Surgical Reconstruction Techniques
In essence, there are two materials used in reconstructing the female breast. One is alloplastic implants, usually containing saline or silicone. The other is your own tissue, also known as autogenous tissue.
It is important that your cancer surgeon and your plastic surgeon work together. If they carefully plan the mastectomy incision, they can preserve skin and tissue to make your reconstruction easier, safer and more attractive.
Implants
When adequate soft tissue remains, an implant filled with silicone and/or saline may effectively recreate the breast mound. This may be the final, permanent implant or an initial spacer.
A spacer saves the patient and plastic surgeon time and effort for the next phase of reconstruction. Placed under the chest wall muscle, the spacer conserves valuable skin, shapes of the over-lying soft tissue, and opens the pocket to hold the final implant or an autologous tissue flap.
Sometimes adequate soft tissue coverage is not available after surgery. Tissue must be added. Tissue expansion and autogenous flap reconstruction are two ways of doing this.
For tissue expansion, you will have an inflatable prosthesis inserted in your breast area. This is called an expander. It helps the soft tissue stretch until there is adequate coverage for an implant. To help it stretch, the implant is injected with saline at regular intervals in the office.
After a minimum of three months, the expander is surgically removed and replaced with the permanent implant.
There is a variation that uses "permanent expanders" which can be used as the final implant. In many situations, especially in those patients who are relatively small-breasted and who opt for a skin-sparing type of mastectomy, expansion may be accomplished with serial implants.
In general, the breast implant procedures are easier and simpler surgeries. They require less hospitalization and recovery time and are less risky surgically. However, there are possible complications and concerns. These include risks of implant hardening, rupture, leakage or displacement, rippling and wrinkling. Long-term effects include risks of soft tissue compression, thinning and the need for corrective surgeries.
Autogenous Reconstruction
The alternative method of reconstruction is to use your own (autogenous) tissue instead of implants. Two types of tissue are used. Pedicle flaps are always kept connected to the body with muscle and blood vessels. They typically come from the back (i.e. latissimus dorsi myocutaneous flap) or the abdomen (i.e. transverse rectus abdominus myocutaneous or TRAM flap).
Free flaps are completely detached from the body and then transplanted. Blood vessels are re-attached using microsurgery. They most commonly come from the abdomen. They can also come from the buttocks, thigh, or groin.
Autogenous tissue reconstruction are generally more difficult to perform require 4-7 days of hospitalization and 4-8 hours or more of operating time, involve significant risk of partial or complete flap loss and additional scars. The beauty of the flap procedure is that when they work they are completely natural, do not insure the concerns with implants, require no further future surgeries and should afford an additional improved body image and proportion.
Nipple-Areola Reconstruction
This is a final stage in reconstruction. It is the final touch on a uniform, artistic and identifiable breast that looks like the other one.
Complete breast reconstruction also includes rebuilding the nipple-areola complex. Local flaps with or without skin grafts are used. Tattooing makes the color match.
This is usually an outpatient surgery or office procedure. You don't have to complete the reconstruction to this extent. But it's the step that brings you closest to your natural form.
