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There are numerous options when it comes to breast reconstruction after mastectomy. While a specific surgical technique may be appropriate depending on the patient’s tumor characteristics, most patients have some say in the final touches (such as nipple reconstruction and nipple tattooing for non-nipple-sparing procedures).
We understand that planning for breast reconstruction while dealing with the unimaginable stress of your breast cancer diagnosis can be overwhelming. We are here for you throughout the process to ensure that you understand and feel comfortable with your reconstruction journey.
One of the best ways to prepare and feel confident with the process is to understand what your breast reconstruction will entail and why the chosen technique is appropriate for your specifications.
No two breast cancer diagnoses are the same. Therefore, no two breast reconstruction surgical plans are the same. Dr. Cohn and his team will customize all aspects of your reconstruction around your physical needs and expected cancer treatments.
At its most basic level, breast reconstruction is performed with expanders and implants, tissue flaps, or a combination of the two. However, variations may be needed to recreate the breast mound after mastectomy of one or both breasts.
What Is the Best Technique for Breast Reconstruction?
Often, patients are curious about which breast reconstruction technique is the best.
There is no simple answer. Most women are not candidates for every technique—and, therefore, do not always have a choice. Ultimately, the best technique for you is the technique that is best suited for the specifications of your diagnosis. These specifications will include the stage of your cancer as well as the tumor’s characteristics (size, placement in the breast, etc.).
During a breast reconstruction consultation, you will be presented with the best reconstruction option(s) based on your needs. Dr. Cohn will then be able to provide you with more specific information about your selected technique.
What Are My Potential Reconstruction Options?
What Is Implant Reconstruction With Tissue Expanders (Nipple-Sparing and Non-Nipple-Sparing)?
Implant reconstruction is the most common option and is performed similarly to the well-known breast augmentation surgery, where synthetic implants are inserted to add breast volume and shape.
Implant reconstruction with tissue expanders can be performed with both nipple-sparing and non-nipple-sparing variations—depending on the nature and stage of your breast cancer diagnosis.
Breast reconstruction with implants and tissue expanders is performed in stages—with two surgeries (usually 90 days apart depending on insurance requirements) and multiple appointments in between.
To begin this process, a tissue expander is placed in the breast (usually at the time of the mastectomy) where the breast tissue once was. Over the following months, this expander is gradually filled (just like a water balloon). This gradual expansion allows the skin and tissues in the breast to stretch to prepare for the final implant.
Once the breast tissue has been stretched to the appropriate amount, a final implant is placed, and the nipple is reconstructed (if undergoing non-nipple-sparing reconstruction). Nipple tattooing can be performed once you have healed from the second surgery—usually after 90 days.
On very rare occasions, the expander may not be necessary. If that is the case, an implant can be inserted without stretching the existing tissue; however, this is not common, and most women require the expander.
When Is Nipple-Sparing Implant Reconstruction Using Tissue Expanders Best?
While many women lose their nipple-areola complex as part of their mastectomy, some are able to keep them.
This technique is appropriate for women whose cancer is found in a very early stage and whose tumor is located away from the nipple. Most women who undergo nipple-sparing implant reconstruction have moderate breast volume and minimal droop in their nipple position.
When Is Non-Nipple-Sparing Implant Reconstruction Using Tissue Expanders Best?
Often, the safest course of action when performing a mastectomy involves the removal of the nipple-areola complex.
Non-nipple sparing implant reconstruction using tissue expanders is most often chosen for women who are not expected to require further radiation as part of their treatment. Non-nipple sparing implant reconstruction is also beneficial for women who cannot undergo a lengthy procedure and cannot use tissue from another area.
What Is the Latissimus Dorsi Flap Technique Using Tissue Expanders?
The latissimus dorsi flap breast reconstructive technique using tissue expanders works by borrowing muscle from your back to form a pocket to hold tissue expanders (in preparation for an eventual implant).
The latissimus dorsi muscle is a back muscle below the shoulder and behind the armpit. This muscle helps you conduct twisting motions, such as swinging a hockey stick or a golf club.
During the latissimus dorsi flap reconstructive procedure, an oval section of skin, muscles, fat, and blood vessels are tunneled from your upper back, under your arm to the chest. This option allows for the artery vessels and vein vessels of the flap to remain attached to their original blood supply in the back.
This technique is combined with an expander and implant and requires the same multi-step process described above.
When Is the Latissimus Dorsi Flap Using Tissue Expanders Best?
The latissimus dorsi flap using tissue expanders is often chosen for women who will require chemotherapy or radiation. Women with a history of healing complications (such as diabetics and smokers) may require this technique so that their own tissue will provide a “protective layer” within the mastectomy pocket.
This technique often allows for the nipple(s) to be reconstructed using skin from the back. This technique also avoids the straight-line mastectomy scar common with other techniques that remove the nipple(s).
The latissimus dorsi flap using tissue expanders is appropriate for women with small or large breasts.
What Is the TRAM Flap Technique?
The TRAM flap breast reconstructive technique works from the abdomen. TRAM flap is usually reserved only for specific women who are not candidates for the above options.
Because this technique takes tissue from the abdominal region, candidates must have adequate tissue in that area to harvest. They must also not have undergone any extensive abdominal surgery in the past.
In this procedure, an incision is made at the bikini line. Next, a section of your skin, muscles, fat, and blood vessels are taken from the lower portion of your abdomen and moved up to make a breast mound.
This technique is performed on women who are not candidates for implant reconstruction and women who have had chest wall radiation.
Which Breast Reconstruction Technique Is Better?
All of the above techniques will successfully rebuild your breast and provide the confidence-enhancing and life-changing benefits of breast reconstruction.
Ultimately, it is best to discuss with your doctor which surgery is best for you. You can ask questions about cost, healing, downtime, and more at a consultation.
Immediate Reconstruction Vs. Delayed: Which Is Better?
You may be wondering how long after your mastectomy you should have your reconstruction.
Most often, the mastectomy and first stage reconstruction are performed sequentially. Both the surgeon performing the mastectomy and the surgeon performing the reconstruction are in the operating room together.
However, not all women are candidates for immediate reconstruction. Women who expect additional treatment, such as radiation or chemotherapy, might need to wait until treatment is complete.
Generally, most women choose to do immediate reconstruction, but the decision is determined by the outcome desired by both patient and surgeon. The surgical plan is determined during the consultation.
Interested in Learning More?
Schedule your breast reconstruction consultation with Dr. Al Cohn today by calling 205-930-1600 or filling out our online contact form. We are currently offering virtual consultations for patients who cannot come into our office.