Breast Cancer

Breast Reconstruction - What you should know

As a woman in the field of plastic surgery, I am extremely sensitive to the issues surrounding breast cancer. When a newly diagnosed breast cancer patient enters into my office, I know she is struggling with the diagnosis of cancer and what kind of an impact that is going to have on her life. She also faces the concerns and grief associated with the possibility of losing one or both of her breasts. This disease is not limited to a small group of women. According to the latest statistics of the American Cancer Society on breast cancer, approximately 1 in 8 women will be diagnosed with the disease during her lifetime. Given these figures, all of us will face the challenge of coping with this disease in family members, loved ones, or ourselves.

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What should you know about breast reconstruction?
Does reconstruction interfere with treating my breast cancer?
When can the procedure be performed?
How do you reconstruct my breast?

What should you know about breast reconstruction?

Is everyone a candidate? Yes, with only a few exceptions. However, the best candidates are women whose cancer has been eliminated entirely by the mastectomy.

Does reconstruction interfere with treating my breast cancer?

Breast reconstruction has no known effect on the recurrence of cancer in the breast, nor does it interfere with chemotherapy or radiation treatment.

When can the procedure be performed?

Usually, this decision is made by the patient. The reconstruction can be performed at the time of the mastectomy (immediate reconstruction), so that the patient can avoid suffering the trauma of breast loss. Immediate reconstruction has become an appealing option because it combines effective treatment of the cancer with restoration of the breast. The other option is a delayed reconstruction, waiting 6 months to many years later. Some women delay the reconstruction, not wanting to deal with this at the same time as the cancer surgery. In addition, some oncologists suggest delaying reconstruction for medical reasons, for example, in women with very large cancers or in cases where the tumor has spread.

How do you reconstruct my breast?

We really have 2 main options: with implants or with the patient's own tissue.

Implants - These are round implants filled with salt water and are very similar to those used for breast augmentation. They are placed beneath the remaining breast skin and muscle and left deflated until the scars have healed. Once the mastectomy scars have healed, they are slowly inflated until they match the uninvolved breast. This process can take several weeks. Reconstructing the breast with implants is the simplest procedure. The patient doesn't have any additional scars and her recovery is fairly quick, because the implant is placed through the existing incision. However, the implant can sometimes become hard and may not match the uninvolved breast.
Patient's own tissue (flaps) - Plastic surgeons have been using flaps to reconstruct breast cancer patients for many years. There are 2 main options when we talk about flaps: the TRAM (transverse rectus abdominus myocutaneous) flap and the LD (latissimus dorsi myocutaneous) flap. Big words that describe the part of the body from which we take tissue to reconstruct the breast. When we use flaps, we're acting a little like Robin Hood, who stole from the rich to give to the poor. In the same way, we take tissue from one area (that has plenty), and take it up to the chest to reconstruct the breast.

Some patients describe the TRAM flap as the "tummy tuck" procedure, because in this procedure we take extra fat and muscle from the lower abdomen and use this tissue to make the breast. The added benefit is that the tummy is tighter and more youthful after the surgery. Our other commonly used procedure is the LD flap, during which we are using fat and muscle from the upper back. One of the drawbacks to the LD flap is that we must often use an implant with the flap, because the flap isn't big enough to match the uninvolved breast.

When we use either of these flaps, we need to make sure that the patient realizes that reconstructive surgery causes additional discomfort and leads to a slightly prolonged recovery time. On the other hand, using the patient's own tissue generally gives a more natural feeling breast which matches the uninvolved breast well.

Breast reconstruction is one of the most satisfying aspects of my practice. As a member of the Plastic Surgery faculty at the University of Cincinnati Medical Center, and an integral member of the breast cancer team, I am very interested in providing advice and answers to women who wish to explore reconstruction.

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Last Reviewed: Aug 19, 2003

Jennifer L Butterfield, MD

Division of Plastic Reconstructive & Hand Surgery
Department of Surgery
College of Medicine
University of Cincinnati