A breast reconstruction operation is a procedure that recreates a breast shape, size and appearance after a mastectomy. This can be performed using your own tissue, a breast implant, or a combination of the two. This operation can usually be performed at the same time of the mastectomy, and can be done months or years later, as a delayed procedure. Each option has benefits and drawbacks, and the best choice for you can be discussed with Dr Perron.
This procedure uses the abdominal skin, fat and sometimes muscle to recreate the breast shape. It is a longer procedure that requires microsurgery to attach the abdominal tissue to new blood supply. This option can provide an excellent appearance and natural feel, as your own tissues are used.
TRAM vs DIEP
The difference between a TRAM (Transverse Rectus Abdominus Myocutaneous) flap and a DIEP (Deep Inferior Epigastric Perforator) flap is related to whether or not the abdominal muscle (6 pack muscle) is preserved. The decision to use a TRAM or DIEP flap relates to the anatomical blood supply of the abdominal tissues. Everyone has a slightly different blood supply to their abdominal wall. As such, the choice to use a TRAM or DIEP relates to your specific anatomy.
A TRAM/DIEP flap reconstruction usually takes several hours, and is performed under a general anesthetic. The stay in hospital can be from 5 -10 days, rarely longer. You will need to wear a post-operative garment after the procedure for several weeks, to reduce the risk of abdominal complications.
The recovery time usually takes 3-4 weeks before you feel comfortable. Resumption of heavy exercise/lifting should be avoided until at least 3 months.
Latissimus Dorsi Flap
This flap uses a combination of your own tissues, and a breast implant to recreate the breast shape. This option is usually performed in two stages, a few months apart. The latissimus dorsi muscle with a small patch of skin is moved from the back to the chest, and an expander is placed behind this muscle.
This procedure usually takes a few hours, and will require a few days in hospital to recover. There is a scar on the back from where the muscle and skin is lifted, and moved to the chest. A breast implant expander is placed behind this muscle and skin on the chest to recreate the breast shape. The expander is inflated over several weeks with saline injections. A second procedure then removes the expander and it is replaced with a silicone implant.
The time to recover is usually a few days for each procedure. Resuming normal exercise and lifting or high reaching should be limited for the first 6-8 weeks.
This procedure is usually done in 2 stages, involving the use of a tissue expander and a silicone breast implant.
The first stage involves creating a pocket for the tissue expander, usually behind the pectorialis major (‘pec’) muscle. This expander is then inflated over several weeks with saline to expand the pocket, and the overlying skin. The expansion phase can be variable for each patient, and depends on several factors. These factors include the total volume needed in the expander to achieve the size desired, and skin quality over the expander. The second operation replaces a fully inflated expander with a silicone implant. More frequently, plastic surgeons are using ADM’s (Acellular Dermal Matrices) to help protect the implants, and reconstruct the breast shape. The specifics of this new technology can be discussed with Dr Perron.
As with any operative procedure, there are risks involved. The most common complications are some minor bleeding, infection, wound healing problems, and some pain. If the operation involves the use of implants, complications specifically for this include:
- capsular contracture
- implant rupture/leakage
- implant malposition (rotation/movement)
If the operation involves a flap, complications for this operation includes the following:
- loss of blood supply to the flap (partial or total)
- fat necrosis
- fluid collection in the breast, or the donor site
- decreased abdominal strength
- asymmetry in breast size
- shoulder pain
Other details about breast reconstruction, specific concerns, or your suitability for this procedure can be discussed with Dr Perron.