When is breast reconstruction considered?
Breast reconstruction can be performed after:
Mastectomy for breast cancer. Breast reconstruction is most commonly associated with a mastectomy in which all breast tissue and some degree of skin are removed. In general, in these cases, the missing tissues are reconstructed by 1) replacing them with a flap (such as a TRAM, DIEP, latissimus or TUG), or 2) stretching out the remaining tissues with a tissue expander and replacing missing breast tissue with an implant.
Partial mastectomy or lumpectomy. Breast cancer is often treated with breast conservation therapy when a lumpectomy is used to remove the breast cancer and radiation is then delivered to the entire breast to reduce the risk that another breast cancer develops. Although this technique minimizes the degree of breast deformity, in many cases patients are still unhappy with the appearance of their breasts after breast conservation therapy. Reconstruction is frequently available for these patients, as well, and is also covered by insurance because a partial mastectomy for breast cancer has been performed. In moderate- to large-breasted women, the plastic and general surgeon work as a team so that the lumpectomy can be designed as a breast reduction or lift. In that way, the breast cancer is removed and the patient benefits from a breast reduction or lift procedure at the same time. The opposite side can be lifted or reduced to match. In other cases, breast implants, flaps or fat grafts can be used to reconstruct the breast after lumpectomy. These techniques are often referred to as oncoplastic surgery.
VIDEO: Oncoplastic Breast Reduction-Reconstruction
Congenital absence of the breast (Poland’s syndrome). Men and women are sometimes born with very little or no breast, nipple or normal chest muscle tissue. Absence of the nipple is called athelia, absence of the breast tissue is called amazia, and absence of the nipples and breast tissue is called amastia. Absence or abnormality of a combination of the chest muscles, breast tissue and chest wall is called Poland’s syndrome. Women with Poland’s syndrome can undergo breast reconstruction procedures similar to patients who have had a mastectomy for breast cancer. This classically involves a latissimus flap with breast implant to reconstruct both the missing pectoral muscle and breast gland, but may also involve a breast implant alone, or a DIEP, or free TRAM reconstruction. Males with Poland’s syndrome are also candidates for reconstruction with a latissimus muscle flap to recreate the pectoral muscle and possibly a chest wall implant.
Loss of breast tissue due to injury or chest surgery. Breast tissue may be lost or disrupted after surgical procedures or injuries to the chest. Breast reconstruction can be used to restore breast tissue that is lost or damaged because of previous breast- or chest-related injuries.