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Breast Reconstruction

A hard voyage, if you are going through this or just found out you have Breast Cancer its very scary. There are many choices, hard ones also my mind saying over and over  "I don't know what to do". I found that Doctors are reluctant to say as they have had complaints at the end result. 

Here are some of the choices:


Latissimus dorsi flap

The latissimus dorsi flap moves muscle and skin from your upper back when extra tissue is needed. The flap is made up of skin, fat, muscle, and blood vessels. It is tunneled under the skin to the front of the chest. This creates a pocket for an implant, which can be used for added fullness to the reconstructed breast. Though it is not common, some women may have weakness in their back, shoulder, or arm after this surgery.
Diagrams of latissimus dorsi flap. First diagram shows skin used for flap and latissimus dorsi muscle on back. Second diagram shows breast implant under muscles, latissimus dorsi flap in place on breast, and closed incision on back.

    TRAM (transverse rectus abdominis muscle) flap

    The TRAM flap procedure uses tissue and muscle from the tummy (the lower abdominal wall). The tissue from this area alone is often enough to shape the breast, and an implant may not be needed. The skin, fat, blood vessels, and at least one abdominal muscle are moved from the belly (abdomen) to the chest. The TRAM flap can decrease the strength in your belly, and may not be possible in women who have had abdominal tissue removed in previous surgeries. The procedure also results in a tightening of the lower belly, or a "tummy tuck."
    There are 2 types of TRAM flaps:
    • A pedicle flap leaves the flap attached to its original blood supply and tunnels it under the skin to the breast area.
    • In a free flap, the surgeon cuts the flap of skin, fat, blood vessels, and muscle for the implant free from its original location and then attaches it to blood vessels in the chest. This requires the use of a microscope (microsurgery) to connect the tiny vessels and takes longer than a pedicle flap. The free flap is not done as often as the pedicle flap, but some doctors think that it can result in a more natural shape.
    Two diagrams showing TRAM flap incisions. First diagram shows muscle used; skin and fatty tissue for flap taken from abdomen. Second diagram shows transplanted skin, fat, and muscle for reconstructed breast; closed abdominal incision.Diagram detailing the tissue used to rebuild the breast shape: blood vessels, muscle, skin, and fat.
      TRAM flap incisions The tissue used to rebuild the breast shape



    Implant procedures

    The most common implant is a saline-filled implant. It is a silicone shell filled with salt water (sterile saline). Silicone gel-filled implants are another option for breast reconstruction. They are not used as often as they were in the past because of concerns that silicone leakage might cause immune system diseases. But most of the recent studies show that silicone implants do not increase the risk of immune system problems. Also, alternative breast implants that have different shells and are filled with different materials are being studied, but you can only get them in clinical trials.
    One-stage immediate breast reconstruction may be done at the same time as mastectomy. After the general surgeon removes the breast tissue, a plastic surgeon places a breast implant where the breast tissue was removed to form the breast contour.
    Two-stage reconstruction or two-stage delayed reconstruction is done if your skin and chest wall tissues are tight and flat. An implanted tissue expander, which is like a balloon, is put under the skin and chest muscle. Through a tiny valve under the skin, the surgeon injects a salt-water solution at regular intervals to fill the expander over time (about 4 to 6 months). After the skin over the breast area has stretched enough, a second surgery is done to remove the expander and put in the permanent implant. Some expanders are left in place as the final implant.
    The two-stage reconstruction is sometimes called delayed-immediate reconstruction because it allows options. If the surgical biopsies show that radiation is needed, the next steps may be delayed until after radiation treatment is complete. If radiation is not needed, the surgeon can start right away with the tissue expander and second surgery.
    There are some important factors for you to keep in mind if you are thinking about having implants:
    • Implants may not last a lifetime. You may need more surgery to replace them later.
    • You can have problems with breast implants. They can break (rupture) or cause infection or pain. Scar tissue may form around the implant (capsular contracture), or you may not like the way the implant look.
    I just wanted to share this with you. I found it's best to talk to people that have been through these. Breast Cancer woman are amazing, they will show you or tell you what mistakes they think they have made. Not that there is mistakes, but its a personal choice so not all options work for you. Research and make sure you are happy with your choice after all it is your body.......


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