Breast Reconstruction Surgery & Other Options
As a comprehensive cancer center, Siteman has breast reconstruction options not found at community hospitals. It’s important to review the choices open to your situation before your cancer surgery and in conjunction with your treatment plan, including concurrent mastectomy or lumpectomy and breast reconstruction.
You may not want to go through more surgery to replace the breast or partial breast, but even then, you have options. Reconstructive surgeons at Siteman are working on using a 3-D printer to build custom breast prostheses based on 3-D photography of your natural breast prior to surgery, so the prosthesis fits your clothing as naturally as your own breast.
When possible, nipple-sparing mastectomy (30-40 percent of the mastectomies done at Siteman) prevents more surgery to reconstruct the nipple at a later time. With this surgery, reconstruction can be done at the time of the mastectomy or later.
Direct to Implant Reconstruction: This can be done at the time of the mastectomy, instead of the two-step process of using a tissue expander to be later replaced by the permanent implant.
Flap reconstruction with your own tissue: You may not want an implant, or your breast is not amenable to implant because not enough skin was left from a previous mastectomy, or because of earlier radiation that damaged the skin. In those cases, flaps from other parts of the body may be used to rebuild the breast.
- Flaps from the abdomen include: DIEP, SIEA, and TRAM: The DIEP (deep inferior epigastric artery perforator) flap is a significant improvement over the TRAM flap, so much that 99 percent of the last 200 reconstructions have been DIEP flaps. The DIEP and SIEA flaps use skin and fat from the abdomen, but leave the muscle (taken for the TRAM flap) for continued abdominal support. Both can be done at the time of mastectomy or later.
- Flaps from the inner thigh: TUG and PAP: The TUG and PAP flaps are new reconstruction techniques that use microsurgery and tissue from the inner thigh to reconstruct the breast, creating a well-concealed scar.
- Flaps from the back (Latissimus): For women without enough tissue in the abdomen or thigh, the latissimus flap brings tissue around from the back to rebuild the breast. The back incision scar can often be placed at the bra strap line to conceal it.
Lumpectomy, partial removal of breast tissue with clean margins, makes up 60-70 percent of cancer surgery: Studies have shown that after lumpectomy, 46 percent of women were unhappy with the cosmetic outcomes. There are several options offered for Siteman patients to reconstruct breasts after lumpectomy:
If you have moderate to large breasts, the oncology surgeon and plastic surgeon can work as team to do bilateral breast reduction, doing the cancer breast first to make sure the tissue removed includes the lump and clear margins, and then sculpting the other breast to match.
- Depending on the size of the tissue removed, a breast implant can replace the lost volume.
- Fat grafting: Our plastic surgeons have an ongoing study to use your own fat, harvested from a place it isn’t wanted, to inject into the breast to correct the defect.
- Also using your own tissue, TDAP harvests skin and fat from near the armpit area and side of the back to reconstruct defects of the outer breast, usually without muscle tissue.
- LICAP flaps use skin and fat from the side of the chest near the armpit.
To read more about these reconstruction options and see actual before-and-after photos, visit: