It’s difficult to know about all the choices unless you do your homework, and doctors don’t always advise patients about reconstruction or all of the ways it can be done. The Breast Reconstruction Guidebook can help you learn about the benefits and limitations of each reconstructive method, but here’s a quick summary of what’s available.
Reconstruction with Breast Implants
Expander-to-Implant: A temporary implant called a tissue expander is placed behind the pectoral muscle and gradually inflated with saline during several short visits to your plastic surgeon’s office. When this “pocket” is of sufficient size, the expander is then exchanged for an implant. AeroForm®, a newer tissue expander, allows you to control the pace of your own expansion at home, eliminating several office visits.
Direct-to-Implant: If you have nipple-sparing mastectomy, a breast implant can be placed behind your pectoral muscle without the tissue expansion process. (A patch of acellular dermal matrix (soft tissue replacement) is sewn onto the bottom of the pectoral muscle, creating an instant pocket, so tissue expansion isn’t necessary. With this “one-step” method, you leave the OR the same way you went in: with fully formed breasts.
Reconstruction with Your Own Tissue
Flaps of your own excess fat, skin and sometimes muscle can also be used to recreate your breasts; not surprisingly, new breasts of your own living tissue will feel and move more like natural breasts.
From your back: LAT, TDAP*
From your abdomen: TRAM, DIEP*, SIEA*
From your buttocks: GAP*
From your thighs: TUG, TUT*, PAP*
From your hips: LAP*
LAT, TRAM and TUG flaps include muscle
* Flaps leave the muscle in place. These require a plastic surgeon with microsurgical skills.
- Immediate reconstruction is performed with your mastectomy; delayed reconstruction (a separate procedure) is performed months or years later.
- Not all surgeons do all procedures.
- The best source of information for a specific procedure is with a surgeon who regularly performs it.
- Consider travel as an option. If your local reconstruction options are limited or non-existent, you might want to consider travelling to plastic surgeon who performs the breast reconstruction method you prefer. This doesn’t work for everyone, especially since health insurance doesn’t pay for the cost of travel or accommodations. And if you’re insured with an HMO, your carrier may not pay for your reconstruction if it is performed out-of-network.
- Understanding all of your options, what they require, and how they will affect your reconstruction, is the best way to make an informed decision that is right for you.