Breast reconstruction: An overview

October 25, 2016

WHAT IS BREAST RECONSTRUCTION?

Breast reconstruction is the surgical restoration of breast morphology and volume after mastectomy (usually done for breast cancer patients).

WHAT ARE THE PROS AND CONS OF IMMEDIATE AND DELAYED BREAST RECONSTRUCTION?

In immediate breast reconstruction, skin- sparing mastectomy preserving native breast skin envelope and breast reconstruction are performed on the same day. Immediate breast reconstruction has a huge positive psychological benefit for the patient who wakes up from the surgery without feeling the loss of body form. It is also more cost-effective as a single stage procedure.

Delayed breast reconstruction tends to result in more scars and is less natural in appearance. However, it is preferred in advance breast cancer because of the high risk of recurrence.

WHAT ARE THE VARIOUS METHODS OF RECONSTRUCTION?

The transverse rectus abdominis myo-cutaneous (TRAM) flap is the most common autologous breast reconstruction procedure which removes excessive lower abdominal skin and fat together with a portion of the abdominal muscle, transferring it to the breast for reconstruction. The nett result is a flatter tummy and reconstructed breast.

The latissimus dorsi (LD) flap is more suitable for those who wish to be pregnant after the treatment. The LD muscle is a thin fan-shaped muscle from the back. Reconstruction using the LD muscle flap may be combined with a breast implant to provide more volume.

Breast reconstruction using only implants is a simpler and faster procedure. In some instances, a tissue expander is used to serially stretch the skin before placing the definitive breast implant. In the long run, implant replacement may be required in the event of implant rupture or capsular contracture (scarring around the implant).

HOW SHOULD THE PATIENT DECIDE ON THE METHOD OF BREAST RECONSTRUCTION?

Autologous reconstruction is recommended if the patient wants a reconstructed breast that is natural in appearance and feel, and has long- lasting results. She must be willing to accept a higher initial cost, longer surgery and additional scar from the tissue donor site.

Alloplastic reconstruction using an implant is suitable for a patient who wishes for a simpler and shorter surgery with lower initial cost. She would also accept a less than ideal match of breast shape with the contralateral un-operated side.

ARE THERE ANCILLARY PROCEDURES AFTER THE INITIAL RECONSTRUCTION?

Nipple reconstruction is planned four to six months after the first stage of breast reconstruction followed by nipple areolar tattooing one to two months later.

Fat transfer may be done at a later stage to improve the minor contour of the breast.