If you have had breast cancer, you may be considering breast reconstruction surgery. There are several types of breast reconstruction to think about, and the kind that’s best for you may be different than what someone else may do. The best reconstruction option is primarily based on the specifics of your anatomy.

Below is detailed information about the three kinds of breast reconstruction surgery options. The best way to find out which is best for you is to talk with your plastic surgeon. They will discuss the options and advise you about which may be best for your situation.

1. Implant-Based Breast Reconstruction

Implant-based breast reconstruction might be best if your mastectomy or radiation therapy left enough breast tissue to cover a breast implant. It’s also critical that there’s enough tissue left in the breast to support the implant’s weight.

You can choose either silicone or saline implants, both of which have advantages and disadvantages. Your plastic surgeon will talk to you about the implant options and help you decide. This procedure uses the same implants involved in traditional breast augmentation and breast lift surgeries.

If you don’t have enough tissue left on the chest wall, or you don’t want breast implants, you will need autologous breast reconstruction. That procedure is described below. Most patients who choose the flap method use abdominal skin and fat to create a new breast.

2. Autologous Tissue Reconstruction (Flap Procedure)

Sometimes breast cancer treatment won’t leave enough breast tissue to cover and support an implant. In this situation, you may need breast reconstruction with a flap technique.

This is the most popular type of breast reconstruction, which involves using some of your abdominal skin and fat to create a new breast. However, some women also may have personal reasons for not wanting a breast implant.

The skin and fat used for the flap procedure are usually between the belly button and pubic bone. When the surgeon takes this tissue to make the new breast, you will probably have a scar between hip bones and near the belly button.

But not every woman is a good candidate for a flap procedure. Some women lack sufficient donor tissue in the lower abdomen, and others have scars that may have damaged vital blood vessels. Last, some patients may have had a flap procedure that failed previously.

Flap Options

Surgeons use several flap options that involve the tissue of the lower abdomen. The difference between each flap is that different blood vessels feed the flaps. The most common flap procedures are listed below.

Pedicled TRAM Flap

The TRAM flap procedure uses skin, muscle, and fat from the lower abdomen to create a new breast. But for the breast to survive on the chest, the tissue must have a blood supply. So the blood supply to the new breast comes from the abdominal muscles.

The flap connects to the rectus abdominis muscle and moves through the abdomen and chest to make a new breast. Unfortunately, the entire rectus muscle is used for the new breast, so that you may have some permanent muscle weakness in the abdomen.

Free TRAM Flap

The free TRAM flap also uses the blood vessels coming from the rectus abdominis muscle. But in this procedure, the muscle above and below your blood vessels is separated, so only part of the abdominal muscle is taken out.

Taking out just a part of the abdominal muscle means you won’t have as much abdominal weakness after the procedure.

Then the entire flap is moved to the chest. The blood vessels from the abdominal muscles are linked to blood vessels in the chest with a microscopic procedure.

DIEP Flap

This flap procedure uses your lower abdominal skin and fat as the other options above. But it doesn’t use the rectus abdominis muscle and fascia. So instead of taking the muscle and surrounding tissue from the abdomen, the small blood vessels are identified.

Then, the surgeon dissects the blood vessels before they’re divided. After the surgeon divides them, the tissue is moved to the chest. Finally, the blood vessels are linked to blood vessels in the chest.

This flap procedure preserves the abdominal muscle, so you won’t experience abdominal weakness.

SIEA Flap

This procedure uses your lower abdominal skin and tissue, but the blood vessels that feed the flap don’t go through your abdominal muscle. Instead, they only pass through the fat.

One of the advantages of the SIEA flap procedure is it preserves your abdominal muscles. So you have less pain and a faster recovery. But not every woman has these blood vessels, and even if they are present, they may not provide enough blood to feed the flap.

All flap procedures involve microsurgery, so blood flow to the new breast is closely monitored for a few days after surgery.

3. Combination Of Implant-Based And Autologous Procedures

The third option for breast reconstruction is a combination of implant and autologous procedures that uses tissue from your back and a breast implant. This procedure requires sufficient fat on the back to make a new breast.

However, thin patients may not be good candidates for this procedure. An advantage of the combination procedure is it can be done during the same surgery as the mastectomy.

Breast reconstruction after breast cancer is often considered a critical step to feeling like yourself again. Fortunately, your surgeon can use several proven breast reconstruction procedures to create a natural-looking breast.

Request a Houston Breast Reconstruction Consultation

Interested in breast reconstruction in Houston? Please set up a consultation with Dr. Ashley Steinberg today. She’ll talk to you about the breast reconstruction options and help you decide if it’s a good choice for you. She has specialized skills in breast reconstruction as well as breast implant explant surgery.

References

Three Types Of Breast Reconstruction. (n.d.). Accessed at https://airsfoundation.org/news/three-types-breast-reconstruction/#:~:text

Breast Reconstruction Overview. (n.d.). Accessed at https://www.breastcancer.org/treatment/surgery/reconstruction/type

Breast Reconstruction Techniques. (n.d.). Accessed at https://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction/techniques