Many women require surgical removal of the breast (mastectomy) for a variety of conditions (cancer, severe fibrocystic disease). With modern techniques, reconstructing the breast is often an appealing option. Using either a woman's own tissues or implants, Dr. Kunkel is able to create a breast that may be very natural in appearance. Breast reconstruction is almost always covered by insurance and can make an enormous difference is a woman's self-image. A consultation will provide you with information on the many options available for post-mastectomy breast reconstruction.
Breast reconstruction often involves at two or more operations, with the operations being separated by four to eight months. The different types of reconstruction techniques are discussed below.
Tissue expander - This is the most common technique used for breast reconstruction. At the first operation, Dr. Kunkel inserts a temporary device called a tissue expander beneath the skin and chest muscle at the mastectomy site. Saline (salt water) is injected into the tissue expander at the time of the surgery. The amount of saline added during surgery varies depending on how loose the tissues are, the quality of circulation to the tissues, and the patient's expectations. As the woman is seen in the office over the next several months saline is added to the tissue expander. This is easily accomplished through a device called a port that is built into the expander. The woman comes into the office every two or three weeks for this and it takes just a few minutes to do. Over time the tissue expander is filled to a size and shape that she thinks fits her overall frame. Once the final size of the expander has been reached, the woman undergoes a second operation to replace the tissue expander with a longer-term implant, either saline or silicone. This operation usually takes about an hour or two and the woman goes home the same day.
Latissimus flap - This is a common operation, particularly for a woman with breasts that are somewhat droopy (“ptotic”) and who is only going to have one breast removed. Skin, fat, and muscle are transferred from the woman’s back to the mastectomy site. This tissue is draped over a tissue expander or an implant that has been placed in the mastectomy site. Latissimus flap technique allows for more shaping and sculpting of the breast than just using a tissue expander or an implant alone. The skin, muscle, and fat create a more natural look and feel to the breast. In most cases the tissue expander is later replaced with a long-term implant.
TRAM flap - TRAM flap breast reconstruction is a less common technique today, but remains a good option for the right candidate. This operation uses abdominal skin, fat, and muscle to create a breast; usually there are no breast implants or tissue expanders involved. In most cases there is enough skin, fat, and muscle to be transferred from the abdomen to the mastectomy site to create a breast that looks very similar to the other breast. However, women who have had several abdominal operations, are overweight, have other medical conditions, or smoke are not good candidates for TRAM flap breast reconstruction.
Free tissue transfer - This type of breast reconstruction completely detaches skin, fat, and usually muscle from one area and reconnect the blood vessels of these tissues with blood vessels around the mastectomy site. The most common of these techniques is called a DIEP flap, which is a modification of the TRAM flap. In DIEP flap reconstruction abdominal skin and fat are used to reconstruct the breast, with only a small cuff of muscle being taken.
Women undergoing tissue expander or latissimus flap breast reconstruction typically spend one or two nights in the hospital. TRAM flap patients may spend two or three nights, and DIEP flap patients may spend 4 or 5 nights in the hospital. Women who undergo breast reconstruction are usually tired and sore for a week or two. Surgical drains may be left in place to prevent a build-up of fluid and are usually removed within a few weeks. The majority of women will want two or three weeks off from work, and they need to arrange for some help around the home for at least one week.
Some women decide that they want to have a nipple/areola reconstruction. This is usually accomplished after the breast shape has been created and the woman is happy with her overall size, shape, and symmetry. Nipple reconstruction is a short operation and often is performed under local anesthesia. The areola is made by using color placed by a tattoo technique.
If you would like more information about Breast Reconstruction or to schedule an appointment, feel free to fill out our convenient contact form or call us directly at (817) 335-5200.