Breast Reconstruction

There are a number of carefully designed operations, which, depending on your circumstance, may apply. In some cases, a saline expander is inserted under the muscle at the time of mastectomy and subsequently inflated. In other procedures, the patient’s own tissues are transferred from one site into the breast position, or a combination is used. Some procedures require the use of a breast implant; others do not. Careful use of a patient’s own tissue is important in all breast reconstruction.

When transposing a flap (segment of skin and fat) of the patient’s own tissue, an independent blood supply (pedicle) is required. A flap of tissue is brought to the front of the chest from a distant site and formed to look like a breast. If lower abdominal skin and fat are used, sufficient volume can usually be achieved without the use of an implant. This operation is called the Transverse Rectus Abdominus Myocutaneous Flap (TRAM flap). Skin and subcutaneous island flap are transferred on a muscle carrier for blood supply.

An alternative flap involving muscle, fat, and skin taken from the back is called the Latissimus Dorsi Myocutaneous Flap (LDM flap). Using the broad fan-like muscle of the back, this can be rotated around to the front of the chest with an island of skin and subcutaneous tissue and together with an implant create a sufficient mound. Every effort is made to equalize the breasts. If the opposite breast is too large it can be reduced in size. Fortunately, the use of muscle pedicle flap is well tolerated and provides little disability to the patient.