Advances in Breast Reconstruction – Breast Cancer Awareness Month

Advances in Breast Reconstruction – Breast Cancer Awareness Month

Oren Lerman, M.D.

As October comes to an end and breast cancer awareness month wraps up it is a great time to learn about the latest advances in breast reconstruction.  Breast reconstruction awareness day or ‘BRA day’ carves out one day in October to highlight all of the options available to woman who have been or will be treated for breast cancer.  Whether or not they have had total or partial mastectomy, lumpectomy, radiation, previous reconstruction or no reconstruction, the latest techniques for breast reconstruction go far beyond those used in the past to create a more natural aesthetic result and restore one’s self to look and feel as good as possible. 

Mastectomy Reconstruction

The options for reconstruction after mastectomy usually fall into one of two categories: Reconstruction with breast implants or with natural tissue 

Natural Tissue Reconstruction (Autologous Reconstruction) has advanced dramatically over the past few years. The DIEP flap allows for excess fat from the abdomen to be transplanted to create a breast without cutting the abdominal wall muscle as was done in the old fashion technique called a TRAM flap. This allows for a faster less painful recovery with a less invasive procedure that has less risk of abdominal wall weakness or hernia. Woman can now have this surgery and expect to be home from the hospital in as little as 2 days and back to their normal activities in 4 weeks. This is the most advanced form of breast reconstruction and achieves a result that looks, feels and moves like a natural breast. Most importantly the result lasts a lifetime because it is your own tissue and unlike breast implants, it feels and looks better with time. Because the DIEP flap transfers extra fat and skin from the lower belly, the result is similar to a tummy tuck and therefore patients can expect an overall improved waistline in addition to a natural appearing breast that often looks better than before surgery. 

The PAP Flap from the upper leg or posterior thighs is an option for natural tissue reconstruction that has largely replaced the GAP flap from the buttocks in patients’ who are too thin to perform the DIEP flap. It has many of the same advantages of the DIEP flap but is often smaller than the DIEP flap and the donor site scar while usually hidden well in the buttock crease but can sometimes be less desirable than the tummy tuck scar of the DIEP flap.  

The latest trend in Implant Reconstruction is PrePectoral (in front of the muscle) Reconstruction. For over 3 decades breast implant reconstruction was typically performed by placing the implant or tissue expander beneath the muscle of the chest wall. This allowed for greater soft tissue coverage of the implant in order to reduce complications. The long term downside to submuscular placement however, is visible muscle movement or “animation deformity” on the breast which can be unsightly, additionally, the submuscular placement can be uncomfortable producing a feeling of tightness that can be greatly exacerbated by scar tissue around the implant called capsule contracture. The severity of this capsule of scar tissue formation can vary amongst woman but high grade capsule contracture can lead to a painful deformed breast and the submuscular placement can be extremely uncomfortable. The latest technique in implant reconstruction places the implant above the muscle in the “PrePectoral“ space and reinforces the implant with  Acellular Dermal Matrix a form of biologic mesh instead of the muscle. This technique is less invasive than the submuscular procedure and therefore has a shorter recovery and less pain. The long term benefit is no animation deformity and less tightness on the chest wall. The downside is less soft tissue camouflage of the breast implant which often requires fat grafting to correct.  

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