Breast Reconstruction

INDICATIONS

Loss of breast tissue and skin after a mastectomy on one or both sides

Loss of breast tissue after a mastectomy, partial mastectomy, lumpectomy, or other breast trauma

INTENDED RESULT

Reconstruction of a missing breast or replacement of breast tissue

PROCEDURE DESCRIPTION

There are many different ways to reconstruct a breast. The most commonly used techniques are transverse rectus abdominus myocutaneous flap (or TRAM flap) and breast implants.

When a TRAM is performed, a flap of lower abdominal wall fat, muscle (and usually skin) with its own blood supply is transferred to the area of missing breast tissue. The wound is closed as a tummy tuck, which leaves a horizontal scar and a tighter abdomen.

The surgeon tries to create a normal breast mound during the first operation, but additional shaping procedures are sometimes needed.

Implant reconstruction is typically done in two stages. In the first operation, the surgeon places a tissue expander under the chest skin and muscle. This stretches the tissue to allow for proper fitting of the breast implant. Several months later, the tissue expander is removed and a permanent implant is put in place.

Other body areas can occasionally be used as donor sites for reconstruction.

Nipple/areolar reconstruction is elective and is performed in a subsequent operation. This procedure can be used after any reconstruction technique and can be performed at any time after full recovery from surgery.

Additional procedures that may enhance result:

• Nipple/areolar reconstruction
• Lifting of the opposite breast
• Reduction of the opposite breast
• Enlargement of the opposite breast

RECUPERATION AND HEALING

These procedures are generally performed in the hospital and require 2 to 6 days of hospitalization. The patient can walk the day after surgery and will be reasonably comfortable within 10 to 14 days.

Initial discomfort is controlled with oral pain medications. The abdominal site causes the most discomfort during healing. Complete recovery usually takes about 6 to 8 weeks.

INSURANCE GUIDELINES

Breast reconstruction is usually covered by insurance