For many women receiving surgery for breast cancer[MB1] , breast reconstruction is an option. There are several types of breast reconstruction that involve using implants, the woman’s own tissue (flap procedures), or a combination of both. Fat grafting and/or tattooing of the nipple and areola may also be used in addition to make the breast look as natural as possible.[1] Breast reconstruction can be used for both women who had surgery to remove the entire breast (mastectomy) or surgery to remove only the tumor and a small margin of surrounding tissue (lumpectomy). Women who receive a mastectomy may want reconstructive surgery to rebuild the breast mound, while women who receive a lumpectomy may choose reconstructive surgery to correct dimpling by adding fat to the area where the tumor was removed.[2] Breast reconstruction can be done during the cancer surgery (immediate reconstruction) or after (delayed reconstruction).[3]

Implants are made of silicone shell on the outside and can be filled with saline (sterile salt water) or silicone gel. Of the implants filled with silicone, there are traditional silicone implants and cohesive gel implants (also known as form-stable implants). Cohesive gel implants have a thicker silicone gel inside, allowing them to keep their shape even if the silicone shell breaks. The thickest cohesive gel implants are referred to as gummy bear implants because the gel inside resembles the consistency of gummy bears. While saline implants have been used the longest, silicone implants tend to feel more similar to natural breast tissue. Cohesive gel implants are less likely to rupture than saline or silicone implants.[3]

For immediate reconstruction during a mastectomy, the implant can be placed under the chest skin or muscle. A mesh may also be used to hold the implant in place. Since the breast skin is preserved, immediate reconstruction can provide a better cosmetic appearance than delayed reconstruction. For delayed reconstruction, an expander is placed during the mastectomy to slowly stretch the skin. A second surgery is then done to place the implant and remove the expander once the skin has stretched enough. Expanders can use saline or compressed carbon dioxide gas to stretch the skin. For saline expanders, saline is injected through a tiny valve under the skin every 1-3 weeks to expand over a period of several months. Carbon dioxide expanders release small amounts of gas several times a day via a remote to expand over a period of 2-3 weeks.[3]

Flap procedures, also known as autologous tissue reconstruction, use tissues from a patient’s stomach, buttocks, thighs, or back to help rebuild the breast. Tissue flaps tend to look and act more natural than implants and can even grow or shrink with weight changes. Additionally, tissue flaps do not have the potential to rupture like implants do. However, flap procedures require two surgical sites meaning additional surgery, more scars, and longer recovery time. The most common types of flap procedures [MB2] are a transverse rectus abdominus muscle (TRAM) flap, deep inferior epigastric perforator (DIEP) flap, latissimus dorsi flap, gluteal artery perforator (GAP) flap (also known as gluteal free flap), and transverse upper gracilis (TUG) flap.[4]

Fat grafting can be done after the initial reconstruction to correct any shape abnormalities that remain. This technique uses liposuction to remove fat from the stomach, buttocks, or thighs. The fat is then cleaned and dissolved so it can be injected into the reconstructed breast.[4] Nipple and areola reconstruction is generally done as a separate surgery 3-4 weeks after the initial reconstruction. Tissue is typically taken from reconstructed breast or in some cases another part of the body such as the inner thigh. Tattooing can be done a few months after the nipple and areola reconstruction surgery to match the color of the nipple and areola to the opposite breast. Tattooing can also be done without the nipple and areola reconstruction by utilizing shading techniques to make the tattoo look 3-dimensional.[5]  

 [MB1]Link to ‘surgery’ article

 [MB2]Link to ‘types of flap procedures’ article

References

1.     Breast Reconstruction Options https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options.html (accessed May 24, 2021).

2.     Breast Cancer Surgery https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer.html (accessed May 21, 2021).

3.     Breast Reconstruction Using Implants https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options/breast-reconstruction-using-implants.html (accessed Jun 28, 2021).

4.     Breast Reconstruction Using Your Own Tissues (Flap Procedures) https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options/breast-reconstruction-using-your-own-tissues-flap-procedures.html (accessed Jun 28, 2021).

5.     Reconstructing the Nipple and Areola After Breast Surgery https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options/reconstructing-the-nipple-and-areola-after-breast-surgery.html (accessed May 24, 2021).