After a mastectomy for breast cancer, some women opt for surgical reconstruction. According to breastcancer.org, 75 percent of women who have a mastectomy go on to have reconstruction of one or both breasts. Some women who have lumpectomies also have reconstruction to "balance" their breasts. It remains a personal choice, and various procedures prove available. Women should talk with their doctors to help them decide which procedure is best for them.
Breast Implants
Two different kinds of breast implant procedures exist; one-stage immediate breast reconstruction, and two-stage delayed reconstruction. The immediate breast reconstruction occurs at the same time as the mastectomy; the surgeon replaces the excised breast tissue with a breast implant. The two-stage delayed reconstruction typically occurs when the chest wall tissues and skin have become tight and flat, according to the American Cancer Society. The tissue expander replaces the breast, and over several months, a physician injects a salt-water solution into the expander to stretch the skin and tissues. Once the skin has stretched enough, the surgeon removes the expander and replaces it with an implant. Some women have the expander as the permanent implant.
TRAM flap and DIEP flap Procedures
A TRAM (transverse rectus abdominis muscle) flap reconstruction involves taking tissue, fat and muscle from the wall of the lower abdomen, according to breastcancer.org. A physician then slides it up under the skin to the breast area, and shapes it into a breast shape, before sewing it into place. Since this procedure means moving at least one muscle from a woman's abdomen to the chest, her abdomen might lose some strength. Previous surgery to the abdominal area may render a TRAM flap procedure impossible, if a significant of tissue was taken previously. A DIEP (deep inferior epigastric artery perforator) flap proves similar to a TRAM flap, but physicians don't remove abdominal muscles. Instead, fat and skin are completely removed from the abdomen and put into the chest area.
Latissimus Dorsi Myocutaneous Flap
The latissimus dorsi flap procedure uses tissue from the back. Breastcancer.org describes this procedure as involving a section of skin, fat and latissimus dorsi muscle that a surgeon slides through a tunnel to the breast area. The surgeon then creates a natural looking breast and sews it into the breast area. Blood vessels remain attached, but if cut, the surgeon will reattach them. Due to the lack of excess fat in this area of the back, this surgery proves best for women with small to medium sized breasts. The UCLA Division of Plastic and Reconstructive Surgery states that many patients need implants under the muscle when it is moved to give the breast volume and projection.
Nipple/Areolar Reconstruction
Upon construction of a new breast mound, some women choose to have a nipple and areola constructed as well. Physicians do this by using tissue taken during the reconstruction, and the coloring of the areola is done using permanent tattooing to make it appear more natural. According to UCLA, nipple reconstruction usually occurs two to three months after the initial breast reconstruction and is an outpatient surgery.
