Description

If you are having breast reconstruction at the same time as your mastectomy, your surgeon may do a skin sparing mastectomy. This means only the area around your nipple and areola is removed, and more skin is left to make reconstruction easier.

If you will have breast reconstruction later, your surgeon will remove enough skin over your breast to be able to close the skin flaps.

The two most common methods of breast reconstruction are transverse rectus abdominous muscle flap (TRAM) and latissimus muscle flap with a breast implant. For both of these procedures, you will have general anesthesia (asleep and pain-free)

For TRAM surgery:

• Your surgeon will make a cut across your lower belly, from one hip to the other. Your scar will be hidden later by most clothing and bathing suits.
• Your surgeon will loosen skin, fat, and muscle in this area. The surgeon will then tunnel this tissue under the skin of your abdomen up to the breast area. Your surgeon will use this tissue to create your new breast. Blood vessels remain connected to the area from where the tissue is taken.
• In another method, the skin, fat, and muscle tissue are removed from your lower belly. Then the surgeon places this tissue in your breast area to create your new breast. In this method, the arteries and veins are cut and reattached to blood vessels under your arm.
• This tissue is then shaped into a new breast. Your surgeon will match the size and shape of your remaining natural breast as closely as possible.
• Your surgeon will close your belly cut with stitches.
• If you would like a new nipple and areola created, you will need a second, much smaller surgery later.

For latissimus muscle flap with a breast implant:

• Your surgeon will make a surgical cut in your upper back, on the side of your breast that was removed.
• Your surgeon will loosen skin, fat, and muscle from this area and then tunnel this tissue under your skin to the breast area. This tissue will be used to create your new breast. Blood vessels will remain connected to the area from where the tissue was taken.
• This tissue is then shaped into a new breast. Your surgeon will match the size and shape of your remaining natural breast as closely as possible.
• An implant may be placed underneath the chest wall muscles to help match the size of your other breast.
• If you would like a new nipple and areola created, you will need a second, much smaller surgery later.

When breast reconstruction is done at the same time as a mastectomy, it adds about 2 to 4 hours to the surgery. When it is done as a second surgery, it may take more than 2 or 6 hours.

Why the Procedure is Performed

You and your doctor will decide together about whether to have breast reconstruction, and when. The decision depends on many different factors.

Having breast reconstruction does not make it harder to find a tumor if your breast cancer comes back.

The advantage of breast reconstruction with natural tissue is that the remade breast is softer and more natural than breast implants. The size, fullness, and shape of the new breast can be closely matched to your other breast.

But muscle flap procedures are more complicated than placing breast implants. You may need blood transfusions during the procedure. You will usually spend 2 or 3 more days in the hospital after this surgery compared to other reconstruction procedures. Also, your recovery time at home will probably be longer.

Many women choose not to have breast reconstruction or implants. They may use a prosthesis (an artificial breast) in their bra that gives a natural shape, or they may choose to use nothing at all.

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Blood loss
• Breathing problems
• Heart attack or stroke during surgery
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Reactions to medicines

The risks for breast reconstruction with natural tissue are:

• Loss of sensation around the nipple and areola
• Noticeable scar
• One breast is larger than the other (asymmetry of the breasts)
• Skin loss or chronic wounds on the chest wall

There is also a risk of bleeding into the area where the breast used to be. Sometimes a second operation is needed to control this bleeding.

Before the Procedure

Always tell your doctor or nurse if you are taking any drugs, supplements, or herbs you bought without a prescription.

During the week before your surgery:

• Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before surgery.
• Take your drugs your doctor told you to take with a small sip of water.
• Shower the night before or the morning of surgery.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will stay in the hospital for 2 to 5 days.

You may still have drains in your chest when you go home. Your surgeon will remove them later during an office visit. You may have pain around your cut after surgery.

Fluid may collect under the skin of your armpit. This is called a seroma. It is fairly common. Seromas usually go away on their own, but sometimes they need to be drained.

Outlook (Prognosis)

Results of reconstruction surgery using natural tissue are usually very good. But reconstruction will not restore normal sensation on your new breast or nipple.

Recovery is usually faster when reconstruction is done after the mastectomy wound has healed.

Having breast reconstruction surgery after breast cancer can improve your sense of well-being and quality of life.

Alternative Names

Transverse rectus abdominous muscle flap; TRAM; Latissimus muscle flap with a breast implant; DIEP flap; Gluteal free flap

References

Wilhelmi BJ, Phillips LG. Breast reconstruction. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 35.

Update Date: 1/26/2012

Reviewed by: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.