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The surgeon’s goal is to match the natural
appearance of the remaining breast in shape, texture and symmetry using
one of the several techniques that are currently available. The methods
used fall into two general types: implant type reconstructions and those
using the patient’s own tissues.
Implant Type Restorations
An implant of silicone filled with silicone gel or saline (IV solution) or a
combination of both is placed beneath the skin and pectoral muscle to recreate the breast.
Some surgeons prefer to first use a tissue expander (a silicone balloon) to gradually
stretch the skin over a period of weeks or months followed by replacement with a breast
implant at a second operation.
Restorations with the
Woman's Own Tissue
The breast can be recreated using tissue from the abdomen, back, buttock
or upper thigh. The most common of these is the abdominal source, the
so-called T.R.A.M. flap. In this operation, the area of skin and fat
around and below the umbilicus is moved to the site where the breast
has been removed. It is sculptured to resemble the remaining breast
or into two breasts when a double mastectomy has been done. Removal
of the tissue from the abdomen creates a 'tummy-tuck' effect. In some
women who are having an immediate reconstruction, the added benefit
of a skin-sparing mastectomy may be used. When the conditions are right,
as when a small, centrally located, low risk tumor is present, virtually
all of the breast skin can be saved (spared) except for the nipple and
aerola. The T.R.A.M. flap tissue is used to refill the breast skin envelope
yielding a more natural restoration.
Less commonly, tissue can be moved from the back using the latissumus
dorsi muscle. Although the skin and muscle may be sufficient to reproduce
a small breast, in most instances an implant is needed to restore a
larger one.
Finally, soft issues can be borrowed from the buttock or thigh using microsurgery.
These represent the most sophisticated and complex methods and are generally reserved for
specific indications.
Restoration of Symmetry
Many women wish to have a nipple aerola reconstruction to make their new breast look as
normal as possible. Others may benefit from taking the remaining breast smaller, larger or
reshaping it to match the reconstructed one. These procedures are usually done several
months after restoration of the breast mound.
The techniques of breast reconstruction vary in their complexity, risk,
incidence of complications, length of surgery and length of time for recovery.
Each woman should review these issues with her plastic surgeon so that
the most appropriate method can be chosen. However, it is only under unusual
circumstances that a woman cannot restore her sense of wholeness through
breast reconstruction.
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