Reconstruction

Breast reconstruction is achieved using plastic surgery techniques that attempt to restore a breast to a natural shape, size and appearance following mastectomy. Our team will educate you on the multiple options available and formulate a plan that takes into account your health and your final aesthetic desires.

Fat Transfer Reconstruction

  • Fat grafting, also called autologous fat transfer, is emerging as a new breast reconstruction technique. In fat grafting, fat tissue is removed from other parts of your body -- usually your thighs, belly, and buttocks -- by liposuction. The tissue is then processed into liquid and injected into the breast area to recreate the breast.

Direct to Implant Reconstruction  

  • Post mastectomy reconstruction with a direct to implant, or “one-step” approach allows for a single-stage reconstruction of the breast mound in select patients. This approach is best suited for patients with good preservation of the breast skin after mastectomy. A permanent implant is inserted immediately following the mastectomy, forgoing the initial placement of a tissue expander and subsequent expansion process.

Tissue Expander to Implant

  • Post mastectomy reconstruction with a tissue expander and implant involves a staged approach. A tissue expander is a temporary device that is placed on the chest wall deep to the pectoralis major muscle. This may be done immediately following the mastectomy, or as a delayed procedure. The purpose of the expander is to create a soft pocket to contain the permanent implant. Tissue expanders are available in a variety of shapes and sizes.

Latissimus Flap

  • The latissimus flap is a standard method for breast reconstruction. The latissimus flap is most commonly combined with a tissue expander or implant, to give the surgeon additional options and more control over the aesthetic appearance of the reconstructed breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape as compared to an implant alone.

TRAM

  • The most common method of autogeneous tissue reconstruction is the pedicled transverse rectus abdominus myocutaneous (TRAM) flap. In this approach, the entire rectus abdominus muscle is used to carry the lower abdominal skin and fat up to the chest wall. A breast shape is then created using this tissue. In order to transfer the flap to the chest, the muscle is tunneled under the upper abdominal skin. Since the patient’s own body tissue is utilized, the result is a very natural breast reconstruction. 

TRAM Free Flap

  • The TRAM free flap is similar to the DIEP flap in that this type of flap is also based on the deep inferior epigastric vessels. In the TRAM free flap, the lower abdominal skin and fat is removed along with a small portion of the rectus muscle. The portion of muscle removed carries these blood vessels with the flap.

DIEP

  • The deep inferior epigastric perforator (DIEP) flap is based on the deep inferior epigastric vessels, an artery and vein at the bottom of the rectus abdominis muscle. These vessels provide the primary blood supply to the skin and fat of the lower abdomen. In the DIEP flap, the lower abdominal skin and fat is removed without having to harvest any of the rectus abdominis muscle. Instead, blood supply is provided through the perforator vessels that are teased out from the rectus muscle, using a muscle incision alone. The surgeon will apply judgment in the operating room to determine how many perforators are needed to provide sufficient blood supply for the DIEP flap to survive.

Reconstruction Revision

 

Read Breast Reconstruction Planner: Tips to Manage a Speedy Recovery from the American Society of Plastic Surgeons.