Breast Reconstruction after mastectomy for breast cancer

What options for breast reconstruction are there for women who have breast cancer and need a mastectomy?

Plastic Surgeons are all trained to perform breast reconstructive procedures, although some specialize in this area and may be able to offer options that may not be available everywhere.

The two main methods of breast reconstruction are either by placing a breast implant (alloplastic - foreign body) under the breast or by using the body's own tissues (autologous - body's own). Withing the Autologous category, there are two main sub-categories. Free flaps and pedicled flaps. Pedicled flaps are the older method, and involve movement of tissues while still attached to the body... the 'pedicle' carries the blood supply to the flap tissue which is then moved from one area to another (the chest/breast in this case).

In Free Flaps... the tissue is cut out and then reattached at another location, sort of like a transplant but instead of moving a body part from one patient to another, here the body part/tissue is moved from one area of a patient to another area of the same patient. This is complicated because the blood vessels and possibly the nerves need to all reattached. This is done under a microscope or with the help of magnifying glasses, and is called "Microsurgery" (everything is microscopic, the sutures and needles used are so small you may not even be able to see them without a microscope).

In summarize:
- the simplest option is to use implants to recreate breast
(this usually involves first placing a tissue expander to expand the existing chest muscles as the implant goes under the muscle, followed by a second surgery where the expander is replaced by a permanent implant)

- next is the pedicled flap
(every plastic surgeon should be capable of performing this reconstruction, using either Latissimus dorsi flap, or more commonly a TRAM (transverse rectus abdominis musculocutaneous) flap)

- finally, the most complex but probably the best outcome is the free flap
(to provide this option, plastic surgeons usually undergo additional trainings (microsurgery fellowship) to learn the techniques of free flaps and perforator flaps)

Martin Jugenburg, MD
Toronto, ON
(www.plastica.ca)
(www.microsurgeon.ca)