Breast reconstruction after mastectomy is a very difficult decision. It is important to understand that it is your personal and only choice whether to proceed with it or not.
Some women choose not to reconstruct their breast. It reminds them of their victory over cancer, they may fear the surgery part, or there may be other reasons.
It is also important before making any decision to discuss with your doctor what options are available. Ask for and receive support — if you need it — in terms of psychological counseling. You may also want to talk to other women who have gone through the same experience as you.
Being open will help you understand your own feelings, which naturally can vary widely.
When Can I Undergo Breast Reconstruction?
Breast reconstruction can be performed either immediately after mastectomy (primary breast reconstruction) or after completing all related treatments, i.e., at a later time (delayed breast reconstruction).
What Are the Methods of Breast Reconstruction?
There are two main techniques used for breast reconstruction: reconstruction with silicone implants and reconstruction with autologous tissues (using tissue from your own body).
However, in modern plastic surgery, there are specific sub-methods for the above techniques, which the plastic surgeon can choose individually for each patient. These are based on body areas that can provide sufficient tissue for reconstruction.
Below are descriptions of the tissue harvesting methods and how these techniques are applied.
With Silicone Implant
After mastectomy, breast reconstruction can be done either with immediate placement of a silicone implant, which is rare, or in two stages, which is more common.
Initially, a tissue expander is used to stretch the skin. In a second stage, usually after a few months, the expander is replaced with a permanent implant.
The advantages of this method include that it is a less invasive technique, requiring less surgical time and faster recovery.
The disadvantages include that implants do not exactly follow the natural shape of a normal breast.
Additionally, reconstruction takes a longer time, requiring at least one more surgery to place the permanent implant, plus the potential risks associated with breast augmentation in general.
With Autologous Tissue
The use of autologous tissue in immediate breast reconstruction involves transferring a flap of tissue from the patient’s body, maintaining its blood supply (a flap), to the site of the lost breast.
Flaps play a very important and necessary role in modern Reconstructive Plastic Surgery, which is rapidly evolving.
In general, the tissues (flaps) used can come from:
- Back (LD flap)
- Abdomen (DIEP or TRAM flap)
- Thigh or buttock (SCAP, IGAP, TUG, PAP flaps)
Back Tissue:
This procedure uses a muscle from the back along with the overlying skin to create a new breast. This is called the latissimus dorsi muscle flap.
This tissue offers very good quality (skin and muscle), which is especially important if radiation therapy is applied to the breast area and resistance is needed.
However, although this is a very reliable flap, it provides limited volume for reconstruction.
Practically, this means silicone implants are often also required to achieve the desired breast volume, especially if the other breast is larger.
Abdominal Tissue:
This procedure reconstructs the breast using dermo-subcutaneous tissue from the abdomen (Deep Inferior Epigastric Perforator Flap or DIEP). This may be used alone or combined with the rectus abdominis muscle (Transverse Rectus Abdominis Myocutaneous Flap or TRAM).
An advantage of this procedure is that the final result includes a tummy tuck in one surgery.
It should be clear that these procedures are very specialized and demanding, making the choice of plastic surgeon extremely important. The surgeon must have experience not only in the chosen method but also in selecting the most appropriate technique from the start.
Thigh or Buttock Tissue:
Some reconstruction surgeries use dermo-subcutaneous tissue from the thigh or buttock. However, these have disadvantages such as being technically difficult, leaving visible scars (especially on the buttock), and relatively small volume results.
There are indications for certain patients that tissue from the abdomen or back cannot be used due to quality, volume, or previous surgeries, guiding the surgeon to select these methods as the best choice.
Obviously, this can also apply to other methods, so weighing all factors and making the best decision is crucial for selecting the appropriate donor site.
Are There Advantages and Disadvantages to the Methods?
In flap transfer techniques, the tissue is surgically removed from the abdomen, thighs, or buttocks and transplanted to the breast area to be reconstructed, reconnecting blood vessels to those in the recipient site.
This process requires technical and cognitive skills from the plastic surgeon, who must be experienced in such microsurgeries.
If autologous tissues are used, either as free or pedicled flaps, the procedure is more complex than skin expansion.
Note that scars will remain on both sides — the donor site and the reconstruction site — and recovery will take longer than with implant placement.
On the other hand, when the breast is fully reconstructed with your own tissue, the result is obviously more natural. There will be no concerns regarding silicone implants.
Do not hesitate to contact us with any questions you may have about breast reconstruction.
Whatever your concerns, we are here to help, to answer every question clearly and honestly.
Be assured that in the end, everything will go well and you will regain your confidence and strength!
Remember that no matter how difficult this journey is, you can always receive the support you need and regain everything this experience has taken away. Picking up the thread of life where you left off, looking toward the future with optimism and new prospects.
