Breast Reconstruction: How Is It Done?

Breast Reconstruction: How Is It Done?
Dr. June J. Lee Surgeon Smithtown, NY

June Lee, MD is breast surgeon specializing in breast cancer as well as other problems of the breast, including lumps, abnormal imaging studies, and high risk conditions such as brca mutation. Her cutting-edge surgical care includes; the nipple-sparing mastectomy and oncoplastic surgery, which means treating breast problems... more

Breast reconstruction is a surgical procedure that's done after a woman has received a mastectomy. Breast cancer patients often have to get their breasts removed, and this surgery replaces or rebuilds the breast. While it is plastic surgery, it's considered reconstructive surgery instead of cosmetic surgery due to the nature. Fortunately, most of our patients look amazing afterwards, thanks to the wonderful team that we have. Breast reconstruction can also take place after any necessary chemotherapy or radiation therapy has been completed.

The surgery can be done using either breast implants or the patient's own tissue, and this decision is made by the patient with the reconstruction surgeon. After the new breast tissue has healed and settled into place, nipple reconstruction can be performed.  Nipple reconstruction can be done using tissue from the new breast, but again, most of our patients do not require this because we usually do save the nipples. New mastectomy procedures which allow the skin and nipple to be saved along with reconstruction surgery help to keep the appearance of the breast.

Certain reconstruction procedures such as the deep inferior epigastric perforator or DIEP flap procedure allow for optimal cosmetic results. Many patients who have been diagnosed with breast cancer decide with their doctors to undergo a mastectomy to lower the chance of recurrence of the disease. Removing the breast tissue greatly reduces a patient's risk of the cancer returning, and in turn, increases the chances of living a longer life.

In decades past, mastectomy patients have been left unhappy with their reconstruction results. It wasn't out of the ordinary for a patient to be left with asymmetrical breasts. And, traditional breast implants do not last forever, so patients who had no choice but to receive breast implants knew their inserts had a shelf life. With the DIEP flap procedure, patients no longer had to worry about unnatural looking breasts or having implants that would eventually have to be replaced.

During the deep inferior epigastric perforator flap procedure, the patient's own tissue and blood vessels are used to reconstruct the breast. The surgeon takes tissue and blood vessels from the patient's abdomen and relocates them to the breast. By using natural body tissue, the breasts look more natural and the patient doesn't have to worry about replacing silicon or saline implants. The natural body parts will age as the patient's body ages.

No muscle is removed from the abdomen with the DIEP flap procedure, so no threatening damage is done to the region. Many women have excess skin and fat around their lower stomach areas, so this procedure is also attractive in the sense that it gives patients a sort of tummy tuck.

In some cases, a flap reconstruction follows a tissue expansion. Sometimes after a mastectomy, temporary tissue expanders are inserted to stretch the breast tissue and breast muscle, so a patient can later undergo flap reconstruction or receive a permanent breast implant.

A tissue expander is meant to extend the skin and muscle so a permanent implant or the patient's own tissue can fit in spot in the future. It is simply a temporary and inflatable breast implant. The tissue expansion takes place typically at the time of the mastectomy. While the breast surgical oncologist performs the mastectomy, the breast plastic and reconstruction surgeon places the tissue expander underneath the chest muscle and skin.

There is a very tiny valve in the temporary implant, through which one of the patient's medical caretakers, such as a nurse practitioner, will sporadically fill the expander with a salt water solution injection. Since these injections are done periodically, the expander will grow gradually and therefore the skin and muscle will also gradually stretch. This will go on for weeks or maybe month.

Patients can sometimes feel the breast area stretching and may feel sensations and pressure during the procedure. Luckily most women report that the procedure is not too uncomfortable for them.