What You Should Know About Breast Reconstruction (Part II)
What You Should Know About Breast Reconstruction (Part II) By Johnny Franco, M.D. What is the best timing for breast reconstruction? The best timing for breast reconstruction depends on the individual patient. Some of the benefits of immediate breast reconstruction is that the process begins at the moment of the mastectomy. It can decrease the overall number of surgeries that the patient needs to complete her reconstruction. It also allows the woman to have some form to her breast when she first wakes up from surgery. This often helps women move forward with the healing process, as they can see the breast already starting to form. If patients are going to undergo radiation or have other circumstances, it may be recommended by the plastic surgeon or breast surgeon to delay their reconstruction until a later date. This does not mean these women cannot have reconstruction. It just means that it may be in her best interest to have it done at a later time. What is the best reconstruction method? There are two broad types of reconstruction, flaps and implants. When people talk about flaps, they are referring to the method that takes tissue from the patient’s own body to make the breast. The most common flap is from the abdomen, often called a TRAM or DEIP flap. The tissue that would typically be removed when a woman has a tummy tuck is used to recreate the breast. The benefit of this procedure is that the surgeon uses the patient’s own tissue, giving her a very natural feel and appearance (plus a tummy tuck!). The other common type of reconstruction is with a tissue expander and implant. This procedure is extremely popular, as it does not require surgery on any other parts of the body. Typically the tissue expander will be placed at the time of the mastectomy and it will be used to slowly stretch and shape the skin of the breast to create the new breast shape. The expander is removed several months later and a permanent breast implant is placed. At the time of the exchange commonly an implant will be placed on the opposite breast as well for symmetry. Both of these procedures are commonly used. Which one to use depends on the individual patient’s needs and desires. This is the reason that it is very important to spend time with your plastic surgeon discussing the options and the benefits of each procedure. What implant is best for me? One of the most common questions that I get in both breast reconstruction and breast augmentation is what implant is best for me? The short answer is that there is no one perfect implant for everyone. One of the benefits that women have today is that they a wide variety of implants available to them and their surgeon. The implants come in a multitude of shapes and sizes, allowing the surgeon to meet the needs of the patient. Typically a surgeon will measure the size of the breast and then discuss the patient’s particular needs. Keeping in mind the measurements of the breast and the desired outcome, the surgeon and patient can select an implant that will help achieve those goals. What is nipple reconstruction? Nipple reconstruction is often the final step in breast reconstruction, as it is truly the icing on the cake. An actual nipple can be created from the skin of the breast mound and then the areola is created by tattooing the skin to match the color from the opposite nipple areolar complex. I strongly encourage women to discuss this with their plastic surgeon. Patients truly are happy that they had the procedure done. Creating the nipple/areola complex gives the final appearance and completion to the breast. 3D nipple/areola tattooing is an option for patients who do not want to undergo a further surgery. The procedure can be performed in the office to complete the breast reconstruction. Completing the nipple/areola complex transforms the reconstruction from a mound of tissue or a round implant, to a breast. What is fat grafting/transfer? Fat transfer is a type of reconstruction that uses a person’s own body fat to improve the shape of a patient’s breast. Typically fat is removed with liposuction from unwanted areas of the body, then processed and used to shape the breast. It is commonly done in combination with other types of breast reconstruction. The fat can be used in combination with breast implant reconstruction to give the breast a more natural feel and appearance. It can also be used in combination with flap surgeries to add volume to the breast or improve the shape of the breast. Recently it has also been used to reconstruct the breast of patients who have had a lumpectomy. These patients have done very well with fat grafting as they often have a small defect and may not want breast implants. This procedure should be performed by your plastic surgeon. What is the difference between a TRAM and a DIEP Flap? TRAM (transverse rectus abdominal musculocutaneous) flap has been the most common method of autologous breast reconstruction for years. It became very popular, because it combines a tummy tuck with a breast reconstruction. The abdominal tissue that is typically removed during a tummy tuck is used to shape the breast. The benefit of this surgery is that it avoids the need to use breast implants in the vast majority of patients, while also improving the abdominal contour. DIEP (Deep inferior Epigastric Perforator) flap is very similar to the TRAM flap except the muscle is not taken. Only the abdominal skin and fat are taken. This is a benefit because it preserves the abdominal muscles, retaining core strength. However, these surgeries tend to take longer than the TRAM and more post-operative care. Patients always ask which is better. The answer has to be based on the individual patient, because as with any surgery, there are pros and cons to each. Some patients are better suited for one procedure over the other.