Breast Reconstruction Choices 
 
 
 

Women who have had a mastectomy to treat breast cancer have several choices when deciding how to restore the look and feel of the removed breast. While reconstruction techniques have improved over the years, surgical incision lines may still be visible and the new breast will not appear exactly as the original breast. However, the cosmetic results can help breast cancer survivors feel better about themselves, improve their quality of life, and be less self-conscious about their appearance.

There a two main types of breast reconstruction. One takes tissue from the woman’s abdominal, buttock or back areas; the other uses implants filled with either silicone or saline (salt water). Both have advantages and disadvantages. Using a woman’s own skin, fat and muscle can create a more natural looking breast, but these procedures are more complicated and can cause additional scaring. Implants typically require less surgery, but results may not look as natural as the original breast. Women should talk with their doctors about which option is best for them, taking into account their overall health, extent of breast cancer, breast size, amount of available tissue and type of procedure.

Surgical reconstruction using a woman’s own tissue can be performed several ways:

  • The transverse rectus abdominus muscle (TRAM) flap procedure uses skin, fat and muscle from the abdominal area.
  • The latissimus dorsi procedure uses skin, muscle and fatty tissue from the upper back.
  • The deep inferior epigastric artery perforator (DIEP) flap procedure uses only fat and skin, not muscle, from the abdominal area.
  • The superior gluteal artery perforator (S-GAP) flap procedure uses only skin and fatty tissue from the upper part of the buttock.

The TRAM flap and latissimus dorsi procedures are typically performed as pedicle flaps, which involve sliding tissue up a tunnel to the breast area without cutting the original blood supply. In contrast, DIEP and S-GAP procedures are free flaps, which involve cutting tissue from the original location and then reattaching it in the chest area.

Artificial implants require the least amount of reconstructive surgery and may even be inserted under the chest muscle when the mastectomy is performed. Although there is no proven evidence that silicone implants cause immune system diseases, implants filled with saline are the most common choice. In some cases, a tissue expander may be necessary to stretch the skin to make room for the implant. Breast implants may need to be replaced at some point and there is a risk of developing scar tissue around the implant.

The last stage of breast reconstruction is to make the breast look more like the original by creating a nipple and areola. This procedure usually is done three to four months after surgery to give the new breast time to heal. The nipple can be recreated using tissue from the new breast and the areola can be created by tattooing.

Women should avoid strenuous sports, overhead lifting and sexual activity for up to six weeks after breast reconstruction surgery. Some breast sensation may return and most scaring will gradually fade over time, but not disappear completely. For more information about breast reconstruction surgery, visit the American Cancer Society website at www.cancer.org.

For a Physician Referral, call St. Mary's Medical Center at (561) 882-9100.