The Breast
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Breast Reconstruction

Restoration of the female breast is a challenge to which plastic surgeons have devoted a great deal of time and energy. The last 25 years have seen the development of a number of techniques of use in the treatment of patients after cancer surgery and in those stricken with congenital abnormalities of the breasts. The various techniques fall broadly into three areas:

  • Alloplastic methods (the use of implantable devices)
  • Autologous tissue methods (the use of tissue "flaps" transferred from other body areas)
  • Combinations of flaps and implants
  • All of the techniques have use in certain clinical situations, and none is perfect. However, a careful evaluation of the patients health, her anatomy, and her goals, will allow the plastic surgeon to tailor the best treatment plan for the individual woman. When such a plan is successfully carried out, most patients can be returned to a sense of "wholeness."

    (Note: The Foundation for Reconstructive Plastic Surgery has supported the development of educational software about breast reconstruction. Information about this can be obtained by clicking "Breast Restoration."


    Alloplastic Methods are those surgeries in which the physician employs an implant device to simulate a breast mound. The device is placed beneath the malformed breast (or the skin and muscle left after mastectomy), producing a contour change in the chest which resembles a youthful, round breast. Because the result will be round and prominent, alteration of the opposite, normal breast will often be needed to provide reasonable symmetry.

    Implants are sterile plastic devices made from silicone rubber. The silicone envelope has been filled with silicone "gel" in the past, but today's devices contain only salt water ("saline"). Most implants have smooth surfaces, but some have been given a rough surface texture in an effort to diminish the incidence of firming, ("capsular contracture"). This rough surface is produced by stippling the silicone itself and does not change the chemical nature of the device. (Recently there has been heightened public concern about the possible risk for systemic reaction to implants in some women. All available data have shown no cause and effect link between breast implants and any illness. Notwithstanding this fact, the FDA and independent scientists continue to investigate this matter).

    Gel and inflatable (saline) implants
    In most cases, implant reconstructions will be accomplished in stages. The first stage will involve the placement of a "tissue expander" which will be used to stretch tissues in the breast area before placement of the definitive implant. Tissue expanders are implant-like devices placed within the body while empty and then serially inflated by the surgeon. The patient will usually make weekly visits to the doctor's office for the staged addition of fluid with a hypodermic syringe. Tissues overlying the expander are serially and slowly expanded much like the abdominal tissues of a pregnant woman. This makes more tissue available for the reconstructive endeavor.
    Empty and inflated expanders
    Implant Reconstruction Example/ Expander Reconstruction Example


    Autologous Tissue Methods are operations in which the surgeon "borrows" skin and fat from another body area and transfers it to the chest for breast formation. These are more involved surgeries than those using implants, and will require the patient to accept a scar in the area from which tissues were taken. However, the breast produced with these methods is superior, with a soft, natural character that will last indefinitely.

    Tissues may be taken from the lower abdomen, the back, or the buttocks, depending upon the patient's anatomy and the surgeon's experience. Some of the procedures will require that microvascular surgical techniques be used.

    At times, a mastectomy can be performed which spares all the breast skin save the nipple and areola. This so-called "skin-sparing mastectomy" needs to be immediately reconstructed with a tissue transfer. In the end, the restoration can very closely mimic the original breast.

     

    Autologous Tissue Reconstruction Example

    Skin-Sparing Mastectomy Reconstruction Example

    Immediate Lumpectomy Reconstruction


    Combination Methods are appropriate in a number of circumstances. If implant reconstruction is preferred, but the tissues on the chest are insufficient to provide healthy cover, a tissue tansfer can be employed to "house" and protect the device. Also, some patients may seek somewhat greater fullness than a particular flap can provide on its own, leading the surgeon to "augment" the tissue transfer with a small implant. Finally, combination methods are of great use in bilateral reconstructions when tissues alone cannot provide the breast size desired on two sides.

     

    Combination Reconstruction Example


    2/21/00

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