Breast Reconstruction Surgery & Other Options
Some breast cancer patients find that undergoing breast reconstructive surgery is an important part of their healing process. A full reconstruction often requires several procedures, depending on any additional treatments or other factors that arise.
As a comprehensive cancer center, Siteman offers every available reconstructive option. Our plastic surgeons practice alongside our oncologic surgeons, which frequently allows our patients to receive their first reconstructive procedure at the same time as their mastectomy or lumpectomy. These combined surgeries yield excellent medical and cosmetic results.
Opting for a combined procedure will not cause a delay in your treatment. At Siteman, the surgery can usually be scheduled within two to three weeks. More than 95 percent of patients who want reconstruction can have their first surgery at the same time as their mastectomy or lumpectomy.
We recognize that choosing whether or not to have a reconstructive procedure is a highly personal decision. At Siteman, our physicians and reconstructive surgeons will participate with you in a shared decision-making process, providing a consistent level of information about the procedure and any risks involved.
Not all patients are good candidates for reconstructive procedures right away. However, at Siteman, more of our patients go on to receive reconstructions than at any other center in the region.
Some of our reconstruction options are listed below. For more detailed information about these procedures, as well as before-and-after photos, visit the West County Plastic Surgeons of Washington University website.
Some patients do not want to pursue reconstructive surgery. Our surgeons fully endorse that decision, but also recognize that such patients sometimes need additional care in order to feel comfortable in their clothes. To help these patients, reconstructive surgeons at Siteman are using 3D printing technology to develop a new method of creating customized breast prostheses. The prostheses will be based on 3D photography of your own breast, so they will fit inside your clothing as naturally as possible.
The following procedures are used to reconstruct the breast following a full mastectomy, or removal of the breast. If a patient has chosen to undergo a combined mastectomy and reconstruction, surgeons will usually perform a nipple-sparing or skin-sparing mastectomy. This keeps the patient from having to undergo an additional procedure to reconstruct the nipple later on.
A direct-to-implant reconstruction can be performed at the same time as a mastectomy. The implants are made of safe, synthetic material.
At many hospitals, mastectomy patients seeking implants first have tissue expanders inserted, and then receive the implants during a second procedure later on. Direct-to implant reconstructions at Siteman allow patients to skip this step and avoid an extra surgery.
Pre-pectoral implant reconstruction
Washington University surgeons at Siteman are now performing pre-pectoral implant reconstructions, a new procedure in which the synthetic implant is placed above the pectoral muscle. This means that the pectoral muscle will not interfere with the appearance or movement of the implant, which leads to a more lifelike reconstruction overall. In addition, patients who receive this procedure often find that they recover more quickly and with less pain.
Some patients don’t want synthetic implants, or are not eligible to receive them due to the effects of their cancer treatments. In these cases, tissue – or “flaps” – from other parts of the body can be used to rebuild the breast.
Tissue flaps may be removed from the abdomen, the inner thigh, or the back. At Siteman, our physicians are skilled at performing abdominal flap surgeries that do not take any muscle. Known as DIEP or SIEA flaps, these procedures allow the patient to maintain full abdominal strength. Not all facilities are equipped to conduct DIEP or SIEA flap surgeries at our level of expertise.
Though lumpectomies take much less tissue than full mastectomies, they can often lead to unsatisfying cosmetic outcomes. A recent survey of lumpectomy patients found that 46% were unhappy with the appearance of their breast after the surgery. Fortunately, surgeons at Siteman offer a number of reconstructive procedures that are ideally suited for lumpectomy patients.
Implants can sometimes be appropriate for lumpectomy patients who have had a significant amount of tissue removed.
Oncoplastic breast reduction
If you have moderate to large breasts, the oncology surgeon and plastic surgeon can work as team to do bilateral, oncoplastic breast reduction. They will reduce the breast with cancer first to ensure that all of the cancerous tissue is removed and then sculpt the other breast to match.
Our plastic surgeons can remove fat from another part of your body and inject it into your breast.
Tissue flap surgeries such as the TDAP and LICAP can be effective solutions for lumpectomy patients. In these procedures, the flaps taken from the armpit, the chest, and the side of the back.
Are there any risks associated with reconstructive procedures?
Reconstructive procedures are not inherently dangerous, especially because they don’t impact any major organs. But it can be challenging for surgeons to manipulate, reroute, and reconnect all of the tiny blood vessels that will support the new breast. When complications arise, it’s usually because the blood vessels are failing to carry enough oxygen to the breast tissue, which can lead to tissue death.
Any surgical procedure also carries a dimension of risk due to the use of anesthesia, a risk that can escalate the longer a procedure continues. Breast reconstructive procedures that involve a transfer of the patient’s own tissue can take especially long to complete, sometimes as long as ten hours. However, patients should keep in mind that many other surgical procedures are longer than this.