Surgeons at NYU Langone’s Perlmutter Cancer Center offer an array of approaches to reconstruct the breast after mastectomy. When necessary, some reconstructive techniques can be used after breast-conserving surgery.
Our doctors most frequently use silicone-filled breast implants to replace breast tissue removed during a mastectomy. To perform this procedure, the plastic surgeon needs a certain amount of skin surrounding the breast in order to place the implant and reconstruct the breast.
Sometimes reconstruction can be performed in one step. This is called direct implant reconstruction. During this procedure, implants are inserted immediately after the mastectomy. This can only occur if there’s enough skin remaining and enough space can be created under the chest wall muscles. Doctors usually use an acellular dermal matrix, a biologic material that acts as support for the implant.
More commonly, our doctors use a two-step process called tissue expansion. During the mastectomy, the plastic surgeon inserts a tissue expander, a device that is placed underneath the skin and chest wall muscle and inflated over a period of several months to stretch the tissue.
After the expander is fully inflated, surgeons exchange it for a permanent implant. Doctors can reconstruct the nipple and areola at this time or, more often, during a separate surgery at a later date.
Completing the implant procedure during a mastectomy does not increase the length of the hospital stay. If it is done in two steps, the initial surgery may require a stay of one or two days. Follow-up procedures are done on an outpatient basis.
Women may also opt to have reconstruction after they have fully healed from the mastectomy. This is called delayed reconstruction.
Tissue Flap Reconstruction
In a tissue flap reconstruction, plastic surgeons use tissue from another part of the body to reconstruct the breast. The flap ideally contains skin and fat with a “feeding” blood vessel that supplies the tissue with blood and nutrients. This blood vessel is called a perforator. This tissue replaces the tissue removed during the mastectomy.
Occasionally, some muscle also needs to be included in the flap to ensure that it has a healthy blood supply. Doctors typically take flap tissue from the abdomen. This procedure is called a deep inferior epigastric perforator, or DIEP flap. If abdominal tissue is not an option, tissue may be taken from the thighs or buttocks.
Surgeons at Perlmutter Cancer Center use microsurgery, in which tiny surgical tools and a microscope are used to carefully connect the flap blood vessels to blood vessels in the chest. Imaging scans of the flap donor site help our plastic surgeons view the anatomy of the perforators. This allows for a more precise and shorter surgery.
Another option is to take a flap from the back, moving the tissue to the chest but retaining the original blood supply. This is known as a pedicled flap. Microsurgery is not required because the tissue is still connected to its feeding blood vessels.
The back does not usually have enough tissue for total breast reconstruction. An implant is usually required to replace the missing volume of the breast.
During breast reconstruction, the healthy breast is often shaped with a breast lift, breast reduction, or breast implant so that both breasts look similar. If a nipple-sparing mastectomy is not an option, doctors can reconstruct the nipple and areola using a variety of techniques.
Flap procedures can increase the hospital stay after mastectomy by several days, depending on the type of reconstructive surgery you choose. During this time, doctors monitor you and help manage any pain. Additional surgical procedures to help the breasts look the same or to reconstruct the nipple and areola are done at a later date.
Although tissue flap reconstruction results in breasts that look and move naturally, the procedure is more complex and can require additional healing time. Your breast surgeon and plastic surgeon can discuss which type of reconstruction is best for you.
Options After Breast-Conserving Surgery
The appearance of the breast after breast-conserving surgery depends on how much tissue the surgeon needed to remove and the location and size of the cancer. Radiation therapy can also cause changes in the appearance of the breast.
Perlmutter Cancer Center plastic surgeons offer several options to improve the appearance of the breast after breast-conserving surgery. Doctors can remove fat from the lower part of the abdomen or inner thighs and inject it into breast tissue, helping to reshape the breasts. Flap tissue can also be used to fill in missing breast tissue. Occasionally, breast implants are used to achieve symmetry. These are often outpatient procedures.
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