Breast reconstruction is for women who have lost one or both breasts due to mastectomy or who lack breasts due to congenital or developmental abnormalities. The goal of breast reconstruction is to create a breast and nipple as closely as possible in shape, size and position to the natural breast. Patients may choose reconstruction at the time of their initial breast surgery or delay reconstruction.
Breast reconstruction is performed in several steps, but there are essentially two types. The first type is called autologous and uses the woman’s own tissue to recreate the breast. The second type uses a breast implant or expander to create the breast. The procedure type is based on patient preference combined with the judgment of the plastic surgeon.
Implant/tissue-expansion breast reconstruction involves inserting an implant in the chest after stretching the skin with an expander. First, the surgeon inserts a balloon expander beneath the skin and chest muscle where the reconstructed breast will be built. During the next few weeks or months, the surgeon will inject a saline solution into the expander. As it fills with saline, it stretches the skin and creates a pocket for the breast implant. A final procedure reconstructs the areola and nipple. Some patients do not require tissue expansion and can immediately be reconstructed with a permanent implant.
Autologous-tissue breast reconstruction is used either by patient choice or surgical need. During autologous-tissue breast reconstruction, we create a breast using skin, fat and, sometimes, muscle from other parts of the body. The abdomen, back, buttocks or thighs are all donor sites. The donor tissue, which is called a “flap,” is surgically removed and reattached (free flap) to the chest or left connected to its original blood supply and “tunneled” to the chest (pedicle flap). Factors taken into consideration include how much extra tissue is available for transfer; the width and flexibility of blood vessels; and how large the breasts need to be. Implants may or may not be used with autologous-tissue breast reconstruction. We construct a nipple and areola in a separate surgery.