PLASTIC & COSMETIC SURGEON416.447.6176     1.855.447.6176

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Breast Reconstruction (Post-Mastectomy)

What Is It?

Breast cancer is devastating and takes a major physical and emotional toll on all women who experience the disease. It is reassuring to many of these women that much can be done to reconstruct the breast that has been partially or completely removed in the treatment process.

Dr. Neu's expertise is in cosmetic surgery, but he is a fully trained reconstructive surgeon, and applies the same skills to women who have lost their breasts from breast cancer.

In the past, breast reconstruction was an operation done largely through the transfer of tissue from other parts of the body. The most popular procedure in this regard was the "TRAM" flap where skin, fat and some muscle from the tummy region was tunnelled up to the chest to reconstruct a breast mound. This is an operation that Dr. Neu has done frequently, and still does in certain situations. However, the quality of new tissue expanders and the variability of new implant sizes and shape, combined with the relative simplicity of the procedure, have made implant surgery the more frequently chosen type of breast reconstruction today.

Patient Examples

Click on any photo for larger version and more views of that patient.

Before Surgery Consultation

During the initial consultation, Dr. Neu will take a detailed history of the patient’s general health and the procedures undertaken to treat breast cancer. Were lymph nodes involved? Did the patient have chemotherapy or radiation? What are the patient’s personal preferences for breast reconstruction? Is there a risk of developing breast cancer in the opposite breast and is surgery being considered there? These are all factors that influence the course of further surgery.

If a simply lumpectomy has been carried out on one breast, then a contouring operation on that side, with a breast reduction on the other side, may be the procedure of choice. If the breasts were small, and the patient wishes to have a larger breast size, then differential breast implant augmentation may be the best approach. Sometimes small defects in one breast can be managed with fat injection.

When there has been radiation to a breast, this influences the decision. It is more difficult to expand irradiated skin with a tissue expander. Typically a patient will have to accept a smaller breast size from a tissue expander, or will have to consider a tissue transfer procedure such as a TRAM flap, assuming there is adequate tummy tissue for the purpose.

Dr. Neu will review the various options and explain the potential advantages and disadvantages of each.

The Surgery

There is a tremendous variability in techniques for reconstructive surgery of the breasts, depending on each patient's circumstances.

Implant Surgery

Prior to implant surgery, a tissue expander is surgically inserted under general anesthetic during a day surgery operation. The expander is a deflated balloon that is slowly inflated at two- to three-week intervals by passing a needle into the expander via a specially designed "port" that is identified through the skin with a magnet. Once the breast tissue has been adequately stretched, the expander and the overlying skin are allowed to settle for a few months. The expander is then removed during a second operation and is replaced with a permanent implant. Most patients opt to have the newer generation of form-stable anatomical cohesive gel implant, but a saline implant can also be chosen.

TRAM Flap

A TRAM flap is a more extensive procedure and patients usually stay in hospital for two days after surgery. Skin, fat and muscle are elevated from the mid to lower tummy region and brought up to the chest. Sometimes a cloth-weave reinforcement has to be placed onto the tummy wall to reduce the chance of hernia formation. While reconstruction of one breast typically causes no permanent weakness of the abdominal muscles, when two breasts are reconstructed, more muscle is required and this may leave some weakness to the tummy musculature—for example when attempting to do a sit up. A couple of months after surgery, a second operation is done to contour and shape the tissue that has been transferred onto the chest.

In either form of reconstruction, additional procedures are needed at a later time to address breast asymmetry and nipple reconstruction.

Resumption of Activity

After insertion of a tissue expander, patients typically resume sedentary work in five to seven days, and vigorous activities within three weeks. After a TRAM flap, patients are usually off work for four to six weeks. Vigorous activities are started after three months.