The Breast Center of Medical City, accredited by the National Accreditation Program for Breast Centers (NAPBC), is dedicated to offering the highest quality of surgical care for mastectomy patients. Our highly specialized team of Board Certified plastic surgeons, nurses, and staff offer all types of breast cancer reconstruction procedures, including some of the newest advances available across the country.
What is a reconstruction?
After a mastectomy, and sometimes after a lumpectomy, a woman may choose to have surgery to rebuild the breast. This does not have an impact on the cancer treatment, but is designed to help restore what was lost to cancer.
Who should have reconstruction?
Any patient who has had a mastectomy can consider a reconstructive procedure. There are a variety of types of reconstruction available, and not all patients are candidates for all methods of reconstruction, but each patient should have the opportunity to learn about the reconstructive options available to her. Her plastic surgeon can guide her on the options, but the choice is ultimately that of each woman.
As with any surgery, the overall health of the patient will impact on the decision to have reconstructive surgery. Patients must be sufficiently healthy to safely undergo surgery.
What does reconstruction achieve?
It is, unfortunately, not possible to completely recreate a natural breast. The goal of reconstruction is to create a breast shape that will help make the body feel and look balanced. This ideally helps restore a woman’s comfort level with her own body image.
Timing of reconstruction
Reconstruction can be done at the same time as the mastectomy in some cases, or at any later date. There is no limit to how long after a mastectomy the patient can undergo reconstruction. The decision of timing is usually made based on a combination of factors including other cancer treatments needed such as chemotherapy or radiation therapy, whether the patient has decided on the desired type of surgery, etc. The timing of a reconstructive procedure may be affected by whatever breast cancer treatments are being recommended for the patient. At all times the treatment of the cancer is the first priority, and the reconstruction can be timed around this as needed for the individual patient.
Types of reconstruction
All types of reconstruction involve multiple stages, usually a minimum of two surgeries. In most cases the first surgery is the biggest, with the subsequent typically being outpatient procedures.
If a woman has a mastectomy on one side, it may be necessary to do a procedure on the other side to help the final result be as symmetrical as possible. This may involve a lift of the natural breast on the other side, or a reduction, or an implant.
- Breast implants: In some cases it is possible to place an implant, whether saline or silicone-filled, directly after a mastectomy. However, in most cases it is necessary to first use a tissue expander. The tissue expander is essentially an “empty” implant which can be gradually filled with saline over the course of weeks or months to help stretch the skin in the breast area to the desired size. Once this is achieved the tissue expander is replaced with an implant. Implant reconstruction allows for greater control of the final size achieved, and typically involves less recovery time than some other methods. However, the implants themselves may become ruptured or develop capsular contracture, which would lead to needing to replace the implants at some future date.
- Latissimus Flaps: A Latissimus Flap involves using skin and muscle from the back, in the region over the shoulder blade, which is rotated around to the breast area. This is almost always done in conjunction with a tissue expander or implant to provide additional coverage.
- TRAM Flap: The TRAM flap is a reconstruction using tissue from the abdominal area to create a breast, usually without any need for implants. This allows an all-natural-tissue reconstruction, but may have some negative impact on the abdominal muscles which could weaken them or result in hernias developing at a later date. The recovery time from this surgery is longer than that with implants as well. For patients who are having radiation, the use of all natural tissue is often a benefit.
- DIEP / SIEA Flaps: These flaps also use tissue from the abdominal area to create a breast, thereby providing an all-natural-tissue reconstruction. However, because this is done using a complex microsurgical technique the impact on the abdominal muscles is much less and therefore the risk of abdominal muscle weakness or hernias is much less. Most patients experience less discomfort and a shorter recovery than with a TRAM flap, but it is still a longer surgery and longer recovery than with implants. For patients who are having radiation, the use of all natural tissue is often a benefit. This is one of the newer types of reconstruction available, along with related procedures such as the GAP or TUG or PUP flaps. There are still only a handful of surgeons around the country providing these types of flaps. One of the physicians at the Breast Center of Medical City was the first to bring these types of flaps to North Texas and Medical City is proud to continue to have these performed at its hospital.
What are the later stages of surgery?
In most cases patients will need nipple & areolar reconstruction, as well as possibly adjusting of shape or size before reaching the final desired result. These later stages are usually done over a period of a few months following the first stage of surgery and are typically outpatient procedures.
Medical City Dallas Hospital is proud to offer a Guest Services department to assist patients with more information about the hospital’s services, local hotels, many of which offer special rates for patients. You can call the Guest Services department at (972) 566-2400.
Breast Reconstruction Resources
- American Cancer Society
- FORCE – Facing Our Risk of Cancer
- Susan G. Komen for the Cure
- Young Survivor Coalition
- Living Beyond Breast Cancer – nonprofit with info to help breast cancer patients
- Breast Reconstruction Forum
- National Breast Reconstruction Awareness Day
- Breast Reconstruction: Your Choice
- DIEP Sisters