Breast Reconstruction by Tissue Expander / Implant
Tissue Expander / Implant reconstruction has gained significantly in popularity over the last five years due to the re-emergence of safe predictable silicone gel breast implants and the introduction of acellular dermal matrix (ADM) (a human cadaveric donated tissue segment) used in reconstruction to aid in predictability, speed, and lessen the discomfort
of breast reconstruction.
Women who undergo mastectomy elect to undergo a staged approach to reconstruction, whereby a temporary fillable implant device is initially placed, sequentially filled in the office over weeks, and later replaced with a softer more permanent implant solution.
Stages are generally three months apart and apply to various types of mastectomies including traditional skin sparing (nipple removal), as well as nipple sparing (preserved) techniques. All procedures after mastectomy are out-patient with fairly simple quick
Latissimus flap and implant surgery in mastectomy reconstruction is perhaps the most underutilized procedure. It can allow for near complete immediate breast reconstruction. It often may provide the best cosmetic outcome. It may allow for the least visible scarring. There is little, if any donor site deficiencies. It’s versatility extends to radiated patients.
I have a unique way of combining latissimus muscle with pectoralis to produce the most optimal mastectomy camouflage. After a short inpatient stay, recovery is relatively fast and uncomplicated.
TRAM flap (Transverse Rectus Abdominus Musculocutaneous Flap) is a method of breast reconstruction which takes lower abdominal fat, skin, and a segment of rectus muscle and relocates it into the mastectomy defect to make a breast.
TRAM flaps can be either pedicle (left attached and therefore more predictable and reliable) or performed as a microsurgical free tissue transfer (DIEP or Free Flap). Pedicled flap reconstruction are more versatile as they can be combined with small
implants under muscle for better shape projection and the muscle itself creates projection. DIEP flaps can preserve better abdominal wall function but are more limited in breast aesthetics.
TRAM flap surgery is the longest recovery of the three major methods of breast reconstruction. It initially requires a 3-4 day hospitalization.
New Techniques for Breast Reconstruction including Nipple Sparing and Fat Grafting
Several recent advances in post mastectomy breast reconstruction are highlighted here. They include nipple sparing mastectomy and reconstruction, and combining fat grafting in reconstruction.
With nipple sparing reconstruction, the nipple can be saved at mastectomy (only if the breast surgeon allows based on cancer recurrence risk criteria). Tissue expander to implant outcome progresses quicker with the potential for better cosmetic outcomes.
With fat grafting procedures, body fat is liposuctioned from unwanted areas of the body, processed and re-injected immediately back into the patient into areas of the mastectomy that are camouflage challenges which cannot be corrected solely by implants and or flaps.