Following a mastectomy, many patients choose to have breast reconstruction as opposed to wearing an external prosthesis which can feel awkward and unsatisfactory. If you do choose reconstruction, there are three basic techniques that Dr. Kent employs:
- Tissue Expander/Implant Technique
- Latissimus Dorsi Flap plus Implant
- Rectus Abdominis Flap (TRAM or tummy tuck flap)
Tissue Expander/Implant Technique
A tissue expander is a balloon of silicone which is put beneath the skin of the chest and filled with saline in order to expand the skin. The balloon is placed during your initial mastectomy surgery and saline is injected into it every week or two until the skin is of sufficient volume. Then, in a second operation, the expander is removed, and a saline or silicone gel breast implant is put in its place. This second surgery is done as an outpatient under general anesthesia anywhere from five to eight months after mastectomy.
While this is the simplest of the three techniques with the shortest operating time and produces no additional scars, it is hard to match an existing breast with significant hang and Dr. Kent will often find it necessary to operate on the opposite breast with either a breast lift, breast reduction, or breast augmentation in order to achieve symmetry.
Latissimus Dorsi Flap Plus Mammary Implant
In this technique, Tulsa plastic surgeon Dr. Kent creates a flap by taking skin from the back with the attached underlying latissimus dorsi muscle and rotating it onto the chest to replace tissue that was removed during the mastectomy. A tissue expander or breast implant is then placed beneath the “flap” to create the breast. If an expander is used, it is replaced with an implant at a later date as in the technique above. The back area is then sutured closed.
Although this is an extremely reliable procedure with few potential complications, it does result in a linear scar across the back. Also, the loss of the latissimus dorsi muscle weakens the strength of the shoulder by 10-15% though most patients rarely notice this.
Rectus Abdominis Flap (Tram or Tummy Tuck Flap)
In this operation, fat and skin from the lower abdomen is transferred to the chest with the attached underlying rectus abdominis muscle. A breast is then fashioned from the transferred tissue. Then, the abdomen is closed, resulting in a tummy tuck or abdominoplasty. A breast implant is rarely necessary with this technique.
Although this is a bigger surgery than the first two techniques, it gives you a breast made from your own tissue, which will remain “biocompatible” for the rest of your life. Also, there is more flexibility in how you fashion the breast so surgery on the opposite breast isn’t needed as often. But it is the longest of the procedures. Also, the blood supply for the transferred tissue is not as vigorous as that of the latissimus dorsi flap, and sometimes a portion of the flap does not survive. This may lead to delayed healing, a mediocre or unsatisfactory aesthetic result, or further surgery. Your abdomen will be weaker because of the absence of one or both rectus muscles, and although this is usually well tolerated, about 10% of patients develop an abdominal bulge or hernia which may require further surgery.
There are differences in appearance between a reconstructed breast and a normal breast. If skin from the back or abdomen is used, it will retain its original color and texture and is, therefore, different from that of the chest. Also, although many women find that creating a breast mound is sufficient, others desire a more detailed effort at reconstruction. Dr. Kent can mimic the appearance of an areola by transferring a skin graft from the inner part of the upper thigh or the lower abdomen to the nipple area, or he can tattoo the skin of the reconstructed breast. To make the middle part of the nipple protrude, he simply lifts the tissue from the reconstructed breast.
The nipple reconstruction is a separate procedure done once Dr. Kent and the patient are completely satisfied with the breast mound as an outpatient under local anesthesia. The operation takes about 1-1½ hours for one nipple to 2½ hours for both nipples.
Recovery time will depend on which technique is used but in general, suction tubes are placed in the incision to drain the operative site for the first 5-7 days after surgery, and then they are removed. The patient can usually go home on the second or third day after surgery if they have an expander or latissimus dorsi flap reconstruction, and on the third to fourth day after surgery if they have a TRAM flap. Stitches are typically removed in about 10-14 days, and you can shower shortly after the drains are removed. Most patients are driving within two weeks of surgery, and can usually return to light work duty after two weeks if they feel ready. Contact our office in Tulsa Oklahoma to learn more about Post-Mastectomy Reconstruction