Breast Reconstruction

About Breast Reconstruction

Breast reconstruction recreates the shape of the breast after mastectomy or, less often, after lumpectomy with significant deformity. It can be performed at the same time as the mastectomy, called immediate reconstruction, or months to years later, called delayed reconstruction. Implant based reconstruction is the most common approach in many countries. It may be done in two stages, using a tissue expander that is gradually filled with saline over a period of weeks before exchange for a permanent implant, or in a single stage directly to implant when the skin envelope allows. The implant may be placed beneath the pectoralis major muscle or in front of it, a prepectoral placement that avoids visible movement of the implant when the muscle contracts, and acellular dermal matrix is often used to support the implant. Autologous reconstruction uses tissue from elsewhere on the body and generally feels more natural and changes with body weight. The deep inferior epigastric perforator, or DIEP, flap transfers skin and fat from the lower abdomen with microsurgical connection of its blood vessels to vessels in the chest, sparing the rectus abdominis muscle that was taken in the older TRAM flap. Other donor sites include the thigh, buttock and back, as in the latissimus dorsi flap, which is often combined with an implant. Radiation therapy increases complications, particularly with implants, and influences the choice and timing of reconstruction. Fat grafting is used to refine contour, and nipple reconstruction and tattooing complete the process. In the United States, federal legislation enacted in 1998 requires most group health plans that cover mastectomy to also cover reconstruction.