Reconstructive Surgery

Reconstructive surgery is a type of plastic surgery that is used to rebuild the shape of the breast tissue. It may be performed at the time of the initial breast cancer surgery, or it may be delayed months or years after the initial surgery. In some cases, reconstruction may take multiple procedures. Regardless of when the reconstructive surgery occurs, it’s best to consult with a plastic surgeon before you have surgery for breast cancer if possible.1

Reconstructive surgery may be an option for women who have had a mastectomy, as well as women who have had a lumpectomy. Although lumpectomy is a breast-conserving procedure, some women may not feel comfortable with the appearance of their breast after lumpectomy and may benefit from reconstructive procedures. Reconstructive surgery following a lumpectomy may also be referred to as oncoplastic surgery.2

Breast reconstruction can potentially help a woman feel better about her body’s appearance after breast cancer and can eliminate the need for using an external prosthesis. While reconstructive surgery does typically cause scars, newer techniques help minimize the scars. Women who are considering reconstructive surgery should talk to their surgeon about what to expect. While breast reconstruction procedures have advanced, a reconstructed breast will not look and feel exactly like a natural breast, and the sensation of a reconstructed breast differs from a natural breast.1

Reconstructive surgery: after mastectomy

There are two categories of reconstructive surgery procedures3:

  • Implants
  • Flap procedures

With implants, the implant itself makes up the breast mound. Implants may be silicone or saline. Flap procedures use tissue from another part of the patient’s own body to reconstruct the breast mound. In certain cases, a combination of implant and flap procedure may be used.3,4

Flap procedures for breast reconstruction

Flap procedures use tissue from other parts of the patient’s body to construct the breast mound. Flaps may be free or pedicled. Free flaps are procedures in which the tissue is lifted from one area of the body and reattached to the chest. The blood vessels from the flap tissue must be reattached to blood vessels in the chest. Pedicled flap procedures use a tunneling approach, allowing the blood vessels to remain connected to the original location and moving the other tissues to create the breast mound. Flap procedures include5,6:

  • TRAM (transverse rectus abdominis muscle) flap, which uses a portion of the skin, fat, muscle, and blood vessels from the lower abdomen
  • DIEP (deep inferior epigastric perforator) flap, which uses fat and skin from the lower abdomen, but not muscle tissue to help form the breast mound like a TRAM flap
  • SIEA (superficial inferior epigastric artery) flap, which also uses fat and skin from the lower abdomen, but uses different blood vessels than the DIEP procedure
  • Latissimus dorsi flap, which uses muscle, fat, skin, and blood vessels from the upper back
  • GAP (gluteal free) flap, which uses skin, fat, and blood vessels from the buttocks
  • TUG (transverse upper gracilis), or inner thigh, flap, which uses skin, muscle, fat, and blood vessels from the inner thigh

Figure. Breast reconstruction options

Figure showing reconstruction options like implant or flap procedures where tissue is used from other areas of your own body.

Additional procedures that may be used in reconstruction include fat grafting (removing fat from the buttocks, thighs, or abdomen via liposuction and injecting it into the breast area) and nipple or areola tattooing. Nipple and areola reconstructive surgery, as well as nipple prosthetics, may also be options. Often, a combination of these approaches may be used to create a breast that looks similar to the original breast.4,5

Reconstructive surgery: after lumpectomy

If a woman is not satisfied with the cosmetic appearance of her breast following a lumpectomy, breast reconstruction can help restore the breast shape. Breast reconstructive techniques that may be used after a lumpectomy include2:

  • Implants
  • Fat grafting
  • Flap procedures

Procedures to increase symmetry

In cases where only one breast was affected by breast cancer, plastic surgery may be performed on the unaffected breast to increase symmetry. As the new breast is reconstructed using implants or flap procedures, the healthy breast may be reduced or lifted to improve the symmetry and overall cosmetic appearance of both breasts.3

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Written by: Emily Downward | Last reviewed: October 2020.