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Breast Reconstruction:
Options after a Traditional Mastectomy

In a traditional mastectomy, much of the breast skin is removed. This creates scars on the breast skin that can never be removed.

Note: Any implant (or extender) must be covered by a layer of muscle, not just the skin of the breast left after a mastectomy. This is because an implant just under the skin and not covered by muscle is very visible, looks unnatural, feels unnatural and, most importantly, very often becomes infected.

TRAM Flap Reconstruction

TRAM stands for transverse rectus abdominis muscle, the tissue that is used to reconstruct your breast in this method. Unlike most other methods of breast reconstruction, the TRAM flap is completely natural, because it uses your body's own tissues to reconstruct your breast.

The advantage of this type of surgery is that the reconstructed breast is very soft, natural and lifelike. Size, fullness and shape are as closely matched for symmetry as possible.

In order to reconstruct the breast, we use the "tummy" tissue — skin, muscle, and fat from the area of the abdomen below the navel. This procedure is very similar to a "tummy tuck" which may be considered a benefit for some women.

This procedure requires one surgery and a second, very minor one, if you would like your nipple reconstructed. This procedure may be done on women who have had radiation therapy treatment to the breast.

The disadvantage of this type of surgery is that there is a long abdominal scar below the navel and this surgery is more painful than other breast reconstructive surgery. It also requires a few more days in the hospital after surgery and a longer recovery time than other surgeries.

The TRAM flap reconstruction has been performed on women ranging in age from their late twenties to their mid-seventies. After recovery from surgery, most women report that they are pleased with the outcome and they believe that they made the correct choice for them. Most patients do very well and are extremely pleased following their surgery.

The following instruction information is designed to help you know what to expect following surgery as well as to allow you to become involved in your post-operative recovery. Familiarizing yourself with and following these suggestions will be your best preparation for surgery.

Latissimus Muscle Flap With a Breast Implant

In this method, a permanent implant is placed and the latissimus muscle and some skin from the back are used to create a breast in one operation. The muscle used is one that is "replaced" by other muscles so that the majority of women report that they, after surgical recovery, adapt comfortably and are able to do the important physical activities that they were able to do before surgery. Again, a permanent implant matched carefully to your other breast is used.

The advantage of this surgery is that it requires one operation and has a much smaller breast scar. A second, very minor surgery is necessary if you would like your nipple reconstructed as well. This procedure may be done for women who have had radiation therapy treatments to the breast.

The disadvantages of this type of surgery include a long back scar. The scar, however, can be designed so that it's hidden by your bra or a one-piece bathing suit. This surgery is a somewhat more painful than expander surgery. Finally, some women prefer a more natural reconstruction using their own tissues, without an implant, to create a breast.

Tips for Preparing for Your Recovery

It's recommended that you have the following ready when you get home to make your recovery more comfortable:

  • Two wedge pillows for under the knees and behind the back
  • Body pillow, not necessary but helps comfort
  • Well stocked library of books, magazines, books on tape and videos
  • Telephone by your bed (some women find a portable phone easier)
  • Frozen foods and easily prepared foods
  • Relaxation tapes
  • A supportive, non-underwire bra to wear after okay from plastic surgeon
  • Have a friend who can wash your hair over the kitchen sink
  • An eye pillow for daytime resting
  • Loose overshirts or dresses to hide the drains
  • No showers for five to days, so consider alternatives like a sponge bath, a favorite spray cologne or scented powder

A Tissue Expander With an Implant

In this method, a tissue expander is placed under your chest muscles — these muscles have no change in function after surgery. The expander is then inflated every two to three weeks for about three to four months. This inflation requires a visit to the plastic surgeon who injects salt water using a needle into the expander.

There is some temporary (one to four hours) chest tightness after each procedure. When expansion is finished, it is generally painless.

In three to six months when the chest skin is stretched enough — like a woman's abdomen stretches during pregnancy — the expander is removed and a permanent saline (salt water) implant that matches your other breast is put in. This involves a second, relatively minor operation. Then, if you wish, the nipple is reconstructed in a third, minor operation.

Your plastic surgeon can show you these expanders and implants when you are in the office. These implants now come in a very wide range of shapes and sizes, so that most women's opposite breast can be closely matched.

The advantages of this surgery are that it is the simplest reconstructive method and all of the surgeries are relatively minor.

Disadvantages of this type of breast reconstruction include a longer mastectomy scar and two to three operations — one of which is done at the same time as the mastectomy if you have immediate reconstruction. Also, you must go to your plastic surgeon's office every two to three weeks to have your expander inflated.

In addition, initially after surgery, there is really no breast until after the expander had been inflated a few times. This technique may not be possible in some patients who will receive radiation therapy treatment, because the radiation can cause hardening of the implant. The reconstructed breast always feels hard and often tight, and will never droop naturally. Finally, some women prefer a more natural reconstruction using their own tissues to create a breast.

More Information:

 

Reviewed by health care specialists at UCSF Medical Center.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.