Restorative Techniques

Breast Reconstruction After Mastectomy

Although there are many options, all breast reconstruction procedures fall into one of two broad categories:

• Breast reconstruction using natural tissue from your own body
• Breast reconstruction using breast implants

Natural tissue generally provides the highest quality and most durable type of breast restoration. The most advanced methods of breast reconstruction available today use natural tissue to restore a breast removed by mastectomy without sacrificing a woman’s muscles in the process.

State-of-the-Art Approaches to Breast Reconstruction

Living tissue that is surgically relocated from one part of the body to another is called a “flap.” One of the most important factors differentiating natural-tissue reconstructions from one another is whether muscle must be removed from a flap’s donor site and transferred to the chest along with the skin and fat needed to restore the breast.

Perforator Flap Reconstruction

Perforator flaps such as the DIEP flap are sophisticated methods of natural-tissue restoration that leave muscle intact at the donor site while still providing the necessary blood supply to the tissue used for reconstructing a breast. This is possible through the use of microsurgical techniques. Without destroying important functional muscles, a new breast from healthy, warm, living tissue can be shaped to closely resemble the breast removed by a mastectomy. Because they do not remove muscle, perforator flaps are now considered by many experts to be the very best option for natural-tissue breast reconstruction.

Other Methods of Breast Reconstruction

Muscle Flap Reconstruction

Although muscle is not needed to restore the shape and form of a breast––only skin and fat are needed––some methods of natural-tissue breast reconstruction do remove muscle from their respective donor sites in order to carry the blood vessels that nourish the tissue of the reconstruction. The removal of muscle from a flap’s donor site, as occurs with TRAM flap, for example, is the principal drawback to muscle flaps––also called musculocutaneous flaps––used in an era well before techniques for using perforator flaps were developed.

Reconstruction with Breast Implants

All methods of reconstruction that use an implant require inserting into the body a prosthesis made of synthetic material. Breast implants may vary from one another not just in terms of the material used to fill them --saline or silicone-- but also in terms of shape (round or “anatomic”), the texture of their outer surface (smooth or “textured”), profile (how far it sticks out), and volume (size). You will need to weigh he advantages of this quicker and technically less demanding reconstruction method against its disadvantages and possible later complications, including capsular contracture, implant rupture and a high rate of unplanned re-operation.


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