Breast Reconstruction

After mastectomy, the breast may be reconstructed using a combination of surgical techniques.  These include Tissue Expansion and Implants and Autologous Tissue Reconstruction using a graft of the patient’s own tissue. In some cases, implant and flap surgeries may be combined to achieve ideal results.  Your surgeon will explore these options with you to determine the best approach.

Tissue Expanders with Implant

At the time of mastectomy surgery a Tissue Expander, similar to a balloon, is placed under the pectoral muscle where it will create the space for a breast implant.  During regular office visits over four to six months, your doctor will gradually enlarge the expander, filling it with saline fluid through a small needle-access point.

As the expander fills, the surrounding chest tissue and skin expand to accommodate the larger size. Once the expansion process is complete, your surgeon will perform a second surgery to remove the tissue expander and insert a Saline or Silicone Breast Implant. During this surgery, your doctor may insert drainage tubes to direct excess fluid away from the implant site and promote healing.

Autologous Tissue Reconstruction

Also known as flap surgery, autologous breast reconstruction surgery uses tissue taken from the patient’s own body to recreate the breast.  With flap surgeries, the recovery process may be longer but the resulting breast tissue feels more natural and patients avoid the potential complications associated with implants. Flap surgeries may be used alone or with implants as an alternative to tissue expanders.

Flap techniques vary depending on the location of the donor tissue (abdomen, buttocks, or back) and whether muscle tissue is harvested from the donor site. There are vascular distinctions in flap surgeries as well. In pedicle flap surgery, the blood supply to the donor tissue remains intact.  In free flap surgery, donor tissue is completely detached and microsurgery is required to restore blood vessels at the reconstruction site.

The TRAM Flap (Transverse Rectus Abdominis Myocutaneous) procedure uses abdominal muscle, fat and skin to reconstruct the breast. Abdominal flap surgery has the positive side effect of a tummy tuck, as the abdomen is trimmed and tightened at the donor site.

Alternative techniques like the DIEP and SGAP flaps leave muscle tissue intact. The DIEP Flap (short for Deep Inferior Epigastric Artery Perforator) donor tissue is also taken from an abdominal site while the S-GAP and I-GAP Flap (Superior and Inferior Gluteal Artery Perforator) harvests donor skin and fatty tissue from the buttocks.

Breast Reconstruction involves members of a multidisciplinary team from VCU Massey Comprehensive Cancer Center, including:

• Surgical Oncologists
• Medical Oncologists
• Radiation Oncologists
• Radiology / Breast Imaging