous reconstruction and implant-based reconstruction. Autologous means that we use the patient's own muscle, fat and skin to recreate the entire breast and implant-based reconstruction is where a breast implant is used as the foundation for the reconstruction. There are advantages and disadvantages to each.

Dr. William L. Owens, MD
Vascular Surgeon

Plastic surgery reconstruction after breast cancer surgery is becoming more common in the United States. Once a woman is diagnosed with breast cancer, she usually has options for surgical therapy. She can choose to have the cancerous lump removed (a lumpectomy), usually followed by radiation, or she can choose to have the entire breast removed (mastectomy), usually without need for radiation after surgery. If she chooses lumpectomy, there is usually modest change in the form of the breast, and plastic surgery afterwards isn't needed. There are some cases of lumpectomy, however, where the breast form may change enough that plastic surgery helps, including work on the opposite breast to achieve symmetry, is worthwhile. If the patient chooses mastectomy, she can usually be offered plastic surgery reconstruction to create a new breast "mound."  The plastic surgery can be delayed for months or even years after the mastectomy, but such reconstruction is technically more difficult as a large amount of skin and tissue needs to be brought in to create a mound from a flat surface. So, the plastic surgery is usually started immediately, at the time of the mastectomy. 

When the breast surgeon performs mastectomy and immediate reconstruction is planned, he or she leaves as much of the breast skin envelope as possible for the plastic surgeon (a skin sparing mastectomy), "scooping" the breast tissue out from beneath the skin. Sometimes even the nipple and areola can be left (a nipple sparing mastectomy). While the patient is still under anesthesia, the plastic surgeon can then fill the space for reconstruction. In the United States, 80% of immediate reconstruction is done using implants, either salt water filled or silicone gel type. In the other cases, tissue from other parts of the body is recruited to fill the space, such as muscle from the abdomen or flank, or fatty tissue from the abdomen. This reconstruction may involve a few surgical steps to complete. Federal law has mandated that all plastic surgery done in the course of treatment for breast cancer has to be covered by insurance, including Medicare and Medicaid. There is no age limit for reconstruction. 

Dr. Stuart A. Linder, MD
Plastic Surgeon

There are two major techniques in constructing the breast.

  1. Implant placement - Silicone gel implants are most often used reconstructing the breast to maintain a volume, especially in nonradiated breasts.  
  2. Flap reconstruction - Flaps include transferring tissue from the abdomen or back area normally in order to reposition those tissues of skin and fat into the breast to reconstruct a breast mound. A free flap may include the use of a microscope to perform microvascular reanastomosis, bringing the blood vessels back to the chest wall and creating a new blood supply to the flap. Most common flaps include TRAM flaps and latissimus dorsi myocutaneous flap. Normally these reconstructive surgeries or flaps are performed at university-based hospitals where patients can be monitored for several days.
Dr. Homayoun N. Sasson, MD
Plastic & Reconstructive Surgeon

There are generally three main types of breast reconstruction after breast cancer surgery:

  • breast implants alone to replace the missing part or all of the breast tissue
  • autologous tissue in the form of skin, fat, muscle or the combination thereof, from various parts of the body, such as abdomen, back and buttocks
  • combination of breast implants and autologous tissue, simultaneously or in tandem

The opposite uninvolved breast frequently requires minor procedures for its better adjustment and symmetry, including lift, reduction or enlargement.

Dr. Erik A. Hoy, MD
Plastic Surgeon

Unlike in the not-so-distant past, there are many options available to women after mastectomy, or breast cancer surgery.  At the most basic level, there are two types of reconstructive options available: prosthetic (implant) reconstruction, or autologous (muscle, fat, skin) reconstruction.  The decision to have either of these types of reconstruction is a personal one, and should be carefully considered with your physicians, and if possible, your family.  There are risks and benefits to either type of reconstruction.  Both may require multiple procedures, and which is “best” for you is dependent on multiple factors. 

Specifically, implant-based options carry implant-related concerns (type, size, silicon vs. saline, and the slight possibility of device failure), whereas autologous (your own tissues) reconstructions carry donor-site concerns.  In transferring fat or muscle from one area to another, your surgeon can obtain a stable, realistic result for your reconstructed breast.  Moving a muscle from its native site can result in a functional weakness or bulge in your abdomen.  However, some recent studies have shown that the functional impact of these surgeries is less than surgeons previously believed. Both reconstructions can achieve excellent results, and techniques and devices are improving all the time.  Breast cancer is increasingly diagnosed and treated: the art and science of reconstruction is something a plastic surgeon can assist you and your surgical oncologist with; cancer treatment and recovery should be a team-approach.

After breast cancer surgery there are a variety of options available to the patient to reconstruct the breast. Learn more from Dr. Mark Sisco on behalf of NorthShore University HealthSystem about reconstruction surgery.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.