Within the breast reconstruction program at Memorial Health, skilled surgeons rebuild natural-looking breast mounds that closely match the form, size and symmetry of the natural breast. Most women are candidates for breast reconstruction surgery after a mastectomy. Factors that may impact reconstruction include:
- The size and location of the cancer, which impacts the amount of tissue that must be removed with the breast
- Issues related to a previous surgery, radiation therapy or other conditions
- Other health concerns such as heart disease, diabetes, smoking or obesity
Types of breast reconstruction
There are two ways for surgeons to create a natural-looking breast mound:
An expander is an empty silicone pocket placed beneath the pectoral muscle. It is gradually filled with saline solution over a period of several weeks. This allows the skin to expand and grow naturally. Later, an implant filled with saline or silicone gel is inserted into the space created by the expander.
Autologous/natural tissue reconstruction
This involves using the woman's own tissue to construct a new breast mound. At Memorial Health, we offer the following types of autologous tissue reconstruction.
TRAM (abdominal) flap
In this procedure, surgeons create a transverse rectus abdominous muscle (TRAM) flap by removing fat, skin and muscle from the abdomen. The TRAM flap is tunneled under the skin and up to chest wall to create a breast mound.
Latissimus dorsi (back) flap
This is similar to the TRAM procedure, except that the fat, skin and muscle are tunneled in from the upper back instead of the abdomen.
DIEP flap microvascular surgery
The deep inferior epigastric perforator (DIEP) flap also removes the patient's own skin, tissue and feeding blood vessels from the lower abdomen, but it does not cut the abdominal muscle. The tissue, with its working blood vessels, is reattached to recipient vessels at the mastectomy site by means of a high-definition microscope. Because working blood vessels are reattached, the breast mound has a constant supply of blood. The DIEP flap typically requires a longer surgery and hospital stay, but preserves abdominal muscle function, which results in less pain after surgery.
SPY technology for breast reconstruction
Memorial Health was the first in Savannah to offer state-of-the-art SPY technology for breast reconstruction. The SPY imaging system lets surgeons see actual blood flow between the abdominal flap and the breast skin flaps.
During reconstruction surgery, surgeons inject a safe fluorescent dye into the body. A laser within the SPY system follows the dye and sends the surgeon high-quality video images of blood flow within vessels, micro-vessels, tissue and organs. The images appear within minutes and in real-time. This allows surgeons to ensure a healthy blood flow to the breast mound and precisely reattach blood vessels and the breast skin flaps.
Possible complications of breast reconstruction surgery
Every surgical procedure carries some risk. Your doctor will discuss all of the risks with you. Complications that may occur after breast reconstruction include:
- Fluid collection
- Excessive scar tissue
- Anesthesia problems
- Circulatory problems with the flap
- Capsular contracture if the scar or capsule around an implant begins to tighten
Preparing for breast reconstruction
Before your surgery, your physician's office or a representative from Memorial Health will contact you for a pre-surgery interview. You will speak with a registered nurse about your medical history, receive information about your procedure, receive your pre-surgery instructions and be encouraged to ask questions. This is in addition to working with the breast care nurse navigator who will assist you throughout your treatment.
Your procedure will require a hospital stay of one to three days. After surgery, it is very important to follow your doctor's orders regarding rest, pain management, drain care and wound care.