Reconstruction / Prosthesis

Saline is injected into an expander sac to slowly stretch the skin and muscle to prepare for a permanent breast implant.

Implants are best for women with small-to medium-sized breasts and those who have not had any radiation therapy to the breast area. In the first step, a pocket is formed from the pectoralis muscle and an expander is placed in that space. Over the next several months, saline is injected through a valve into the expander sac to slowly stretch the skin and muscle in preparation for the permanent implant. During a second, shorter operation, the expander is removed and the implant is inserted into the space. Implants come in different shapes and sizes and are made of saline or silicone. The plastic surgeon will help determine which type of implant is best for each patient.

Latissimus Dorsi Flap, Gluteal Flap, TRAM Flap

Another method for reconstructing the breast is to use tissue transferred from somewhere else in the body. The new breast mound is built using muscle transferred from one of three locations:

• TRAM (transverse rectus abdominus myocutaneous) Flap

  Oval-shaped section of fat and skin is removed from the abdomen and shaped it into a breast on the chest wall

• Gluteal Free Flap

  Tissue is taken from the upper or lower buttocks and shaped into a breast on the chest wall

• Latissimus Dorsi Flap

  Skin and muscle are moved from the upper back to the chest area and shaped into a breast

The type of reconstruction best for each patient depends on the amount of skin remaining on the chest wall, the size and shape of the other breast, the amount of body fat and tissue available elsewhere, a woman's general health, her smoking history, and her personal preferences. If a patient knows she wants reconstruction, she should talk to her doctor about it early on -- even before she has a surgical biopsy, if possible. Her choice might influence where incisions are made.

Once the breast mound is completed, the other breast may be altered (with an implant, a reduction, or a lift) to achieve symmetry. In the final step, a new nipple-areola complex is built, and the area can then be tattooed to match the color of the other side.

Prosthesis

If a patient declines or cannot undergo breast reconstruction, she can use a silicone breast prosthesis for symmetry. Breast prostheses come in firm, medium, and soft silicone textures, as well as a variety of sizes, shapes, and skin tones to match the other breast. Prostheses can be placed in a special pocket in a bra or bathing suit. A properly fitted and weighted prosthesis provides the balance needed for correct posture. Custom-made prostheses are now also available.

To purchase a prosthesis, ask your doctor or nurse for referrals to stores (some hospitals have their own stores on-site), or call the local office of the American Cancer Society. These stores specialize in breast prostheses and post-mastectomy bras and have experienced, sensitive, certified fitters who will help you find the perfect prosthesis for your body. The fitter will consider the type of surgery you had as well as the size, shape, and texture of your remaining breast to select the prosthesis that is best for you.

Fitters also provide instructions on the care of the prosthesis. Make sure you have a prescription from your doctor because both the protheses and post-mastectomy bras are often covered by insurance.

Our nurses from the Plastic and Reconstructive Service offer a monthy class focused on surgical breast reconstruction options following a mastectomy. See details of upcoming classes on our calendar.