Breast Reconstruction

Tissue Expander, TRAM Flap, Latissimus Dorsi Flap

Breast Reconstruction

Top Left – After a Breast Biopsy and the Finding of Breast Cancer

Top Right – After Tissue Expander Placement

Bottom Left – Tissue Expander Replaced & Implants both sides – Nipple Reconstruction

Bottom Right – After Tattooing the Nipple for Color

Tissue Expansion

What You Should Know

  • Easiest recovery after a Mastectomy
  • Best performed immediately following the Mastectomy to prevent scar contracture of the Breast
  • Procedure of choice in a Double-sided Mastectomy
  • The Tissue Expander is inflated with salt solution to stretch the skin and muscle over several weeks
  • The Tissue Expander is generally left in place for months and then replaced with a permanent Breast Implant
  • Reconstruction usually takes about 1 year and includes reconstruction of the nipple area if necessary
  • Two advantages over a Skin – Muscle Flap :
    • Stretching the breast skin allows for a perfect match to the surrounding breast skin
    • Less risk of healing problems because their is no transfer of tissue from another part of the body

 Disadvantages:

  • For large breasts, surgical shaping on the other side is almost always necessary for a better match to the rounded appearance of Breast Implant
  • A poor choice after radiation treatments to the breast

Radiation Therapy and Reconstruction with Implants

For all women who have had radiation therapy placing an implant to reconstruct the breast has a high risk of hardening of the breasts. But it may be a risk that some women are willing to take. For example, the woman below took that risk and ended up with a great result, as well as soft breasts.

Breast Reconstruction

Top Left – After Lumpectomy + Radiation Therapy of the Right Breast for Breast Cancer
Top Right – After a Mentor Spectrum Tissue Expander/Implant on the Right + Implant on the Left
Middle Left – Final Front View After Replacement of Expander with an Implant + Adjustments
Middle Right – Side View Before Beginning Reconstruction
Bottom Left – During Expansion from the Side
Bottom Right – Final Side View After Reconstruction Complete

Latissimus Dorsi (back) Skin Muscle Flap

The Latissimus Dorsi muscle flap, like all other flaps is used in breast reconstruction to add skin lost from the mastectomy. The muscle and a portion of the overlying skin is moved from the back to the front to recreate the breast. Because this flap usually does not have enough bulk, an implant is placed underneath the flap.

Breast

Indications for the use of a Latissimus Dorsi Flap

  • Previous radiation therapy
  • Loss or poor quality pectoralis muscle which lies under the original breast
  • Poor skin quality following the mastectomy
  • A need for bulk and a more maturing looking breast
  • When other areas, such as the TRAM flap are not available for use
  • The Latissimus Dorsi flap is a hardier flap than the TRAM flap and is less likely to have problems with healing
  • The need for using an implant with it is it’s major disadvantage

TRAM Skin Muscle Flap – Transverse Rectus Abdominus Muscle

The TRAM muscle flap, adds skin and much needed bulk after a Mastectomy. The muscle and a portion of the overlying skin is moved from the abdominal area to recreate the breast. Because this flap usually has enough bulk, a Breast Implant is not needed

Breast Reconstruction

TRAM flap reconstruction: After Mastectomy / 6 months after surgery
End result after Nipple Areola Reconstruction and Nipple tattooing for color

Indications for the use of a TRAM Flap

  • Previous radiation therapy
  • Loss or poor quality pectoralis muscle which lies under the original breast
  • Poor skin quality following the mastectomy
  • A need for bulk and a more maturing looking breast
  • Good choice for large breasts, because the weight of the flap creates some sloping like the uninvolved side
  • The TRAM flap doesn’t like to be moved and is less hardy than the Latissimus Dorsi Flap
  • A longer recovery and a longer operation with more chances for complications are it’s more disadvantage

To get Breast Reconstruction and Restoration Surgery with a Board Certified Plastic Surgeon, Call Dr. Costanzo of Thousand Oaks at (805) 373-9919

Breast Galleries