Breast reconstruction is performed if the breasts have been removed partially or completely due to Breast cancer or any major Breast diseases.
Primary Breast reconstruction is performed immediately after removal of Breast glands in the primary surgery, whereassecondary or delayed breast reconstruction is performed after several months of primary breast removal surgery.
Decisions about Primary vs. Delayed reconstruction depends upon many factors, and is largely debatable.
- Extent of breast cancer and its staging
- The amount of breast tissue available after resection
- Post mastectomy adjuvant therapies
- Insurance coverage
- Psychological condition and patient expectations
There are various breast reconstruction options, the most common options are-
- Breast implants
- Latissimus Doris flap with or without breast implants
- TRAM musculocutaneous flap
- DIEP free flap
The type of reconstruction depends upon the extent of surgery to remove the breast such as Breast conservation surgery (lumpectomy or segmental resection), subcutaneous mastectomy (Prophylactic surgery in high risk patients), modified radical mastectomy (with or without nipple preservation) and radical mastectomy.
One stage reconstruction is performed with Silicone implants if there is adequate skin and muscle coverage to protect the implant.
Two staged implant reconstruction is performed with the help of tissue expanders to stretch the skin to accommodate a final silicone implant of desired size.
Risks include –
- Implant extrusion
- Capsular contracture etc
Transverse abdominis muscle flap (TRAM flap) procedure uses your abdominal muscle and overlying skin and fat tissue. It is rotated with intact blood vessels and turned to reconstruct the breast. The abdominal wound is repaired and closed in the Tummy tuck fashion.
- Loss of flap partially or completely
- Abdominal wall weakness etc
DIEP free flap
Deep Inferior epigastric flap (DIEP flap) is a flap taken from lower abdomen similar to TRAM flap except the muscle is left behind. The flap is completely cut off from its source artery and reconnected in the breast area by microvascular anastomosis.
Risks are similar to above procedures except there is no abdominal wall weakness.
Latissimus Dorsi flap
This flap is taken from the back; a paddle of skin is carried along with underlying latissimus dorsi muscle and tunneled under a skin bridge to bring it forward in the chest region. This is used to reconstruct the breast and it often requires an implant to provide enough volume to the breast.