Breast Reconstruction Options
The diagnosis of breast cancer is accompanied by many choices, the most important of which is the surgical options available.   Options include breast preserving procedures (i.e. lumpectomy/radiation) and mastectomy.  This decision is made in consultation with the oncologic surgeon.   Many women choose breast conservation while others may choose mastectomy.    These choices may be based upon the specifics of the individual diagnosis or for more personal reasons such as peace of mind.
Reconstruction can be performed at the same time as the mastectomy.  Referred to as immediate reconstruction, this option allows for one surgery in which the reconstruction can be completed or the first stage of expander placement can be performed.   If immediate reconstruction cannot be obtained, the option of breast reconstruction is still very much an option and can be performed at a later date.

Reconstructive Options:
Tissue Expansion:  One of the most common techniques involves the use of tissue expanders.   The expanders are placed underneath the pectoralis muscle.  The expander is accessed and slowly expanded to stretch the skin.  Once expansion is completed, the expander is replaced with a permanent implant, either saline or silicone.  The expansion process can take up to several weeks to complete.  The exchange for the permanent implant can be delayed in anticipation of the completion of treatments such as chemotherapy.  The technique can be used in both immediate and delayed reconstruction.
Autologous Tissue Transfer:  This technique involves the use of your own body’s tissues to recreate the breast form.   The two most common tissues used are the Transverse Rectus Abdominus Muscle Flap (TRAM) and the Latissimus Dorsi Flap.

  1. TRAM:  This reconstructive technique involves the use of the tissue and muscle of the lower abdomen.  The skin, fatty tissue, and muscle from the abdomen are used to recreate the breast form.  It can be used for both immediate and delayed reconstructions, unilateral and bilateral.   
  2. Latissimus Dorsi Flap:  This procedure uses tissue and muscle from the back.  In certain cases an expander or implant may be used in conjunction with the muscle flap.   The Latissimus flap can be used in patients who are not candidates for the TRAM or for those undergoing reconstruction after radiation.  It can be used for both immediate and delayed reconstructions,  unilateral and bilateral.