Depending on the patient's overall health, breast reconstruction can either be part of the original mastectomy procedure or performed later. Breast reconstruction may also involve more than one procedure, though follow-up procedures are often performed on an outpatient basis. Occasionally breast reconstruction surgery is performed on the natural breast so that it will look similar to the reconstructed one.
Breast cancer patients wanting to discuss or schedule an appointment for breast reconstruction should contact the Emory Breast Center.
Breast Reconstruction Procedures
Breast Reconstruction Methods
Deep Inferior Epigastric Perforator (DIEP) Flap
This is a procedure where fat and overlying lower abdominal skin is harvested without muscle sacrifice, thus preserving abdominal strength and integrity. Microsurgery is performed to vessels under the sternum to provide blood supply to the flap. Additional reconstructive surgery will be needed to create a nipple and areola.
Skin Expansion with Breast Implant
This is the simplest of breast reconstructions and uses a tissue expander placed under the skin of the affected breast. Blood transfusions are not required, pain is often minimal and recovery is fairly quick. After the sutures are removed, saline is added to the expander on a weekly basis, gradually stretching the skin. When sufficient stretching has been achieved, the expander is removed and replaced by a permanent breast implant in a two-stage procedure. Nipple reconstruction, if desired, is a separate procedure
Latissimus Dorsi Myocutaneous Flap
In this procedure, the triangular, flat muscle covering the lumbar region and the lower half of the thoracic region known as the latissimus dorsi is moved to the chest along with the overlying skin from the back to create a new breast mound. If necessary, a breast implant can be placed under the flap to balance any difference in size between the breasts. The incision is usually made along the bra line to conceal the scar. Blood transfusions are typically not required and nipple reconstruction is performed later.
Rectus Abdominus Myocutaneous Flap
This method involves the tunneling of the rectus abdominus (the paired muscle that runs vertically on each side of the anterior wall of the abdomen) and its overlying skin up to the chest. The breast mound is then created to match the opposite breast. A blood transfusion may be required. Implants are usually unnecessary since there is generally enough tissue to match the size of the other breast. If the opposite breast is larger, a simultaneous breast reduction can be done. Contouring of the new breast mound may also be performed and a synthetic mesh placed over the area where the muscle is moved to strengthen the abdominal wall and reduce the chance of hernia formation. Nipple reconstruction is done as a second procedure.
Nipple Reconstruction
This simple outpatient procedure is often performed with local anesthesia and takes about one-to-two hours, the goal being to recreate a nipple using skin from the patient's breast that will match the appearance of the opposite breast.
Oncoplastic Breast-Conserving Surgery
Oncoplastic breast-conserving surgery combines breast cancer surgery and breast reconstructive surgery during the same operation. Working together, a breast cancer surgeon and plastic surgeon remove the cancerous tumor and immediately reconstruct the breast using the patient's own tissue or implants.
In a 2005 study published in the Annals of Surgical Oncology (Jul,12: 539-45, 2005), surgeons from the European Institute of Oncology in Milan, Italy, concluded that, "Oncoplastic surgery adds to the oncological safety of breast-conserving treatment because a larger volume of breast tissue can be excised and a wider negative margin can be obtained. It is especially indicated for large tumors, for which standard breast-conserving treatment may have a high probability of leaving positive margins."