Breast reconstruction is the rebuilding of a breast, usually in women. It involves using autologous tissue or prosthetic material to construct a natural-looking breast. Often this includes the reformation of a natural-looking areola and nipple. This procedure involves the use of implants or relocated flaps of the patient's own tissue. A pregnant womans breasts. ... Diverse women. ... In biology, autologous refers to cells, tissues or even proteins that are reimplanted in the same individual as they come from. ... A United States Army soldier plays foosball with two prosthetic arms Jon Comer, professional skateboarder with a prosthetic leg. ... Cross section of the breast of a human female. ... Typical human female nipple and areola. ... A breast implant is a prosthesis used to enlarge the size of a womans breasts (known as breast augmentation, breast enlargement or augmentation mammoplasty) for cosmetic reasons; to reconstruct the breast (e. ...

Overview

The primary part of the procedure can often be carried out immediately following the mastectomy. As with many other surgeries, those with significant medical comorbidities (high blood pressure, obese, diabetes) individuals who smoke are higher-risk candidates. Surgeons may choose to perform delayed reconstruction to decrease this risk. Patients expected to receive external beam radiation as part of their adjuvant treatment are also commonly considered for delayed autologous reconstruction due to significantly higher complication rates with tissue expander-implant techniques in those patients. Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, is increased to a point where it is associated with certain health conditions or increased mortality. ... This article is about the disease that features high blood sugar. ... The cigarette is the most common method of smoking tobacco. ...

Breast reconstruction is a large undertaking that usually takes multiple operations. Sometimes these follow-up surgeries are spread out over weeks or months. If an implant is used, the individual runs the same risks and complications as those who use them for breast augmentation but has higher rates of capsular contracture (tightening or hardening of the scar tissue around the implant) and revisional surgeries. Breast implant diagram A breast implant is a prosthesis used in cosmetic surgery to enhance the size and shape of ones breasts or to reconstruct the breast (for example, after a mastectomy). ... The most popular and common questions that regard the risks in a breast augmentation surgery are concerning the recovery period and the procedure itself. ...

In 1998, the Women's Health and Cancer Right Act was passed mandating insurance coverage for breast reconstruction in the United States. Prior to this, many insurance carriers did not cover breast reconstructive surgery as they considered it cosmetic in nature. The law is also known as "Janet's Law", named for Janet Franquet, a breast cancer patient who fought her insurance carrier with Dr. Todd Wider, a New York plastic surgeon who helped lobby for the legislation with Senator Al D'Amato. The act mandates insurance coverage for the surgery of the affected breast and also the contralateral side for purposes of symmetry.

Techniques

There are many methods for breast reconstruction. The two most common are:

• Tissue Expander - Breast implants This is the most common technique used in worldwide. The surgeon inserts a tissue expander, a temporary silastic implant, beneath a pocket under the pectoralis major and serratus anterior muscles of the chest wall. The pectoral muscles may be released along its inferior edge to allow a larger, more supple pocket for the expander at the expense of thinner lower pole soft tissue coverage. The use of acellular human or animal dermal grafts have been described as an onlay patch to increase coverage of the implant when the pectoral muscle is released, which purports to improve both functional and aesthtic outcomes of implant-expander breast reconstruction. ^{[1] [2]}
  • In a process that can take weeks or months, saline solution is percutaneously injected to progressively expand the overlaying tissue (see tissue expansion). Once the expander has reached an acceptable size, it may be removed and replaced with a more permanent implant. Reconstruction of the areola and nipple are performed in a separate operation after the skin has stretched to its final size.
• Flap reconstruction The second most common procedure uses tissue from other parts of the patient's body, such as the back, buttocks, thigh or abdomen. This procedure may be performed by leaving the donor tissue connected to the original site to retain its blood supply (the vessels are tunnelled beneath the skin surface to the new site) or it may be cut off and new blood supply may be connected.
  • The latissimus dorsi muscle flap is the donor tissue available on the back. It is a large flat muscle which can be employed without significant loss of function. It can be moved into the breast defect still attached to its blood supply under the arm pit (axilla). A latissimus flap is usually used to recruit soft-tissue coverage over an underlying implant. Enough volume can be recruited occasionally to reconstruct small breasts without an implant.
  • Abdominal flaps The abdominal flap for breast reconstruction is the TRAM flap or its technically distinct variants the DIEP/SIEP flaps. Both use the abdominal tissue between the umbilicus and the pubis. The DIEP and free-TRAM flaps require advanced microsurgical technique and are less common as a result. Both can provide enough tissue to reconstruct large breasts. The contour of the lower abdomen is reliably improved by these procedures which remove the same tissue as an abdominoplasty (tummy tuck.) TRAM flap procedures may weaken the abdominal muscles, but are usually tolerated well in most patients. To prevent muscle weakness and incisional hernias, the portion of abdominal wall exposed by reflection of the rectus abdominis muscle may be strengthened by a piece of surgical mesh placed over the defect and sutured in place. The DIEP (deep inferior epigastric perforator flap) and SIEP (superficial inferior epigastric perforator flap) require precise dissection of small perforating vessels through the rectus muscle, and purport the advantage of less weakening of the abdominal wall.

