Breast reconstruction is performed when the patient has a congenital or acquired defect in the breast or an absent breast. The most common indication for breast reconstruction is to reconstruct the breast after the diagnosis of breast cancer. However, patients who are born without a breast or with significant breast asymmetry may also require a reconstructive procedure. Severe trauma and burns can also lead to a deformity that could require reconstruction as well.
Plastic Surgery is a key component in the multidisciplinary approach to the care of the breast cancer patient. The care of the patient will be managed by a team which often includes a breast surgeon, oncologist, radiation oncologist, pathologist, radiologist, and the plastic surgeon. The patient who is considering mastectomy as an option for treatment of their cancer should have a consultation with a plastic surgeon to discuss their options for reconstruction.
Click here to watch a detailed 3-D Animation Video that discusses the types of breast reconstruction.
In general, breast reconstruction consists of a series of surgeries that occurred in a staged fashion. The first surgery may be performed at the time of the mastectomy which is known as immediate breast reconstruction. A delayed immediate reconstruction is sometimes indicated for a patient and in this case the 1st stage of reconstruction is performed 2-3 weeks after the mastectomy. In more advanced disease, some cases that require radiation therapy, or if it is the patient’s preference, breast reconstruction can be completed in a delayed fashion months or years after the mastectomy. The breast can be reconstructed using tissue expanders and implants or with the use of the patient’s own tissue, an autologous reconstruction. The two most common flaps used by Dr. Aya-ay for breast reconstruction are the latissimusdorsimyocutaneous flap or the transverse rectus abdominismyocutaneous (TRAM) flap.
In some patients, the nipple and areola can be saved with what is known as a nipple sparing mastectomy. To be a candidate for a nipple sparing mastectomy, the patient most meet criteria from both an oncologic(cancer) perspective and from an aesthetic standpoint. Many patients are not a candidate for a nipple sparing mastectomy and therefore, undergo a skin sparing mastectomy. For these patients, a nipple and areola is reconstructed at a staged procedure.
For women who chose to have a unilateral mastectomy, a symmetry procedure may be needed in the native opposite breast to provide the best aesthetic result. A symmetry procedure may consist of an augmentation, mastopexy, or a breast reduction. Even women who choose breast conservation therapy with a lumpectomy may have significant asymmetry that could benefit from a symmetry procedure. In most cases, symmetry procedures are a standard part of the care of the breast cancer patient that is covered by their health insurance plan.
During your consultation, Dr. Aya-ay will discuss these options with you and together you will decide which form of breast reconstruction is breast for you.