Breast Reconstruction After Mastectomy
After a mastectomy, women who opt for surgical reconstruction of the breast have two ways to restore the shape and feel of their breast:
• Breast reconstruction with the body’s own natural tissue
• Breast reconstruction with breast implants
While breast reconstruction may not appeal to everyone, numerous studies have documented the benefits of breast reconstruction after mastectomy including improved body image, physical and sexual functioning, quality of life and self-esteem.
A great majority of patients are able to undergo breast reconstruction at the same time as their mastectomy without compromising their cancer treatment. In the event that breast reconstruction is not done at the time of mastectomy, reconstructive surgery can be scheduled for a later date.
Breast reconstruction using the body’s tissue
Sophisticated microsurgical techniques make it possible to reconstruct breasts after mastectomy using the body’s own tissue to restore a natural look and feel without sacrificing important functional muscles. Known as perforator flaps, these procedures include the DIEP, LAP and SGAP flaps and represent the gold standard in modern natural-tissue breast reconstruction.
The Breast Center at Smilow Cancer Hospital’s Greenwich Hospital campus is a center for perforator flap surgery with a greater than 99 percent success rate. Hundreds of tissue-preserving flap surgeries have been performed here since the program began in 2007.
Perforator flap reconstruction offers many benefits:
• A more natural look and feel than can be typically achieved with breast implants
• Reconstructed breasts that will grow, shrink and change naturally with changes in weight and age
• A much lower rate of unplanned reoperation: approximately 5 percent, compared to nearly 50 percent for implants 7 to 10 years after reconstruction
• An option for a woman to have a mastectomy that preserves her own nipples, when oncologically safe
• Preservation of core body strength
• The ability to use tissue from all parts of the body for breast reconstruction
Deep inferior epigastric perforator (DIEP) flap surgery uses excess tissue and blood vessels from the patient’s abdomen, but, importantly, not the muscles. With DIEP flap breast reconstruction there is significantly less pain than with transverse rectus abdominus myocutaneous (TRAM) flap reconstruction, which uses the same excess abdominal tissue, but sacrifices abdominal muscles. Further, because the abdominal muscles are not destroyed with DIEP flap, strength is maintained after surgery and the risk of developing a hernia or abdominal bulge is minimized.
Lumbar artery perforator (LAP) flap surgery uses fat from the lower back and hip “love handle” areas. This is an excellent option for women with excess tissue and has the added benefit of contouring the waistline.
Superior gluteal artery perforator (SGAP) flap surgery uses tissue and blood vessels from the patient’s buttocks, but not the muscles. SGAP flap breast reconstruction is a good option for patients who may not be a candidate for a DIEP flap surgery because of too little abdominal tissue to reconstruct the breast to the desired size.
Other natural tissue surgical options include transverse upper gracilis (TUG) flap surgery, which uses tissue (and sometimes a small amount of muscle) from the inner thigh.
Breast reconstruction with breast implants
Implant surgery requires the insertion of a prosthesis made of synthetic material into the mastectomy site. These implants are filled with either saline or silicone gel.
Advantages of breast implants over natural-tissue breast reconstruction include shorter hospitalization, fewer scars and no incisions (or healing required) on other parts of the body.
However, these advantages should be weighed against the potential of later complications that can lead to unplanned reoperation and implant removal.