Breast Reconstruction

Breast reconstruction is performed when a patient has a breast defect, either congenital or acquired, or an absent breast. The most common indication for breast reconstruction is to reconstruct the breast after the diagnosis of breast cancer. However, patients who are born without a breast, or with significant breast asymmetry, may also require a reconstructive procedure. Severe trauma and burns can also lead to a deformity that could require reconstruction.

Plastic Surgery is a key component in the multidisciplinary approach to the care of the breast cancer patient. The care of the patient will be managed by a team which often includes a breast surgeon, oncologist, radiation oncologist, pathologist, radiologist, and the plastic surgeon. The patient who is considering a mastectomy for the treatment of their cancer should have a consultation with a plastic surgeon to discuss options for reconstruction.

Click here to watch a detailed 3-D Animation Video that discusses the types of breast reconstruction.

In general, breast reconstruction consists of a series of surgeries that occur in a staged fashion. The first surgery may be performed at the time of the mastectomy, which is known as immediate breast reconstruction. A delayed immediate reconstruction is sometimes indicated for a patient. In this case, the 1st stage of reconstruction is performed 2-3 weeks after the mastectomy. In more advanced disease, some cases that require radiation therapy, or if it is the patient’s preference, breast reconstruction can be completed in a delayed fashion months or even years after the mastectomy. The breasts can be reconstructed using tissue expanders and implants, or with the use of the patient’s own tissue, known as an autologous reconstruction. In autologous reconstruction, the most common flaps used are the latissimusdorsimyocutaneous flap and the transverse rectus abdominismyocutaneous (TRAM) or the DIEP flap.

In some patients, the nipple and areola can be saved with what is known as a nipple sparing mastectomy. To be a candidate for a nipple sparing mastectomy, the patient must meet criteria from both an oncologic (cancer) perspective and from an aesthetic standpoint. Many patients are not a candidate for a nipple sparing mastectomy and therefore, undergo a skin sparing mastectomy. For these patients, a nipple and areola are reconstructed at a later staged procedure.

For women who chose to have a unilateral mastectomy, a symmetry procedure may be needed in the native opposite breast to provide the best aesthetic result. A symmetry procedure may consist of an augmentation, mastopexy, or breast reduction. Women who choose breast conservation therapy with a lumpectomy may have significant asymmetry that could benefit from a symmetry procedure. In most cases, symmetry procedures are standard in the care of the breast cancer patient, and usually are covered by their health insurance plan.

During your consultation, Dr. Aya-ay will discuss these options with you, and together you will decide which form of breast reconstruction is best for you.