Breast Reconstruction Surgery
Breast reconstruction provides physical and emotional support for women who have lost one or both breasts as a result of cancer or other conditions. The ability to create a relatively natural-looking breast allows women to regain self-confidence and improve their quality of life. Although the goal of breast reconstruction is to restore your breasts to as close to their natural shape, appearance, and size as possible, patients should have realistic expectations about reconstructed breasts. A reconstructed breast doesn’t look, feel, or have the same sensation as the breast that has been removed. Additionally, incision lines will be present on the breast and the donor site, if utilized.
Although the goal of breast reconstruction is to restore your breasts to as close to their natural shape, appearance, and size as possible, patients should have realistic expectations about reconstructed breasts. A reconstructed breast doesn’t look, feel, or have the same sensation as a breast that has been removed. Additionally, incision lines will be present on the breast and the donor site, if utilized.
Breast reconstruction is a highly-personalized treatment that typically involves several procedures performed in multiple stages. It can either be done immediately following a mastectomy or be delayed until you have recovered from your mastectomy and have completed any additional cancer treatments as necessary. There are several different techniques that Dr. Rottman may recommend, including prosthetic implants, pedicled flaps and free flaps. Most reconstruction procedures use breast implants to rebuild the breast, typically involving either a flap technique or tissue expansion.
Flap Technique repositions a woman’s own muscle, fat and skin to create or cover the breast mound. Two basic types of tissue flaps are be used: pedicle flap, which retains an attachment to the original blood supply, and free flap, which does not, and often involves microsurgery to create a new blood supply.
- A TRAM (Transverse Rectus Abdominus Myocutaneous) flap uses donor tissue from the abdomen. The flap may either remain attached to the original blood supply and tunneled up through the chest wall, or be completely detached. Candidates for TRAM flap include patients who either want or need to have their breasts reconstructed with their own tissues.
- A DIEP (Deep Inferior Epigastric Perforator) flap transports fat and skin from the abdomen and does not require implants or any movement of muscle tissue. The soft tissues of the abdomen are transferred to the chest wall, along with blood vessels, which are grafted to the new site with microsurgical techniques.
- A SGAP (Superior Gluteal Artery Perforator) flap transports fat and skin from the buttock and hip area. Using microsurgery, blood vessels from the perforator flap are connected to the internal mammary vessels on the chest. The SGAP procedure is often recommended for patients who exhibit defects resulting from previous breast surgery.
- A Latissimus dorsi flap uses donor tissue from the back that is tunneled to the mastectomy site and remains attached to its donor site, leaving the blood supply intact. On occasion, the flap can reconstruct a complete breast; however, it is most often used to provide the muscle and tissue necessary to cover and support an implant.
Tissue expansion is the most common method of breast reconstruction method in the United States and offers an easier recovery than flap procedures. However, the process is longer and requires regular office visits over a 4-6 month period. Tissue expansion stretches healthy skin at the breast site to leave room for a breast implant. The device is gradually filled through an internal valve and, once ready, a second surgical procedure is necessary to replace the expander with an implant.
AlloDerm, also known as Acellular Dermal Matrix, is a biologic material that acts a skin substitute during breast reconstruction. The material closely resembles normal skin and integrates well with existing tissue. Typically used in expander-based implant reconstruction, AlloDerm supports the tissue and provides necessary coverage of the breast implant.
Breast Reconstruction with Direct Implant Placement
In some instances, a saline or silicone implant can be placed immediately following a mastectomy to create a breast mound.
Nipple Areola Reconstruction
After the implant is in place, Dr. Rottman will use skin grafting or other specialized techniques to recreate the nipple and areola.
Fat Grafting for Breast Deformities
Fat grafting can improve the cosmetic result of breast reconstruction. During this procedure, fat is taken from elsewhere in the body using a low-pressure liposuction method. The fat is washed gently with saline and then injected into contour depressions along the margins of reconstructed breasts. The technique has limitations and risks, but overall it is a safe alternative to more complicated procedures that achieve similar results.
After breast reconstruction, you may be given bandages or a support bra to help reduce swelling and to support your new breast(s). You will be able to see the results of your breast augmentation immediately and as the swelling and bruising subside, you will be able to enjoy your new breast(s) even more. During the months following your procedure, the incision marks will gradually fade and become less noticeable.
Your Consultation with Dr. Rottman
During your consultation, Dr. Rottman will talk with you about whether you are a good candidate for surgery, your expectations, and what to expect during and after surgery. Please contact us to schedule your appointment at either of our convenient Baltimore locations.