Breast Reconstruction Detroit
Breast reconstruction is the right of every woman who has had, or is planning to have, a mastectomy for breast cancer.
Timing of breast reconstruction
Breast reconstruction can help restore the look and feel of the breast after a mastectomy. Performed by a plastic surgeon, breast reconstruction can be done at the same time as the mastectomy (immediate) or at a later date (delayed).
Many women now get immediate breast reconstruction. However, the timing depends on your situation and the treatment you will have after surgery. Not all women can have immediate reconstruction.
It is important to discuss your options with your plastic surgeon, breast surgeon and oncologist (and your radiation oncologist if you are having radiation therapy).
Breast reconstruction can help you feel more comfortable about how you look. Although a reconstructed breast may never match the look or feel of your natural breast, this area of plastic surgery continues to improve.
Choosing the type of breast reconstruction that is right for you
There is no one best reconstruction method. There are pros and cons to each. For example, breast implants require less invasive surgery than procedures using your own body tissues, but the results may look and feel less natural.
Your body shape and anatomy may affect the types of breast reconstruction likely to give you the best results. For example, women with larger breasts may need breast reduction surgery on the opposite, natural breast to create a more even look.
Your plastic surgeon will help you choose the type of reconstruction that will give you the best results. Although this decision may seem overwhelming, it may help to know that most women who have had breast reconstruction do not regret the method they chose. There are fairly few complications with any of the current techniques, especially when a woman is a good candidate for a selected procedure.
Most breast reconstruction methods involve several steps. Both immediate and delayed reconstructions require a hospital stay for the first procedure. However, follow-up procedures may be done on an outpatient basis.
Basic types of breast reconstruction
Expander and implant based reconstruction
Step one: A tissue expander (a modified type of saline implant) is inserted in the envelope formed by the breast skin and chest muscle. The expander has a valve that allows more saline to be added (with a simple injection through the skin into the valve) after surgery.
Step two: Over a period of four to six months (in repeated office visits), the skin-muscle envelope is slowly stretched by injecting more saline into the expander until it reaches the desired size of the final implant. The final volume may be limited by the quality and size of the skin-muscle envelope.
Step three: A surgeon removes the expander and replaces it with the permanent implant (saline or silicone). This is done in an operating room, but usually an outpatient surgery.
Some women do not need tissue expansion and can have an implant (saline or silicone) directly inserted at the time of mastectomy. In these women, the size of the skin-muscle envelope at the time of the mastectomy is large enough to cover the desired final implant.
Breast implants and radiation therapy
Radiation therapy can cause problems (such as changes in skin color and tissue shrinkage) for both implant and natural tissue reconstruction.
If you will have an implant procedure and radiation therapy will be used after mastectomy, immediate rather than delayed breast reconstruction is recommended. Delayed breast reconstruction using an implant may not be possible after radiation therapy. Skin that has received radiation and is later stretched to fit an implant is at high risk for complications and a poor cosmetic result.
Results are better when the procedures to expand the skin are done before radiation therapy begins.
Natural tissue flap surgery
Reconstruction that uses skin and soft tissue flaps from your own body tends to look and feel more like a natural breast than reconstruction with implants. However, these procedures are more complex and invasive, and usually require a longer hospital stay and post-surgery recovery time. They also leave scars in the area of the body where the tissue was taken (donor site).
The most common natural flap procedures use tissue from the back or abdomen. In some procedures, part or all of a muscle needs to be taken to provide blood flow to the flap tissue. This may cause weakness in that area of the body and limit certain physical or athletic activities. If you are active, discuss this risk with your plastic surgeon.
Latissimus dorsi muscle flap breast reconstruction
The latissimus dorsi muscle flap procedure removes a large muscle in the back along with skin and underlying fatty tissue and uses these tissues to reconstruct the breast.
Using fatty tissue helps create a more natural looking breast. In most women, the amount of soft tissue available on the back is limited and the flap itself is only about one inch thick. Therefore, an implant is usually needed in addition to the latissimus flap to create enough volume for the reconstructed breast. The soft tissue of the latissimus flap goes over the implant so that the look and feel of the breast is more natural than with an implant alone.
Transverse Rectus Abdominis Myocutaneous (TRAM) flap breast reconstruction
The transverse rectus abdominis myocutaneous (TRAM) flap uses skin, fat and muscle from the lower abdomen to reconstruct the breast. A TRAM flap creates a natural looking breast. It usually does not require an implant as long as there is enough excess skin and fatty tissue in the lower abdomen. If you do not have excess abdomen tissue, you may not be a candidate for a TRAM flap reconstruction.
The TRAM flap has some drawbacks. Once a TRAM flap has been done, it cannot be repeated. And, since one of the abdominal muscles is removed to provide a blood supply to the flap, its loss can cause some weakness in this part of the body and can leave a large scar across the lower abdomen. If you are active, talk with your plastic surgeon about this drawback.
Natural tissue reconstruction and radiation therapy
Radiation therapy can cause problems (such as changes in skin color and tissue shrinkage) with both implant and natural tissue reconstruction.
For women choosing flap breast reconstruction who will need radiation therapy after mastectomy, it is better to delay the flap reconstruction until after radiation therapy. This greatly lowers the chances that the look, feel and size of the reconstructed breast will be harmed by the radiation therapy.
Women may also consider having immediate reconstruction with a tissue expander to preserve the breast skin envelope. Then, once radiation therapy is done, have flap reconstruction.
Nipple and areola reconstruction
Creating the nipple and areola is the last stage of breast reconstruction. Recreating the nipple and areola gives the reconstructed breast a more natural look and can help hide the mastectomy scars. These procedures are usually outpatient procedures and have few risks.
However, not all women can have nipple reconstruction. And, those who have had radiation therapy may have higher surgical risks.
The nipple can be recreated using skin from the reconstructed breast itself after the implant or flap reconstruction has healed.
The areola may be created with a tattoo or by grafting skin from the groin area. Skin in the groin area has a similar tone as the skin on the areola. The scar from where the skin is taken can be hidden in the bikini line.
Many states require all health insurance providers (including those not covered under the Women’s Health and Cancer Rights Act) to pay for reconstructive surgery after a mastectomy. Check with your state insurance commissioner’s office or your health insurance provider to find out which services are covered by your state’s laws and your health plan.
For more information on coverage of breast cancer-related services by state, visit the American Society of Plastic Surgeons’ website.
Questions for your plastic surgeon
- What types of breast reconstruction can I have?
- Which type is best for me and why?
- When is the best time for me to have breast reconstruction — at the time of the mastectomy or later? Is there a time limit for having reconstruction done?
- How many procedures are involved in the type of reconstruction I am having?
- If I need to have radiation therapy after my mastectomy, how will that affect my reconstruction choices and cosmetic outcomes?
- How many of these procedures have you performed?
- Would you please show me photos of both your best and your more typical results?
- What are the chances of infection and failure with my reconstructive surgery? Are there any other risks or side effects to consider?
- What are the short- and long-term results with implant versus natural tissue reconstruction?
- Will I have a surgical drain in place when I go home? If so, how will I care for it? When will it be removed?
- Is there much pain after surgery?
- Will I have any numbness after the surgery?
- What side effects might I expect after surgery? What problems should I report to you right away?
- Where will the surgical scar(s) be?
- What body changes should I expect after surgery? How many hospital stays are needed? How long will each hospital stay be?
- How can I expect the reconstructed breast to look and feel?
“I look at my “before” photos and can’t believe I waited so long. Now I can finally wear dresses without a bra, and I’m proud of how I look in a bikini.”
- Natalie T.