Breast Reconstruction with Tissue Expander
There are a variety of surgical techniques for breast reconstruction. Breast cancer patients who are medically appropriate for breast reconstruction may consider tissue expander breast reconstruction, either immediately following mastectomy or at a later time. The best candidates, however, are women whose breast cancer, as far as can be determined, seems to be eliminated by mastectomy and other treatments.
Breast reconstruction has no known effect on altering the natural history of breast cancer or interfering with other forms of breast cancer treatments such as chemotherapy or radiation.
Breast reconstruction with tissue expansion is a two-staged process. It first involves the use of a silicone rubber balloon-like tissue expander, which is inserted beneath the skin and chest muscle. Saline is gradually injected into the tissue expander to fill it over a period of weeks or months. This process allows the skin on the chest to be stretched over the expander, creating a breast mound. In most cases, once the skin has been stretched enough, the expander is surgically removed and replaced with a permanent breast implant. Some tissue expanders are designed to be left in place as a breast implant.
There are legitimate reasons to delay breast reconstruction. Some women may be advised by their surgeon or oncologist to wait until other forms of necessary cancer treatment are completed or disease staging has been accomplished. Other patients may require more complex breast reconstruction procedures. Women who smoke or have other health conditions such as obesity may be advised to postpone sugery. Individuals with a weakened immune system (currently receiving chemotherapy or drugs that suppress the immune system), conditions that interfere with blood clotting or wound healing, or have reduced blood supply to the breast tissue from prior surgery or radiation therapy treatments may be at greater risk for complications and poor surgical outcome. In any case, being informed or your options concerning breast reconstruction can help you prepare for a mastectomy with a more positive outlook on the future.
The shape and size of your breasts prior to surgery will influence both the recommended placement of the tissue expander and the final shape of your reconstructed breast. Tissue expander breast reconstruction cannot produce an exact replica of the removed breast. Breasty symmetry surgery on the opposite breast may be needed to produce similar size. The nipple and darker skin surrounding it (the areola) may be reconstructed in a subsequent procedure after the breast mound is created through tissue expansion.
Both saline-filled and silicone gel breast implant and tissue expander devices have been approved by the United States Food and Drug Administration (USFDA) for use in breast reconstruction.
Patients undergoing breast surgery with tissue expanders and implants must consider the following:
- Breast reconstruction with breast implants and tissue expanders may not be a one-time surgery.
- Breast implants and tissue expanders of any type are not considered lifetime devices. They cannot be expected to last forever. You will likely require future surgery for device replacement or removal.
- Changes that occur to the breasts following reconstruction with implants and tissue expanders are not reversible. There may be an unacceptable appearance to the breast if you later choose to have breast implants removed or tissue expanders removed.
Tissue expander breast reconstruction is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure or use of external breast prosthesis or padding, or the transfer of other body tissues for breast reconstruction. Risks and potential complications are associated with alternative surgical forms of treatment.
Breast Reconstruction with TRAM Abdominal Muscle Flap
There are a variety of surgical techniques for breast reconstruction. Most mastectomy patients are medically appropriate for breast reconstruction, either immediately following breast removal or at a later time. The best candidates, however, are women whose cancer, as far as can be determined, seems to be eliminated by mastectomy. Ther are legitimate reasons to delay breast reconstruction. Some women may be advised by their surgeon or oncologist to wait until other forms of necessary cancer treatment are completed. Other patients may require more complex breast reconstruction procedures. Women who smoke or who have other health conditions such as obesity or high blood pressure may be advised to postpone surgery. In any case, being informed of your options concerning breast reconstruction can help you prepare for a mastectomy with a more positive outlook on the future.
Breast reconstruction has no effect on altering the natural history of breast cancer or interfering with other forms of breast cancer treatment such as chemotherapy or radiation.
The TRAM flap technique of breast reconstruction invovles the use of abdominal muscle flap(s) made from the rectus abdominus muscle. This muscle and a portion of lower abdominal skin and other tissue is repositioned to the chest wall region in order to reconstruct a breast mound. The muscle flap maintains its own blood supply, and helps nourish the tissue that is transferred to the chest wall region. Following the reconstruction of the breast mound, the lower abdominal incisions are closed. There are several variations on the surgical technique of TRAM abdominal muscle flap breast reconstruction, including microvascular surgery, to attach the flap to the chest region. In some cases, your plastic surgeon may recommend that a breast implant be inserted underneath the muscle flap to give the breast mound additional projection.
Muscle flap techniques of breast reconstruction are useful in the following situations:
- Inadequate chest wall tissue for breast reconstruction with implants or expanders
- Past history of radiation to chest wall after mastectomy
- Patient with concerns about silicone breast implant/expander
- Failure of earlier breast reconstruction
Contraindications to TRAM abdominal muscle flap breast reconstruction procedure exist:
- A patient who is medically or psychologically unsuitable for breast reconstruction
- A past history of abdominal surgery which has impaired TRAM flap blood supply
A separate consent form for the use of breast implants in conjunction with breast reconstruction with TRAM abdominal muscle flap is necessary.
TRAM abdominal muscle flap breast reconstruction is an elective surgical operation. Alternative treatment would consist of the use of external breast prosthesis or padding, tissue expansion breast reconstruction, saline breast implants or the transfer of other body tissues for breast reconstruction. Potential risks and complications are associated with alternative techniques of breast reconstruction that involve surgery.
Nipple reconstruction involves the restoration of the of the nipple-areolar complex lost due to injury, breast cancer, or other conditions. A variety of different techniques exist for reconstruction of the nipple and its surrounding areolar tissue. These include the use of skin grafts taken from other regions of the body, local flaps of breast skin that are shaped into a nipple, or the sharing of tissue from the opposite nipple-areolar region. Additional techniques such as tattooing may be used to add color to the tissue if needed.
Nipple reconstruction surgery is an elective surgical operation. Alternative treatment would consist of not undergoing the surgical procedure or the use of external nipple-areolar prosthesis. Risks and potential complications are associated with alternative surgical forms of treatment.
This information is only intended as an introduction to the various procedures. It should not be used to determine whether you will have the procedure performed nor to guarantee the result. The best method of determining your options would be to see a board-certified plastic surgeon for a thorough history and physical examination. Only at this time could your candidacy for any procedure be determined. The information provided is not intended to serve as medical advice.