Breast Reconstruction

The decision to undergo breast reconstruction surgery following a mastectomy is a very personal one. There are a variety of factors a woman must consider before making such a choice, including her expectations, possible risks and emotional state following the procedure.


What are the top reasons women choose to undergo breast reconstruction following a mastectomy?

Women choose breast reconstruction surgery for a variety of reasons, but some of the most common factors include:

• Sadness, insecurity or even embarrassment about losing one or both breasts;
• Dissatisfaction with the way clothes look and feel following a mastectomy;
• Dissatisfaction with the way the body looks without clothes following a mastectomy; and
• Reconstruction offers the chance to feel as “normal” as possible following a bout with breast cancer and breast cancer treatment.

What are my breast reconstruction treatment options?

A variety of procedures are available for women considering breast reconstruction surgery. They are as follows:

• Breast Implants- Depending on a woman’s preference, breast implants come in the form of silicone gel or saline (salt water) implants. Some women may be candidates for one-stage implant reconstruction. Or others, the insertion of the implant (s) is typically done in two steps, with the first being the insertion of a temporary tissue expander at the tie of the mastectomy. The temporary expander is then given time to stretch and prepare the skin/breast tissue for the implant’s permanent placement. Once this step is complete, the surgeon will then do a second procedure to put the final saline or silicone implant in place.

• TRAM Flap Surgery- This procedure uses a woman’s own muscle and tissue from the lower abdominal area to reconstruct a new breast without using implants. During the actual TRAM flap surgery, skin, fat and muscle from the lower abdomen will be tunneled under the skin to the chest area, in which the surgeon will then build a tissue only breast. This procedure is admittedly more complicated then breast implants, but it’s a wonderful choice for women that wish to retain a more natural look and feel to their breasts. Furthermore, the removal of fat, skin and muscle from the lower abdominal area often results in an aesthetically pleasing “tummy tuck” for an added bonus.

• DIEP Flap Surgery- DIEP flap surgery is similar to a TRAM flap in that it utilizes a woman’s excess skin and fat from the lower abdomen to reconstruct a breast. However, unlike the TRAM flap, the DIEP flap is a special muscle-sparing procedure and does not require the use of the abdominal muscles when reconstruction the breast. Instead, the skin, fat and blood vessels from the lower abdominal area are transferred to the chest where they are “hooked up” to new blood vessels during the process. Avoiding the use of the abdominal muscles for the DIEP flap procedure then spares the abdominal wall muscles from potential weakness, discomfort, or the risk of bulging/ hernia formation. And similar to the TRAM flap surgery, patients obtain a cosmetically pleasing tummy tuck where tissue was taken in the abdominal region.

• Latissmius Flap Surgery- As in the case of the TRAM and DIEP flap procedures listed above, the Latissmimus Flap procedure also uses a woman’s own skin, fat and tissue to naturally reconstruct the breast without implants. However, in the Latissmius procedure, the surgeon will use the latissimus doris (or the long muscle that runs beneath the armpit and diagonally across the back) instead of tissue from the abdominal wall. This is an extremely popular technique among plastic surgeons simply because the muscle and skin flap used in the chest remain attached to their natural blood supply–thus making it less complicated than the other flap reconstructive surgeries.

What are the benefits and risks of breast implants vs. autologous tissue reconstruction?
As with any procedure, there are a variety of pros and cons that accompany each of the techniques listed above. Some of the most common benefits and risks that accompany breast implants and flap procedures are as follows:

Procedure	Pros	Cons
Breast Implants	1. Less complicated than Flap reconstruction 2. Excellent cosmetic results 3. Implants can easily be adjusted to match the size and shape of the remaining breast	1. Although implants are safe medical devices, no medical devices last forever; they  may need to be replaced at a later time 2. Risks include infection, rupture/deflation, and scar formation around the implant (capsular contracture). 3. If radiation therapy is required, there may be increased risks of scar tissue formation and implant related problems
Autologous Tissue	1. Will last permanently 2. The use of your own tissue gives a more natural look and feel to the breasts 3. Excellent cosmetic results 4. Additional benefit of tummy tuck closure with DIEP or TRAM procedures	1. More complex surgery 2. Small risk (< 2-3%) that part or all of the tissue used to reconstruct breast may not live  if the blood supply is compromised. 3. Surgery performed in another portion of the body (i.e. belly or back)



Breast Reconstruction, Texas: Is the breast reconstruction covered by insurance?
Yes. Insurance companies are required by Federal law to cover all of the above-mentioned procedures for breast reconstruction following a mastectomy.

Also, insurance companies should cover reconstructive options for women who have also undergone partial mastectomy/lumpectomy.




Do I have to undergo breast reconstructive surgery at the same time as my mastectomy?
Breast reconstructive surgery does not have to be done at the same time as a woman’s mastectomy. Similarly, some women report feeling “overwhelmed” by the mastectomy and need additional time before making such a decision; whereas others are seeking to immediately begin their reconstructive journey and wish to awake from her mastectomy with an immediately reconstructed breast.

Dr. Basu or Dr. Kim will make recommendations as to the timing of reconstruction based on your cancer diagnosis. Ultimately, timing of reconstruction is a personal decision and choice.




Are there any benefits to having the reconstructive surgery done at the same time as my mastectomy?
Yes, there are a variety of benefits in having the procedures done all at once. First, the surgeon can use the same incision from the mastectomy to avoid creating an additional scar during the reconstruction process. Also, having breast reconstructive surgery at the same time as a mastectomy is a great option for women suffering emotional trauma at the thought of waking up in the recovery room without a breast.




I’d like to speak with someone further about the options available to me for breast reconstruction. How do I get started?
Our team at the Center for Advanced Breast Restorations is happy to answer any additional questions or concerns you may have regarding breast reconstruction following a mastectomy. We realize the personal nature of such a decision and wish to empower you with the information necessary to make the best choice for you and your body.

While we offer additional information about the procedures using 3D animation videos, please feel free to call our office today, Center for Advanced Breast Restoration at (713) 799-2278 or (281) 363-4546 for further information on breast reconstruction, Texas.