Procedures » Tissue Expander/Implant
Breast reconstruction after mastectomy is becoming increasinglycommon as more women become educated about their options surroundingbreast cancer treatment. Sound oncologic treatment of the cancer is, ofcourse, the primary goal. But there is life after breast cancer, andmultiple studies have proven an increase in quality of life aftermastectomy if the patient undergoes breast reconstruction. Althoughthere are several basic options for reconstructing a breast, the timingand choices surrounding reconstruction can quickly become complicatedwhen considering the cancer treatment plan. Creating a unique plan thataddresses both the cancer treatment and reconstruction is vital to asuccessful outcome. Dr. Gordley will help to guide you through thiscomplex process as smoothly as possible.
The three basic options for breast reconstruction are elaboratedupon below. Please know that not every patient is a good candidate forevery procedure, and that your reconstruction will be tailor fit toyour exact situation.
- Tissue expander/Implant reconstruction- After mastectomy there is ashortage of both skin and volume. Perhaps the simplest method ofreconstruction is to place a tissue expander (inflatable implant)underneath the skin, to then serially inflate the expander in theoffice, and then exchange this implant several months later for a morepermanent implant. The upside of this method is the relatively easierrecovery time, short predictable surgeries, and a very reasonableresult. The downside is the potential for scar contracture around theimplant (requiring surgical revision), at minimum 2 surgeries andmultiple office visits. In addition, these breasts may not be asnatural appearing as the other methods described below.
- Autologous tissue (abdominal tissue reconstruction)- Just as above,there exists a paucity of both skin and volume which can bereconstructed using fat and skin from the abdomen. The typicalincisions are the same as that of a tummy tuck, which is a side benefitof the procedure. There are several techniques used to transfer thistissue up to the chest, depending on the amount of tissue needed andpotential effects on the abdominal muscles. Dr. Gordley is facile in“free” tissue transfers, and muscle sparing procedures (DIEP and musclesparing TRAM) will be used in select patients. The upside of thismethod is the natural appearing and natural feeling result, whichrequires no implant. An added benefit is the simultaneous tummy tuck.The downside is the longer recovery (6-8 weeks), the potential forabdominal hernia and muscle weakness, and a more complicated lengthyprocedure.
- Latissimus dorsi and implant reconstruction - A good mixture of thepros and cons of the above, the latissimus reconstruction is areasonable option for some patients. By transferring a muscle from theback with overlying skin, the skin portion of the reconstruction issatisfied. Then, an implant is used to replace the missing volume. Theback muscle is quite expendable and there is essentially no functionalimpairment after the surgery. There is still the potential forimplant-related issues and need for revisions in the future, but therecovery is 3-4 weeks and the aesthetic result is somewhere in betweenthe other two options.
The final finishing touches of breast reconstruction are the nipplereconstruction (which is done in the office), and tattooing of theareola.
