Breast Reconstruction

Who is a candidate for breast reconstruction?

Women who have had a mastectomy (removal of the entire breast) for cancer treatment or prophylaxis (to lessen the risk of developing breast cancer) or who have undergone a lumpectomy and radiation (breast conservation therapy) with a volume deficit or contour irregularity may be candidates for reconstruction. Breast reconstruction can be performed at the time of mastectomy (immediate reconstruction) or many month or years after mastectomy (delayed reconstruction). Patient preference, medical conditions, and other necessary cancer treatments factor into the timing and type of reconstruction that may be best for you.

What reconstructive options are available?

Partial breast reconstruction:

Lumpectomy and radiation, a treatment termed “breast conservation therapy”, can result in tightening of breast skin, volume loss and asymmetry, and notable contour defects. Dr. Fearmonti specializes in oncoplastic rearrangements, fat grafting, and flap procedures to lessen the appearance of partial breast defects. Procedures on the unaffected breast—i.e. a reduction or lift of the contralateral breast—are also employed to restore symmetry.

Implant- Based Breast Reconstruction:

This is often a two-staged surgical procedure. A tissue expander, or temporary implant, is placed at the time of mastectomy to retain and expand the skin envelope to the desired size and shape. Expansion is performed in the office over a period of time determined by the patient’s schedule and comfort. A second operation is then performed to replace the temporary tissue expander with a permanent implant. Implant-based reconstructions involve two relatively short surgeries and usually just an overnight hospital stay. Implants may be contraindicated when radiation is required for cancer therapy.

Autologous Breast Reconstruction (Latissimus dorsi, TRAM/DIEP/SIEA,TUG, SGAP):

Autologous reconstruction involves using your own tissue to recreate a breast mound. Tissue can be transferred from a local area (your back) or relocated from a remote site, such as your abdomen, thigh, or buttock region and connected to blood vessels on your chest wall using an operating microscope (free tissue transfer, or “free flap” reconstruction). The most common local option is transfer of the muscle and overlying skin of  your back, or the latissimus dorsi. This is often used in conjunction with an implant to replace radiated chest wall skin and to restore an adequate breast size. Most patients have minimal to no functional deficit following removal of this muscle.

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Free tissue transfer and microsurgery can be used for transfer of excess abdominal tissue (TRAM, or transverse rectus abdominis myocutanous flap; DIEP, or deep inferior epigastric perforator flap; and SIEA, or superficial inferior epigastric perforator flap). If you are not a candidate for transfer of abdominal tissue, tissue from your inner thigh (TUG flap, or transverse upper gracilis flap) or buttock region (SGAP, or superior gluteal artery perforator flap, and IGAP, or inferior gluteal artery perforator flap) can be used as secondary options to restore a modest-sized breast mound. Free tissue transfer in general is a lengthy surgical procedure with a longer in-hospital recovery.