BREAST RECONSTRUCTION

NEWMARKET PLASTIC SURGEON SERVING TORONTO AND GTA

DR. WILLIAM ANDRADE

Breast Reconstruction

There are many options for breast reconstruction.  Factors to consider include the timing, type of reconstruction, and other choices regarding the details of the reconstructive procedure.  All of these different options are discussed during a consultation.  An excellent overview of breast reconstruction can be found at http://www.breastreconstructioncanada.ca/

Timing of Breast Reconstruction

  • Immediate Breast Reconstruction:  It is possible to have breast reconstruction during the same operation as the mastectomy.  In these cases, the general surgeon performing the oncological procedure will coordinate with the plastic surgeon.  Advantages of immediate breast reconstruction include the possibility of having a single operation with a quicker recovery, and the psychological benefit of not having to live without a breast mound.  Disadvantages include possible increased risk of complications, or having a negative impact on other aspects of a person’s cancer treatment (for example, if delayed healing after breast reconstruction causes in a delay in starting radiation therapy).  Immediate breast reconstruction can be done with a person’s own tissue or with a breast implant.
  • Delayed Breast Reconstruction:  Breast reconstruction can be performed at any time after mastectomy surgery.  Advantages of delayed reconstruction include enabling the person to focus on their cancer management without adding more complexity to the decision-making process.  Disadvantages include the psychological impact of living without a breast mound, and the potential cosmetic limitations of certain types of delayed reconstruction.

Methods of Breast Reconstruction

  • Reconstruction with Tissue:  A person’s own tissue can be transferred from one part of the body to the chest, to reconstruct the breast.   The tissue that is transferred to the new area is called a “flap”.   The most common areas where tissue is taken is from the abdomen (examples include the TRAM flap or DIEP flap) or the back (latissimus flap).  In some cases the tissue is kept attached to the body and tunnelled under the skin to reach the new location.  This is called a “pedicled flap”.    In other cases the flap is “unplugged” from the blood vessels in one area, and “plugged in” to different vessels in the chest.  This technique is called a “free flap” and it involves a surgical procedure done under a microscope to reattach the blood vessels.  Microsurgery is not performed at Southlake Hospital, so patients who would best be served with a free flap reconstruction are referred to a microsurgical breast reconstruction program in Toronto.  Dr. Andrade only performs pedicled flap reconstruction, including the TRAM and latissimus flaps.  Some advantages of reconstruction with tissue include a natural feel and avoiding the need for a breast implant.  A few disadvantages include longer surgical time than implant-based reconstruction, and potential for complications where the flap was taken.
  • Reconstruction with Breast Implants:  Breast implants can be used either for immediate or delayed reconstruction.  In immediate reconstruction, the mastectomy is performed in a way that most of the breast skin (and in some cases the nipple and areola) are preserved.  An implant is then inserted to re-create the breast mound.  The implant is held in place with a bra-like internal sling of connective tissue called acellular dermal matrix (ADM).  In cases of delayed reconstruction, the chest skin first must be stretched-out with a device called a tissue expander.  The tissue expander is slowly inflated with salt water until it stretches the breast skin into a mound.  At a second operation, the expander is removed and a permanent implant is inserted.  Dr. Andrade frequently performs immediate and delayed reconstructions with implants, tissue expanders, and ADM.

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