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Breast Reconstruction Options
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Breast Reconstruction Options


Reconstructions after surgery for breast cancer is an option but not required. While some survivors choose to have reconstruction performed at the same time as the mastectomy, other prefer to wait until later or wear a prosthesis upon surgery completion. As you consider your options, remember that the choice is completely up to you.

The goal of breast reconstruction is to provide a aymmetrical look when a woman is wearing a bra. The procedure can be done at the same time as the mmastectomy or any time after the surgery. The advantages of immediate reconstruction include waking up from the surgery with a breast and having only one surgery. The advantages of waiting include having additional time to choose a reconstructive option; if undergoing chemotherapy, the chances of infection are minimized; and you don’t have to coordinate schedules of two doctors.


Reconstruction can be done using an implant or the woman’s own tissue. The following are types of breast cancer reconstruction.


Artificial Surgical Implants

Synthetic implants can be filled with saline or silicon gel. Before the implants is inserted, an expander is used temporarily to stretch the breast skin. It is an elastic bag with a tube a valve on it that is inserted behind the pectoral muscle. It is gradually filled with saline over three to six month period to stretch the skin to desired size. The expander is then removed and replaced with an implant.

Advantages to getting implants:
  • Shorter operation and recover time
  • No additional scarring
  • Less expensive than other methods
Disadvantages of getting implants:
  • The most common problem is capsular constracture where scar tissue forms around the implants, squeezing the implant and making the breast feel hard. Removal or replacement may be necessary.
  • Increasing chances of rupture
  • Emotional/financial cost of replacement
  • Difficulty in detecting cancer on a mammogram (the scar is a common place for recurrence)

Flap Procedures Using Your Own (Autologous) Tissue

Reconstruction using your own tissue has the most natural appearance and avoids placing foreign material in your body. On the other hand, the procedures may cause pain at the donor and/or transplant sites, and they are more expensive than implants. Also, the surgery takes much longer.

Perforator procedures use skin and fat only:
  • Deep inferior epigastric perforator (DIED) flap – abdomen. DIEP flapuses abdominal skin and subcutaneous tissue, but spares most or all of the rectus muscles and fascia. The blood supply to the skin is supported by perforating blood vessels from the inferior epigastic artery. The flap is transplanted tot eh chest for breast reconstruction by attaching blood vessels to the internal mammary systems.
  • Superficial inferior epigastic artery (SIEA) flap – abdomen
  • Lateral thigh perforator flap – “saddle bag” area of the lateral thigh
  • Thoracodorsal artery perforator
  • Superior gluteal artery perforator (S-GAP) – upper buttock. For women who lack sufficient flesh for the DIEP flap reconstruction, this is a good alternative. The GAP flap can be used in situations where the abdominal flap (either TRAM flap or DIEP flap ) has been utilized, or scars on the abdomen precludes its use for breast reconstruction.
  • Inferior gluteal artery perforator (I-GAP) flap – lower buttock
Nonperforator procedures use skin, fats and muscle:
  • Transverse rectus abdominis myocutaneous (TRAM) flap – abdomen. The skin, fat, blood vessels and at least one muscle are tunneled from the abdomen to the chest and shaped into a breast, creating a tummy tuck at the same time.
  • Latissimus dorsi (LAT) flap – upper back. The fat, skin, muscles and blood vessels are tunneled from the upper back to the chest. A synthetic implant is often used to match the size of the remaining breast.
  • Lateral thigh flap – “saddle bag” area of the lateral thigh
  • Superior gluteal myocutaneous flap – upper buttock
  • Inferior gluteal myocutaneous flap – lower buttock
  • Free flap – tissue cut from blood supply and reattached. Muscle, fats anmd skin from the abdomen, thigh or buttocks are cut from their blood supply and reattached at the chest. This procedure is the nmost complex, requiring a specialist in microsurgery who sews together hair-thin blood vessels to restore blood to the tissue.

Nipple/Areola Reconstruction

Nipple/areola reconstruction may be performed after breast reconstruction is completed. Since the procedure takes place after the surgery heals, there is a better chance for the nipple to be placed in the correct place on the new breast.