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| Natural Reconstruction |
| The breast can be reconstructed
by surgically moving a section of skin, fat
and muscle from one area of your body to
another. The section of tissue may be taken
from such areas as your abdomen, upper back,
upper hip, or buttocks. The tissue flap may
be left attached to the blood supply and
moved to the breast area through a tunnel
under the skin (a pedicled flap), or it may
be removed completely and reattached to the
breast area by microsurgical techniques (a
free flap). Operating time is generally longer
with free flaps, because of the microsurgical
requirements. |
The transported tissue
forms a flap for a breast implant, or it
may provide enough bulk to form the breast
mound without an implant. |
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| The TRAM Flap
(Pedicle or Free) |
The most common types
of tissue flaps are the TRAM (transverse
rectus abdominus musculocutaneous flap) (which
uses tissue from the abdomen)It is important
for you to be aware that flap surgery, particularly
the TRAM flap, is a major operation, and
more extensive than your mastectomy operation.
It requires good general health and strong
emotional motivation. If you are very overweight,
smoke cigarettes, have had previous surgery
at the flap site, or have any circulatory
problems, you may not be a good candidate
for a tissue flap procedure. Also, if you
are very thin, you may not have enough tissue
in your abdomen or back to create a breast
mound with this method.
Flap surgery requires a hospital stay of
several days and generally a longer recovery
time than breast implant reconstruction.
A pedicle TRAM flap procedure
typically takes three to six hours of surgery under general anesthesia; a free
TRAM flap procedure generally takes longer.
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Tissue
may be taken from the abdomen and tunneled
to the breast or surgically transplanted
to form a new breast mound |
The TRAM procedure may require a blood transfusion.
Flap surgery also creates scars at the site
where the flap was taken and on the reconstructed
breast. However, flap surgery has the advantage
of being able to replace tissue in the chest
area. This may be useful when the chest tissues
have been damaged and are not suitable for
tissue expansion. Another advantage of flap
procedures over implantation is that alteration
of the unaffected breast is generally not
needed to improve symmetry.
During a TRAM flap procedure, the surgeon
removes a section of tissue from your abdomen
and moves it to your chest to reconstruct
the breast. The TRAM flap is sometimes referred
to as a "tummy tuck" reconstruction,
because it may leave the stomach area flatter. |
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| Typically, the hospital
stay is two to five days. You can resume
normal daily activity after six to eight
weeks. Some women, however, report that it
takes up to one year to resume a normal lifestyle.
You may have temporary or permanent muscle
weakness in the abdominal area. If you are
considering pregnancy after your reconstruction,
you should discuss this with your surgeon.
You will have a large scar on your abdomen
and may also have additional scars on your
reconstructed breast. |
Scars at the breast,
nipple, and abdomen will fade substantially
with time, but may never disappear entirely. |
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| The
Latissimus Dorsi Flap With or Without Breast Implants |
During
a Latissimus Dorsi flap procedure, the surgeon
moves a section of tissue from your back
to your chest to reconstruct the breast.
Because the Latissimus Dorsi flap is usually
thinner and smaller than the TRAM flap, this
procedure may be more appropriate for reconstructing
a smaller breast.
The Latissimus Dorsi flap procedure typically
takes two to four hours of surgery under
general anesthesia. Typically, the hospital
stay is two to three days. You can resume
daily activity after two to three weeks.
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With flap surgery, tissue is taken from the back and tunneled to
the front of the chest wall to support the reconstructed breast. |
You
may have some temporary or permanent muscle
weakness and difficulty with movement in your
back and shoulder. You will have a scar on
your back, which can usually be hidden in the
bra line. You may also have additional scars
on your reconstructed breast. Whether or not
you have breast reconstruction with or without
breast implants, you will probably undergo
additional surgeries to improve symmetry and
appearance. For example, because the nipple
and areola are usually removed with the breast
tissue in mastectomy, the nipple is usually
reconstructed by using a skin graft from another
area of the body or the opposite breast, in
addition to tattooing the area. Nipple reconstruction
is usually done as a separate outpatient procedure
after the initial reconstruction surgery is
complete. |
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