82 - Breast reconstruction after mastectomy

Summary

Breast cancer continues to present an alarming health concern for women. As a treatment for breast cancer, mastectomy remains a common modality despite numerous advances in cancer therapy. Fortunately, breast reconstruction has become state-of-the-art plastic surgery, capable of restoring a woman's breast and sense of wholeness, while minimizing the negative psychological impact of mastectomy. Furthermore, “immediate” breast reconstruction – where reconstruction is performed directly following the mastectomy – has become a standard component of breast cancer treatment. Nowadays, after a mastectomy, women can expect a soft, natural-appearing, symmetric breast that will last a lifetime. Delayed reconstruction, performed months to years later, remains an excellent option for women who were not offered immediate reconstruction or simply were not ready for the adjunctive procedure.

Breast reconstruction can be divided into two types: autologous tissue reconstruction or implant-expander reconstruction.

Autologous tissue reconstruction

Various tissue donor sites on the female body can be used for reconstruction, including the backs, hips, gluteal area, and lateral thigh. However, skin and fat from the lower abdomen is the most common region used in what is known as TRAM (transverse rectus abdominis myocutaneous) flap reconstruction. Similar to a “tummy tuck” procedure, TRAM flap involves dissection of an elliptical pattern of skin and fat below the umbilicus that is transferred up to the breast defect on either a “pedicle” (still attached to the rectus muscle and superior epigastric artery) or as a “free” flap (where it is completely detached and then inset into the breast defect with a microvascular anastomosis of artery and vein using a microscope).