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Reconstruction of the breast is an important part of your recovery from cancer. With the techniques that are available to us today, especially with the advent and popularization of microsurgery, we are able to provide woman with many different options for breast reconstruction. No matter how you go about your research to figure out which option is best for you, there remain two main options for reconstruction of the breast- using your own tissue (autologous reconstruction) or using an implant (implant reconstruction).
Trying to decide between these options in a vacuum is hard to do. Everyone who presents for breast cancer treatment and reconstruction has a different story and different options for reconstruction. Thin women without excess tummy, thigh or buttock tissue are typically not good candidates for flaps. Patients who will need radiation as part of their therapy have limitations for decision making for reconstruction. Some patients will need to wait for reconstruction, while others will be able to have the cancer surgery and the reconstruction surgery performed at the same time. Even though this is not an easy decision, please be reassured that we will have a comprehensive discussion with you prior to surgery to make sure we choose together the best option for you.
Autologous tissue reconstruction is offered to patients through two different techniques: a pedicled (or attached) flap or by a free flap microsurgical technique. Because Dr. Vega specializes in microsurgery, we are able to provide you with a free flap for reconstruction of the breast. The “free” flap is named as such because in order to perform this operation, the tissue is “freely” removed from your body for reattachment.
The most common donor site for breast reconstruction is the abdomen. Here there are three major flaps that we can use for your reconstruction: the SIEA (superficial inferior epigastric artery flap), the DIEP (deep inferior epigastric perforator flap) and the free TRAM (or transverse rectus abdominis myocutaneous flap). Another newer less common site for breast reconstruction is the upper inner thigh using the myocutaneous gracilis flap or TUG flap. This flap has the added benefit of giving you a natural breast without leaving you with any functional deficit as the gracilis is a redundant muscle of the adductor muscles in the thigh. Dr. Vega performs all of these operations on a routine basis, both for one sided and two sided defects. Ask him during your consultation which flap will be best for you.
On average, operating time for these flaps is 4-8 operating hours, depending on if we are reconstructing you with one or two breasts. You will always spend at least two to three days in the hospital for the nursing staff to monitor your new tissue reconstructions. Total recovery time for the abdominal based tissue flaps is 6-8 weeks. For the gracilis or TUG flap the recovery is even faster, closer to 3-4 weeks. Most patients are completely happy with their first surgical results and a few require revisions, but you can expect to return to full activities within 2-3 months.
Reconstruction of the breast using a saline or silicone permanent implant is another option. This is performed in two stages. The first stage involves placement of a tissue expander underneath the pectoralis muscle. This is typically done at the same time as the mastectomy. Over the following few weeks, once your incisions are well healed, we expand these “balloons” through a small port accessible right underneath the skin with injectable saline. Once you have reached a size that you like, we schedule you for the second stage, removal of the expander and placement of the permanent implant.
The initial surgery takes approximately 1-2 hours in addition to your mastectomy surgeon and depending on whether we are reconstructing one or both of your breasts. The initial hospital stay is usually 1-2 days.
For the second stage surgery where we remove the expander and place a permanent implant, you can return home that same day. This second surgery takes only an hour or two. The total recovery time for implant reconstruction is 3-4 weeks for the first stage and approximately 1 week for the second.
There are many good reasons why implant reconstruction might be the best option for you, although it is best to keep all of your options open as you discuss your treatment with our surgeon.
Below are descriptions of the breast reconstruction flaps offered by Dr. Vega. Please go to http://www.breastrecon.com for more information.
- Muscle Sparing TRAM
- TUG (gracilis)
- Tissue Expanders/Implants