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Sorta Random Sunday: Basics of Breast Reconstruction

I’m sticking to the theme of Breast Cancer Awareness month like last week’s Sorta Random Sunday. Since a huge part of my practice is breast reconstruction, I thought ‘d share some of the basics of breast reconstruction!

breast reconstruction basics
Using the operative microscope for an autologous breast reconstruction with my partner Dr. Nagai

Who gets breast reconstruction?

Anyone who is having breast surgery for breast cancer or increased risk of breast cancer is eligible for breast reconstruction. In fact, in many states like New York, it is a law that these women be given the option to see a plastic surgeon to discuss breast reconstruction!

This includes women undergoing breast conservation treatment like lumpectomy or total breast removal A.K.A mastectomy. I’ll focus on options for breast reconstruction after total mastectomy in this post.

What are the options for breast reconstruction?

There are 2 main avenues for total breast reconstruction: implant based and autologous (your own tissue based).

Both of these options are good when used in the right situations. So let’s talk about both!

Implant-based breast reconstruction

Within implant reconstruction, there are two main options:

  • Tissue expander
  • Immediate implant

A tissue expander, for lack of a better analogy is like a deflated water balloon. After a mastectomy, we place the tissue expander and partially inflate it with saline or salt water. The skin is closed and then in the clinic, the tissue expander is inflated all the way. Then, in a second surgery, the tissue expander is removed and a permanent, usually silicone, implant is put in.

Another option is putting the immediate implant in at the time of mastectomy. Then a second surgery is not necessarily needed unless touch ups are desired.

The begs the question of why anyone would have a tissue expander placed rather than an immediate implant. And there are two reasons:

  • If you want to have bigger breasts with the reconstruction, or
  • The surgeon is worried about the health of the breast skin after the mastectomy

The biggest downsides with this reconstruction are:

  • It is a foreign body
  • Risk of infection
  • Doesn’t feel quite as natural
  • Not a lifelong reconstruction (need to replace in future)
  • Tough to match a natural breast on the other side with an implant reconstruction

Autologous (own tissue) reconstruction

The other main option in total breast reconstruction is using your own tissue to reconstruct your breast after mastectomy.

In this option, we take tissue (skin and fat) from another part of your body connected to a blood vessel. Then we take this tissue to your breast and connect the blood vessels to other blood vessels in your chest using a microscope. This allows the tissue to live and then we sculpt it into your new breast.

We can take this tissue from lots of places in your body. The most common places are:

  • Abdomen (belly)
  • Inner thighs
  • Back
  • Butt

The biggest upside of this reconstruction is that it is your own tissue and grows and changes with your body!

This biggest downsides are:

  • Risk of the blood vessel connection not working
  • Scars on other parts of your body
  • Slightly longer stay in the hospital (typically 3 days versus 1 day with implant reconstruction)

You can also learn more about sensation=preserving mastectomy here!

The bottom line

The decision and choice of breast reconstruction (or not) and the type of breast reconstruction is very personal. There are factors that favor one or the other in certain patients. But overall, most patients are good candidates for both!

I hope you’ve enjoyed learning some of the basics of breast reconstruction! Here is a great site with more information as well.

As always, feel free to message me with any questions.

What do you think? Did you know about these basics of breast reconstruction? What would you choose? Let me know in the comments below!

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    Jordan Frey MD, a plastic surgeon in Buffalo, NY, is one of the fastest-growing physician finance bloggers in the world. See how he went from financially clueless to increasing his net worth by $1M in 1 year and how you can do the same! Feel free to send Jordan a message at [email protected].

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