How can you expect your breasts to look after breast reconstruction?

How can you expect your breasts to look after breast reconstruction?

Results from breast reconstruction can vary significantly between patients on the basis of several factors including:

1. Breast size prior to surgery. Patients with large breasts who require a mastectomy are generally harder to reconstruct. Frequently, a breast reduction or lift is performed on the healthy breast so it can match the reconstructed side. There are several reasons for this. One is that large breasts are frequently ptotic, meaning that the nipple points downward, and a large proportion of the breast tissue hangs below the breast crease. Breast implants, even implants shaped to look like a natural breast, do not look like a ptotic breast. Reconstruction using your own tissues, and in particular a TRAM, DIEP or TUG flap, can be used to provide a reconstructed breast with mild to moderate ptosis. A TUG flap, however, can only be used to build a small- to moderate-sized breast. Of all of the available flap procedures, a free TRAM flap creates the largest breast possible using just your own tissues.

2. BMI and body shape. Reconstructions with breast implants generally look the best on people who are thin or have a normal body mass index (BMI). (Please refer to the chart below). Patients with a higher BMI (>30) will notice progressively more abnormalities in the armpit region. This may include redundant skin folds and the illusion that the implants are narrow or the chest is wide.

Patients with a BMI between 26 and 35 are frequently candidates for a pedicle TRAM, free TRAM, DIEP or SIEA flap. Very thin patients may not have enough abdominal tissue available for this type of reconstruction. Heavier patients (BMI>35-40) have higher complication rates and are likely to have better outcomes with a microvascular reconstruction such as a free TRAM, DIEP or SIEA flap than a pedicled TRAM flap.

The latissimus flap (or its relative, the thoracodorsal artery perforator [TAP] flap) is probably suitable for patients with the widest range of BMIs (18-45). Usually, it is accompanied by a breast implant to provide shape and volume to the breast. Patients with a higher BMI (>40) will notice a contour depression on their back once this flap is performed.

The TUG flap can be used to reconstruct breasts in patients with a BMI between 24 and 40 in appropriate candidates

 

 
TYPE OF BREAST RECONSTRUCTION 
 
BMI
18-24 25-30  31-35 35-40  40-50    >50
Direct-to-Implant * ** ** *
Tissue Expander *** *** ** ** * *
Pedicle TRAM * ** *
Free TRAM * *** *** ** **
Muscle-Sparing Free TRAM * *** *** ** **
DIEP * *** ** * *
SIEA * *** ** * *
Latissimus (with implant) ** *** *** ** ** *
TUG * *** ** ** *

Blank: Not recommended
* May be an option
** Good option
*** Excellent option

3. Breast cancer treatments required. The type of treatment required for breast cancer will have an impact on the timing of breast reconstruction, how a breast is reconstructed and how it will look:  

Recon_Timeline_No_CR



  • Mastectomy versus lumpectomy: After mastectomy, the entire breast requires reconstruction. After lumpectomy, only a portion of the breast is removed and so different reconstructive strategies are used.
  • Chemotherapy: Chemotherapy can affect reconstruction in several ways. Some forms of chemotherapy may delay wound healing, increase the risk of surgical infection, or cause you not to feel well, thus altering the timing of a reconstruction. Some forms of chemotherapy like Herceptin can temporarily affect heart function, and you may need to wait to recover from this therapy before reconstruction can be completed.


Recon_Timeline_C 

  • Radiation therapy: Radiation therapy may be recommended to treat your breast cancer after lumpectomy or mastectomy. Radiation can cause both temporary and long-term changes to the area of the breast it treats. Temporary changes include red discoloration, injury to the superficial skin layer, and delayed wound healing. Long-term changes include scar tissue, hyperpigmentation of the skin, reduced ability of the skin to heal following subsequent procedures, capsular contractures around breast implants and other radiation-induced skin changes. Often, if radiation is required we will recommend that your final reconstruction use your own tissues (TRAM, DIEP, latissimus, or TUG flap) because there is a higher incidence of complications when breast implants are used alone after radiation.

Recon_Timeline_CR 



4. Type of breast reconstruction chosen. The type of reconstruction chosen will also affect how your breasts look after surgery. Reconstruction with a flap will result in a lens-shaped scar that surrounds the new skin that was transferred with the flap. Generally, reconstructions with flaps have more ptosis or the natural shape that accompanies an aging breast. Implants, when used alone, are associated with a linear scar. In addition, reconstructions with implants generally have more fullness in the upper poles of the breasts.

5. Willingness to undergo “touch-up” or “revision” surgery. Breast reconstructions frequently require some form of touch-up surgery to optimize results. This can include repositioning the breasts, fat grafting, liposuction, improving previous scars and contours, adding an implant to add volume or projection and modifying the shape, position and size of the other breast to help match it. Every patient’s priorities are different. Some patients are more willing than others to undergo these additional “touch-up” or “revision” procedures to improve the appearance or balance of the reconstructed breast. Generally, patients who pursue these additional procedures can achieve more aesthetically pleasing results.

6. Presence of complications that may affect your result. Breast reconstruction  is complex and can be affected by infections, wound healing problems, loss of the tissues or implant used to perform your reconstruction, additional breast cancer therapy or other setbacks. These factors can delay reconstruction and alter how your breast reconstruction looks.

West County
1040 N. Mason Rd., Suite 124, St. Louis, MO 63141
Downtown by appointment only 4921 Parkview Pl., Suite 6G, St. Louis, MO 63110
West County Plastic Surgeons provide care for patients of
Siteman Cancer Center