Breast Reconstruction Surgery
Women who have undergone surgery for breast cancer have many options for breast reconstruction. The best option for you depends on your personal medical history and preferences.
Dr. Malin will coordinate your surgical and oncologic plan with the multi-disciplinary breast cancer team. Here are the types of operations he offers:
Reconstruction after Breast Conservation Surgery
Patients who undergo breast conservation surgery (lumpectomy or partial mastectomy) often require radiation therapy. Reconstruction of the breast before radiation therapy provides the best outcomes. Dr. Malin works with the breast cancer team to coordinate each patient’s personalized surgical plan. Options include rearrangement of breast tissue, reduction in breast size, and implant placement.
Reconstruction after Mastectomy
This type of reconstruction involves placing a saline or silicone implant to recreate the breast. For most patients, this involves placing a temporary implant, or tissue expander, after a mastectomy. The tissue expander is placed under the skin and muscles of the chest, and then slowly expanded over a series of office visits. At a second operation, the surgeon removes the expander and replaces it with a permanent implant.
Some patients may have a permanent implant placed during the same operation as the mastectomy. Additional tissue will be used to support the implant. Often, fat transfer (fat grafting after liposuction) is utilized to improve the shape and appearance of the breast reconstruction.
The latissimus dorsi is a large muscle in the back that can be transferred, with skin and subcutaneous fat, to the breast for reconstruction. The blood supply for this muscle travels through the armpit, so the tissue can be brought forward to the breast with blood vessels intact. An implant may also be necessary to fully reconstruct the breast. The scar on the back can be hidden with clothing. Loss of the latissimus muscle does cause some weakness in the shoulder, although it may not interfere with normal daily activities.
Transverse Rectus Abdominis Muscle (TRAM) Flap
A TRAM Flap predates the DIEP Flap (see below). This type of reconstruction uses intact skin, fat, and blood vessels from the abdomen to form a new breast. The abdominal muscle remains attached to the body as a pedicle. The abdomen is then closed just as in an abdominoplasty or “tummy tuck.” Patients can experience asymmetry, weakness or hernias along the abdominal wall after surgery.
Deep Inferior Epigastric Perforator (DIEP) Flap
A DIEP Flap is a revolutionary technique using microvascular surgery in breast reconstruction. This type of reconstruction uses skin, fat, and blood vessels from the abdomen to form a new breast. The abdomen is then closed just as in an abdominoplasty or “tummy tuck.” Unlike traditional procedures, DIEP flap surgery leaves the abdominal muscle intact to promote a faster recovery and return to a physically active lifestyle. This procedure will be performed at the Beth Israel Deaconess Medical Center in downtown Boston.