Breast reconstruction is the re-creation of a woman’s breast through surgery, either with an implant or with her body’s own tissue. This procedure can be done at the time of a mastectomy (surgical removal of the breast), or delayed until the patient is medically and psychologically ready.
Tests & Procedures for Breast Reconstruction Surgery
Diagnosing Breast Conditions
If you or your doctor detect an abnormality in your breast, such as a lump, change in shape, or discharge, they will order additional testing to determine if the abnormality is malignant (cancerous) or benign (non-cancerous). Additional tests may include:
- Breast ultrasound: uses sound waves to illustrate the inside of a breast.
- Diagnostic mammogram: provides an x-ray image of the inside of the breast.
- Breast magnetic resonance imaging (MRI): produces a highly-detailed image of areas inside the breast.
- Biopsy: removes tissue or fluid from the breast for further lab analysis.
In some situations, additional breast screenings have nothing to do with a known abnormality, but rather a person’s personal and family medical history.
BRCA Gene Test
A BRCA test is a blood test that looks for harmful changes or mutations in one of two genes that increase the risk for developing breast and ovarian cancer – BRCA 1 and BRCA 2. If detected in the breast area, many women face a difficult decision. A positive result does not indicate cancer, but does indicate an increased risk for cancer. They can either take the risk and increase the frequency of breast cancer screenings, or they can opt to remove one or both breasts.
Breast Reconstruction Procedures
The physical and emotional impact of losing one or both breasts can be devastating for some. Our staff and surgical team are sensitive to this, and will work closely with you to determine which procedure (or combination of procedures) will result in the best possible outcome. Possible reconstruction procedures include:
Tissue expansion/implant based
A breast implant restores shape and fullness to a breast by inserting a silicone shell filled with saline or silicone under the chest wall. Your surgeon will place a temporary tissue expander under the chest wall during or after a mastectomy and replace it after 1-2 months with your implant of choice.
Pedicled TRAM flap
Autologous or "flap" reconstruction surgery rebuilds your breast using tissues (skin, muscle, fat, and blood vessels) from your own body. A pedicle TRAM flap utilizes tissues from your transverse rectus abdominis (lower abdomen) and moves it under the skin up to your chest, leaving the blood vessels attached to their original blood supply.
A latissimus flap surgery utilizes tissues from the area of your back behind the armpit and below the shoulder (the latissimus dorsi muscle) to rebuild your breast. Your surgeon will move the flap under your skin around your chest, leaving the blood vessels attached to their original blood supply.
Free TRAM flap
Unlike a pedicled TRAM flap, a free TRAM flap cuts tissues from the transverse rectus abdominis area, rather than keeping the tissues attached. The muscle, fat, skin, and blood vessels are carefully reattached using microsurgical techniques.
A DIEP (deep inferior epigastric perforator artery) flap moves skin, fat, and blood vessels from the abdomen, but no muscle. The tissues are cut from the wall of the lower abdomen and microsurgically reattached.
Non-abdominal free flap
When the abdomen is not an ideal location for removing tissue, a free flap procedure may be used to cut tissues from a non-abdominal location, moved to the chest, and the blood vessels microsurgically reattached. A TUG, PAP, or lateral thigh flap will use tissue from the thighs and a gluteal flap utilizes tissue from the gluteal region.
Nipples and areolas are usually the final stage of breast reconstruction, performed during a separate procedure after the breasts have had time to heal. Nipples and areolas may be crafted from tissue, tattooed, 3D tattooed, or a combination of techniques to match the new nipple to the existing one.
Nipple/areola sparing mastectomy
With a nipple-sparing mastectomy, a surgeon will leave the areola, nipple, and breast skin intact while removing the breast tissue underneath. Nipple-sparing mastectomy is preferred for its aesthetic results; however, if cancer cells are detected, the nipple will need to be removed.
Fat grafting refers to the process of removing fat from one area of the body (typically the belly or thigh) and transplanting it into another area. Fat grafting is performed using a liposuction machine and can be done to many areas of the body including the breasts, face and buttocks.
The recovery process differs depending on which procedure you undergo. You may feel tired and sore for several weeks after your surgery. You may also have drainage tubes in place to remove excess fluids that can collect around the surgical site. These tubes are temporary. Most women resume normal activities within 6 to 8 weeks, however, full recovery can take up to a year or more.
It’s important to give yourself time to heal – not just physically, but also mentally and emotionally. Our team is sensitive to the difficulties you may encounter during your healing process, and will connect you with the right care and support to ensure your health and happiness.
Frequently Asked Questions
What is Fat Grafting?
Fat grafting refers to the process of removing fat from one area and transplanting it into another area. Fat grafting can be done to many areas of the body including the breasts, face and buttocks. The fat that is moved adds volume to the area in which it is placed and may also have beneficial biomedical effects on the surrounding tissues, especially radiated tissues.
Most people are good candidates for fat grafting. It is especially helpful in adding volume to the upper part of a breast reconstruction as this area is difficult to fill with an implant or flap. In addition, if a patient has had a lumpectomy, fat grafting can fill the area where the cancer tissues were removed. Fat grafting has had a profound effect on breast reconstruction after breast cancer.
How is Fat Grafting Performed?
The first part of the procedure is to remove the fat from the donor area. The donor area is usually the belly or thighs. This is done with a liposuction machine, but with a slightly different technique than standard liposuction. After the fat is harvested it is prepared for injection by our team. The fat is then injected into the areas where it is desired.
What are the Results?
The results have been quite good so far. Studies have shown that about 50 to 60 percent of the fat that is transferred will survive. Because of that, we often inject more fat then may be needed during the surgery. However, there is only so much fat that can be injected in one sitting. Some patients may need more than one procedure to achieve their desired results.
Will the Results Change if I Lose or Gain Weight?
The fat we inject is just like the fat elsewhere. If you gain a lot of weight then the fat cells will get bigger. If you lose a lot of weight the cells get smaller. But if your weight is generally stable, plus or minus 15 pounds, the results should not change over time.
Will Fat Grafting Cause Cancer to Return?
Some patients worry that fat grafting to the breast can cause breast cancer recurrence. Currently, there is no evidence to support that fat grafting will cause the cancer to return. A patient still needs normal screening that is recommended by her cancer doctors. She should inform them of any reconstructive procedure she has undergone.
Can Fat Grafting be Seen on a Mammogram or MRI?
Yes, fat grafting can be seen on imaging studies. It is important to have a screening prior to fat grafting so that there is a baseline from which to evaluate. The physicians at The Institute for Advanced Reconstruction order screening for patients who haven’t had one.
Will Fat Grafting Help a Patient who has had Radiation Therapy?
Fat grafting has been shown to improve irradiated tissues as well as help heal wounds in radiated areas. This includes breast tissue as well as tissues elsewhere in the body. No one is sure why it helps, but stem cells are injected along with the fat and this may be what aids the tissues in recovering. A patient should wait until six months after radiation therapy is completed before having any procedures on radiated tissues.
Will Insurance Cover this Procedure?
Yes, insurance will cover fat grafting for breast cancer reconstruction. This includes following both lumpectomy and mastectomy. Since fat grafting is a method of remaking the breast it is considered medically necessary. This includes the cost of liposuction to remove the fat as well.