If a patient plans to have a mastectomy or a lumpectomy for breast cancer, they should consult a plastic surgeon to discuss reconstructive options. Understanding the techniques available may help the patient decide how to treat their cancer.
Breast reconstruction can be:
- Performed immediately, at the time of the mastectomy.
- Delayed after the mastectomy, or for correction of a deformity after a lumpectomy.
Breast reconstruction can be done using the following:
- Breast implants filled with saline or silicone.
- Skin, muscle and fat from the patient’s own body.
- A combination of these methods.
Plastic and reconstructive surgeons at Northwell Health are trained to perform state-of-the-art breast reconstruction including:
- Immediate reconstruction with skin-sparing or nipple-sparing mastectomy with implants or autologous tissue — that is, from the patient's body, rather than from a donor's —when certain conditions exist.
- Immediate or delayed staged reconstruction with tissue expanders followed by implant placement.
- Immediate or delayed reconstruction with autologous tissue.
Not all patients are candidates for all procedures. Factors that may influence a patient's options include other medical problems, previous surgical procedures, a history of radiation or need for radiation, a history of smoking and body habitus (physique or body type). Timing of these procedures may be affected by adjuvant therapies such as chemotherapy or radiation therapy. It is important to consult with a plastic surgeon to review options. Breast reconstruction options can include:
Autologous tissue flap
Skin, fat and muscle from a site on the body are transferred onto the chest to create a new breast. Tissue can be transferred while still attached or microsurgically transplanted to create the new breast. Skin and fat can be transferred from the abdomen (DIEP flap), back, thighs or buttock.
In some cases, immediate reconstruction can be performed with immediate placement of a breast implant. In other cases, a tissue expander may need to be placed to stretch the skin on the chest for a staged reconstruction with a breast implant. Newer implants are shaped better and feel better than previous implants.
Fat grafting is a technique that can correct minor deformities which may exist after a breast reconstruction.
This technique preserves most of the breast skin and in some instances the nipple may be preserved. This technique is only possible for smaller breasts and very early stages of breast cancer or for prophylactic mastectomy. Either autologous reconstruction or implant reconstruction is possible in some cases.
These techniques can also be applied if a patient has a deformity after a lumpectomy.