Breast health

After a mastectomy, and sometimes after a lumpectomy, you may choose to have surgery to rebuild the breast to help restore what was lost to cancer. Although it is not possible to completely recreate a natural breast and not all patients are candidates for every method of reconstruction, your plastic surgeon can give you guidance on your available options.

We offer the full range of breast cancer reconstruction procedures, including some of the newest advances available across the country. All types of reconstruction involve multiple stages, usually a minimum of two surgeries.

In most cases, the first surgery is the biggest, with subsequent surgeries typically performed as outpatient procedures. Many patients will also need nipple and areolar reconstruction, as well as possible adjustment of shape or size before reaching the desired result.

• Breast implants: In some cases, it is possible to place an implant, whether saline or silicone-filled, directly after a mastectomy. However, in most case, it is necessary to first use a tissue expander. The tissue expander is essentially an “empty” implant which can be gradually filled with saline over the course of weeks or months to help stretch the skin in the breast area to the desired size. Once this is achieved, the tissue expander is replaced with an implant. Implant reconstruction allows greater control of the final breast size and typically involves less recovery time than some other methods.
• Latissimus flaps: Latissimus flap reconstruction involves using skin and muscle from the back—in the region over the shoulder blade—and rotating it around to the breast area. This is almost always done in conjunction with a tissue expander or implant to provide additional coverage.
• TRAM (transverse rectus abdominis muscle) flap: The TRAM flap is a reconstruction using tissue from the abdominal area to create a breast, usually without any need for implants. This allows an all-natural-tissue reconstruction but may have some negative impact on the abdominal muscle, which could weaken them or result in the development of hernias. The recovery time from this surgery is typically longer but may be more beneficial for patients who are having radiation.
• DIEP (deep inferior epigastric perforators)/SIEA (superficial inferior epigastric artery) flaps: The DIEP/SIEA flap reconstruction uses tissue from the abdominal area to create a breast, providing an all-natural-tissue reconstruction with reduced risk of abdominal muscle weakness and hernias. Most patients experience less discomfort and a shorter recovery than with a TRAM flap because this is done with a complex microsurgical technique. A Medical City Dallas Breast Center surgeon was the first to bring this new procedure to North Texas. Only a handful of surgeons in the U.S. perform this newer type of reconstruction surgery.

Reconstruction can be done at the same time as the mastectomy, in some cases, or at a later date. There is generally no limit to how long after a mastectomy you may undergo reconstruction. The decision of timing is based on a combination of factors which your doctor can discuss with you. At all times, your cancer treatment is our first priority, and the reconstruction can be timed around it as needed.