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Breast Reconstruction Series (III): Breast (Mound) Reconstruction After Mastectomy



Breast reconstruction is a multifaceted journey, symbolizing resilience and recovery for women who have undergone mastectomy due to breast cancer or other medical reasons. This transformative process typically involves three distinct stages:

  1. Breast (mound) reconstruction

  2. Nipple reconstruction

  3. Tattooing of the nipple-areolar complex

In this article, we will delve into the first stage, breast (mound) reconstruction, which lays the foundation for the restoration of a natural-looking breast. The subsequent stages, nipple reconstruction and tattooing, will be discussed in separate blogs in the future.


Breast (mound) reconstruction is the initial step in restoring a sense of wholeness and self-confidence for women who have undergone mastectomy. The primary objective of this stage is to create a breast mound, and several options are available to achieve this goal:


1. FLAP RECONSTRUCTION




Flap reconstruction is a surgical technique that involves harvesting tissue from another part of the body and transplanting it to the chest to create a new breast mound. Common types of flap procedures include the following:


TRAM Flap (Transverse Rectus Abdominis Myocutaneous)

The TRAM flap utilizes abdominal tissue to reconstruct the breast mound. The skin and fat of the lower part of the belly is transferred to reconstruct the breast defect. One or both rectus abdominis muscle(s) is sacrificed to provide blood supply to the flap.


Latissimus Dorsi Flap

This flap technique uses tissue from the patient's back. Skin and fat for from the back, together with the latissimus dorsi muscle whic provides the blood supply, are transferred to the front to reconstruct the breast mound. It is often combined with implant reconstruction for better cosmetic outcomes.


DIEP Flap (Deep Inferior Epigastric Perforator)

In this procedure, tissue is taken from the lower abdomen. Unlike the traditional TRAM flap, the DIEP flap spares the abdominal muscle, which can lead to reduced postoperative pain and a shorter recovery period.


2. IMPLANT RECONSTRUCTION



Implant reconstruction is another widely used technique. Silicone implants of appropriate sizes are typically placed beneath the pectoral muscle to provide a more natural appearance and feel. Patients have the flexibility to choose implants of the different size that align with their individual preferences and medical recommendations. Some may also opt to augment the contralateral breast at the same time. The surgical time is significantly shorter than flap reconstruction.


3. FAT GRAFTING


Fat grafting is an increasingly popular technique in breast augmentation, especially among those that want natural and relatively subtle improvement. Its role in breast reconstruction is much more limited. Conventionally, it is most commonly used for improvement of contour after breast reconstruction by other methods (e.g. flap / implant) or reconstructing BCT defects. However, in recent years, reports have been published in its use in total (secondary) breast reconstruction. This approach requires internal / external expansion, with serial procedures that may span over a few months to a year.


FLAPS VS IMPLANTS



Pros Of Flap Reconstruction

- Provides a natural look and feel.

- Less affected by radiotherapy.

- Minimizes the need for foreign materials (implants).


Cons Of Flap Reconstruction

- Involves a longer operating time, more complex surgery, with longer recovery.

- Sacrifices a donor site, resulting in additional scars and potential complications and functional limitation.


Pros Of Implant Reconstruction

- Simpler surgery with shorter recovery time.

- Allows for a more predictable breast shape and size.

- Flexibility in shape and size.


Cons Of Implant Reconstruction

- Implants may need replacement over time.

- Risks of complications increase if exposed to radiotherapy.

- Implant risks such as leak, rupture, and capsular contracture.


CONCLUSION


Breast (mound) reconstruction marks the beginning of a remarkable journey towards physical and emotional healing for women who have undergone mastectomy. By carefully weighing the pros and cons of each option and considering personal preferences and health factors, patients can make an informed decision that aligns with their unique needs and aspirations.

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