Reconstructive / Breast Reconstruction
Breast Reconstruction
Breast reconstruction is indicated for anyone who is considering mastectomy or has undergone mastectomy, to restore normal breast shape and volume. In addition, anyone who had a lumpectomy in the past and consequently developed significant asymmetry or deformity is also a good candidate, as is anyone considering lumpectomy where visible deformity and/or asymmetry is expected.
The goal of reconstruction is not necessarily to re-create a breast identical to the pre-surgical one, but rather, to restore an aesthetic breast shape that is normal in three ways: appearance, symmetry, and contour. Complete reconstruction may take more than one procedure, depending on the overall surgical plan and the desired outcome.
The decision on the type of procedure is based on these important factors:
- body shape and weight
- breast shape and volume
- other health considerations
- age
- unilateral vs bilateral (one or both breasts)
- planned radiation
- personality and family considerations
- willingness to accept scarring
- and most importantly, your desire
1. TRAM flap reconstruction
The TRAM flap reconstruction is the most common procedure to reconstruct the breast. It uses autologous tissue - your own - to replace the surgically removed breast tissue. Skin and fat from the lower central abdomen (usually below the umbilicus or belly button), is transferred to the breast to create a breast mound.
There are several technical variations, such as free TRAM, supercharged TRAM, and DIEP flap, but they all make use of the same skin and fat tissues from the lower abdomen.
2. Tissue expansion and implant placement
Following the mastectomy, a tissue expander (a temporary adjustable breast implant) is placed under the mastectomy skin. This expander is filled incrementally, with normal saline, during a series of office visits, over following 2-4 months, to stretch the skin of the breast. Once the desired amount is reached, the expander is removed and a new permanent implant (saline or gel) is placed. The time between the temporary and permanent implant procedures is about 3-5 months depending on the progress of the expansion process.
3. Immediate placement of breast implant
Over the last decade, a new mastectomy procedure - nipple sparing mastectomy - has become an accepted procedure because it preserves the natural nipple without compromising the quality of mastectomy. This procedure removes no skin or minimal skin and retains the nipple during mastectomy. This allows reconstruction of the breast during the same surgery by placing an implant immediately following the mastectomy. Typically, a contoured silicone gel implant is placed, to recreate an aesthetic shape of the breast. No expansion procedures are needed because the permanent implant is placed during the mastectomy surgery.
4. Latissimus dorsi flap and implant
This procedure combines skin and muscle taken from the back along with a breast implant to reconstruct the breast. The tissue from the back alone are not sufficient enough to create an adequate breast mound. Therefore, an implant is needed to give satisfactory volume to the breast. By using the tissue from the back, tissue expansion can be avoided.
Dr Kim offers all of the above procedures and their many variations. The specific procedure that suits your needs and preferences is determined from a comprehensive and complete discussion with your surgeon.
When needed, Dr Kim offers a second procedure to improve minor challenges that may arise after healing from the initial reconstruction. These procedures include scar revision (making the scar less noticeable), fat injection (improving the contour and size), and augmentation or reduction of the non-affected breast (achieving a symmetry).
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