‍Types of Breast Reconstruction

Breast reconstruction is a wonderful, silver lining that offers breast cancer patients hope and something to look forward to. During or after battling such a terrifying diagnosis, making new breasts or optimizing the remaining breast tissue can help a woman feel feminine and whole again. For some, breast reconstruction can make women feel like they are in control again and get some power back! California medical insurances typically cover the cost of breast reconstruction. There are many different types of reconstruction that women can discuss with their board certified plastic surgeon. Below are the types of these surgeries categorized based on timing, type of material, and final details.

Timing

The timing of breast reconstruction depends on many factors. One may be your overall general health. Additional elective surgery is contraindicated in an individual who has poor or suboptimal health. Medical conditions such as hypertension and diabetes mellitus need to be controlled and at healthy levels prior to planning breast reconstruction. The surgical oncologist (the general surgeon who is removing the cancerous tissue) may be networked in with a plastic surgeon. They may plan to perform cancer removal and breast reconstruction surgeries at one time. This is called, “immediate breast reconstruction,” meaning you are having breast mounds reconstructed at the same time as your oncologic surgery. Advantages of this is having less psychological distress than having to deal with not having breasts at all. The patient goes to sleep and wakes up with breasts, even though they are not the same breasts. In these surgeries, the breast pocket is preserved and not given an opportunity to scar down to the chest wall.  Disadvantages of this are longer operating room times, longer anesthesia times, possible increased risk for infection due to the surgical sites being opened longer, possible longer hospitalization for postoperative pain control.

If a plastic surgeon is not available or your surgical oncologist thinks it is best to wait, you may be a better candidate for a “delayed breast reconstruction.” This is where the breast cancer is removed, the patient heals, and later chooses to have breast reconstruction at a later time. Patients who choose this timing are those who rather have the cancer removed and not have to mentally deal with the stress of additional surgery. Some women do not necessarily care about having breasts; they just want to be free of cancer. Perhaps it’s not the optimal time for extensive surgery. Some of these women have young children or cannot take more time off from work.

There is a hybrid of “immediate” and “delayed” breast reconstruction, called “delayed-immediate breast reconstruction. This is where a balloon, called a tissue expander (or T.E., for short), is placed in the breast pocket at the same time as the cancer removal surgery. This is the immediate portion. The patient heals, undergoes any necessary radiation or chemotherapy. This expander acts as a place holder. At a later time, the tissue expander is removed and the “delayed” breast reconstruction ensues.

Material type

Breast mounds can be created with an implant or with the patient’s own tissue. Breast implants are commonly used in creating new breast mounds. These are reserved for patients who want this aesthetic, do not have enough tissue themselves to create a breast mound, or are not healthy enough to endure lengthy surgeries. Although saline-filled implants can be used for this purpose, many plastic surgeons select silicone breast implants to decrease the chance of visible implant rippling. Silicone implants are considered safe for use. It is recommended that both saline and silicone implants are exchanged for new ones approximately every decade as maintenance.

Breast mounds can also be reconstructed using the patient’s own tissue; this type is called “autologous reconstruction.” Typical donor sites are the back and abdominal wall. There are two large muscles on the back called, latissismus dorsi. A sizeable piece of tissue with its overlying skin can be moved to the front of the chest along with this muscle. The offers good blood supply to the area and some thickness. For additional volume, plastic surgeons may add an implant in under this muscle. The abdominal wall is another commonly used area as women tend to have extra skin and fat here, especially after pregnancies or weight gain. Plastic surgeons may completely remove the abdominal wall tissue (as a “free flap”) and relocate it to form breast mounds on the chest or leave the tissue still attached to the blood supply and move it into the chest wall. Using the patient’s own tissue is a major surgery, requires a hospital stay of at least 3 days or more, pain in a separate site (the donor site) and carries higher risk. The major benefit of autologous reconstruction is that the patient does not need to have any implant exchanges if there are none used.

Final Details

It is not uncommon to need touch up procedures, or revisions. Plastic surgeons are trying to recreate God’s work and make man-made breasts. Oftentimes, revisional surgeries are on a smaller scale and do not require as much anesthesia or operating room time. Of course, this depends on what is necessary. Once the mounds are completed, nipples can be reconstructed using the patient’s own tissue. The skin on the front of the breast mound can be incised and folded in a way to form a nipple. Keep in mind that the nipples will never look like the original nipple. The areola, which is the pigmented part where the nipple projects from, is typically reconstructed with tattooing. Some plastic surgeons will harvest a piece of skin from the groin regions and transfer it to the breasts to form new areolas. Three-dimensional tattoo artists are very talented and can create the appearance of a nipple AND areola. This is a non-invasive method to complete a woman’s breast cancer journey and a wonderful option for many.

Concluding Thoughts

It is important to select a board certified plastic surgeon who makes the patient feel comfortable with (see our blog topic on How to Pick Your Plastic Surgeon). Interviewing several plastic surgeons is always a good idea. The patient should discuss the nature, timing, risks, expected postoperative recovery expectations, and realistic goals of their breast reconstruction plan.