Breast Reconstruction
If you have been diagnosed with breast cancer know that there are a number of reconstructive options available to you. Dr. Chiasson will explain these options to you, listen carefully to your questions and concerns, and work closely with your breast surgeon to create a reconstructive plan specifically for you.
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Oncoplastic Reconstruction
Oncoplastics is a term that encompasses many different reconstructive procedures that may be utilized to correct the defect created from a partial mastectomy or lumpectomy. This involves preserving most of your own breast tissue and is also known as breast conservation therapy. Women who chose to conserve their own breast (instead of a mastectomy) will need radiation after their cancer has been resected, but they may benefit from oncoplastic reconstruction. This involves rearranging local tissue from the breast or chest in a way that helps re-create your native breast shape and size. It may also involve a procedure on your non-cancerous breast for symmetry, such as a breast lift or reduction. Dr. Chiasson and your breast oncologic surgeon will consult with you to determine if you are a good candidate for oncoplastic surgery.
Direct to Implant
For some women undergoing a mastectomy, placing a breast implant during the same surgery may be an option. This technique is best suited for women with small to moderate-sized breasts who will not need radiation after the mastectomy. The breast implant is typically placed on top of your pectoralis muscle and may be wrapped in a material called acellular dermal matrix for soft tissue support. Sometimes this procedure is combined with autologous fat grafting in a second surgery. Consultation with Dr. Chiasson and your breast oncologic surgeon will help determine if this is an option for you.
Tissue Expander and Implant Breast Reconstruction
The most common method of post-mastectomy breast reconstruction in the United States is a two-staged procedure. At the time of the mastectomy, a tissue expander is placed. It is usually wrapped in a material called acellular dermal matrix. Over the next few months, the expander is filled with saline. The saline addition is done in the office and is quick and painless. After the desired size has been reached a second surgery is done in which the expander is removed and a final permanent implant is placed. The final implant is silicone gel. Fat grafting may also be done to enhance the overall result if needed.
Latismus Flap
The breast may be reconstructed by transferring skin and muscle (the latisimus dorsi) from the back. The latisimus is a large, flat muscle that provides excellent coverage of an implant. It is a good choice if the mastectomy skin flaps may not be healthy such as in patients who smoke or who have had prior chest wall radiation. The back scar can be placed in the bra line and the loss of the muscle does not result in a physical deficit.
DIEP or TRAM Flap
The TRAM (transverse rectus abdominus musculocutaneous) flap uses tissue from the lower abdomen to reconstruct the breast. The DIEP (deep inferior epigastric) flap also uses abdominal tissue that is transferred to the chest wall as a free flap. It is a complex operation but one that can create a breast with your own tissue, usually avoiding the need for an implant.
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