The TRAM Flap Procedure
Identification of the target and donor sites	Raising the flap and transposing it to the target site	The result of the reconstruction

Skin and tissue expander with inflatable baloon device. ... In medicine, saline is a solution of sodium chloride (a substance also commonly known as table salt) in sterile water, used frequently for intravenous infusion, rinsing contact lenses, and nasal irrigation (or the yogic practice called jala neti). ... Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... Skin and tissue expander with inflatable baloon device. ... Cross section of the breast of a human female. ... Typical human female nipple and areola. ... Painting of a womans back by Edgar Degas. ... Bottom commonly refers to the human buttocks but also has other uses. ... In humans the thigh is the area between the pelvis and buttocks and the knee. ... The human abdomen (from the Latin word meaning belly) is the part of the body between the pelvis and the thorax. ... Latissimus dorsi is a large flat muscle located on the back. ... This article or section is in need of attention from an expert on the subject. ... Abdominoplasty or tummy tuck is a cosmetic surgery procedure to reshape and firm the abdomen. ... Rectus abdominis The rectus abdominis muscle is a paired muscle running vertically on each side of the anterior wall of the human abdomen (and in some animals). ... Image File history File links MentorTRAM1. ... Image File history File links MentorTRAM2. ... Image File history File links MentorTRAM3. ...

Other considerations

Nipple reconstruction is usually delayed until after the breast mound reconstruction is completed so that the positioning can be planned precisely. There are several methods of reconstructing the nipple-areolar complex, including:

• Nipple-Areolar Composite Graft (Sharing) - if the contralateral breast has not been reconstructed and the nipple and areolar are sufficiently large, tissue may be harvested and used to recreate the nipple-areolar complex on the reconstructed side.
• Local Tissue Flaps - a nipple may be created by raising a small flap in the target area and producing a raised mound of skin. To create an areola, a circular incision may be made around the new nipple and sutured back again. The nipple and areolar region may then be tattooed to produce a realistic colour match with the contralateral breast.
• Local Tissue Flaps With Use of AlloDerm - as above, a nipple may be created by raising a small flap in the target area and producing a raised mound of skin. AlloDerm (cadaveric dermis) can then be inserted into the core of the new nipple acting like a "strut" which may help maintain the projection of the nipple for a longer period of time. The nipple and areolar region may then be tattooed later.^[3]

One of the challenges in breast reconstruction is to match the reconstructed breast to the mature breast on the other side (often fairly 'ptotic' - droopy.) This often requires a lift (mastopexy), reduction, or augmentation of the other breast. Mastopexy or breast lift surgery refers to a group of elective surgical operations designed to lessen the degree of breast ptosis (the droop of the breasts). ... Breast reduction, or reduction mammoplasty, is a surgical procedure which involves the reduction in the size of breasts by excising fat, skin, and glandular tissue; it may also involve a procedure to counterract drooping of the breasts. ...

Follow-up and Recovery

Recovery from implant-based reconstruction is generally faster than with flap-based reconstructions, but both take at least three to six weeks to recover and both require follow-up surgeries in order to construct a new areola and nipple. All recipients of these operations should refrain from strenuous sports, overhead lifting and sexual activity during the recovery period (three to six weeks). TRAM flap patients can show abdominal muscle weakness on EMG studies, but clinically most patients return to normal activities after recovery. This article is about sexual practices (i. ...

There is little information about upper body exercise post-mastectomy. Issues such as simple mastectomy, mastectomy with reconstruction, mastectomy with lymph node excision and reconstruction all factor into limitations to amount and extent of upper body exercise. Generally, cardiac exercise (treadmill, walking, etc.) are approved for rehabilitation post-surgery and for weight control. Women who have undergone breast reconstruction must still be followed for local or regional recurrence of their cancer with manual exams of the breast/chest wall and axilla.

See also

• Breast reduction
• Breast implant
• Breast lift

Breast reduction, or reduction mammoplasty, is a surgical procedure which involves the reduction in the size of breasts by excising fat, skin, and glandular tissue; it may also involve a procedure to counterract drooping of the breasts. ... A breast implant is a prosthesis used to enlarge the size of a womans breasts (known as breast augmentation, breast enlargement or augmentation mammoplasty) for cosmetic reasons; to reconstruct the breast (e. ... There are very few or no other articles that link to this one. ...

External links

• Breast Reconstruction Following Breast Removal from the American Society of Plastic Surgeons
• In-depth breast reconstruction discussion from the University of Iowa
• National Cancer Institute breast cancer page
• NCI online Breast Cancer Risk Assessment Tool for patients
• Surgery Choices for Women with Early-Stage Breast Cancer