Breast Reconstruction Options

There is some encouraging news when it comes to breast cancer: You have reconstructive options. Surgical oncologists in the Sutter Health network specialize in the latest breast reconstruction techniques—which they can perform at the same time as your mastectomy or lumpectomy, or at a later date of your choosing.

If you decide you want reconstruction, your breast surgeon will work closely with highly-trained plastic surgery colleagues who can use your own tissue (called autologous reconstruction) or implants to reconstruct your breasts. More good news: Insurance plans that cover mastectomy typically cover these procedures, too.

Of course, you may forgo reconstruction—it’s your choice. We’re here to provide information and to support your decision.

Artistry in Breast Reconstruction

It’s not enough to simply create a breast mound that looks acceptable in a bra. Our goal is to create a beautiful and natural-looking breast. Your care team will carefully weigh your personal wishes and needs to help you choose the most appropriate procedure. When suitable, surgical oncologists in the Sutter Health network offer:

• Skin-sparing Mastectomy — Removes breast tissue but leaves most of the breast skin.
• Nipple-sparing Mastectomy — Saves the breast skin plus the nipple and areola.

Microsurgical Reconstruction

Microsurgery, surgery performed under an operating microscope, uses very fine instruments and sutures to transfer your body’s natural tissue (called a “flap”) and its artery and vein(s) to the breast area, where the blood vessels are reattached.

We offer several microsurgical breast reconstruction procedures, including:

• Free TRAM Flap —The free Transverse Rectus Abdominis Myocutaneous flap procedure transfers skin tissue, fat tissue and rectus abdominis muscle from your lower abdomen to your chest. This muscle removal typically results in a weaker abdomen; fortunately, new microsurgical options avoid removing any abdominal muscle, which also means less pain and a shorter recovery time.
• DIEP Flap—The Deep Inferior Epigastric Artery Perforator flap, named for the blood vessel that supplies the lower abdomen, is the most common microsurgical breast reconstruction option. It excludes any muscle and can look and feel almost exactly like breast tissue. It’s also a good choice if you’ve had chest radiation therapy because it provides a new and robust blood supply. The reconstruction is permanent, soft and reliable and typically lasts for the rest of your life—an advantage over implants. You also get the bonus of a tightened tummy.
• SIEA Flap—This utilizes the exact same tissue as the DIEP flap; but because the Superficial Inferior Epigastric Artery is superficial rather than deep, advantages include a shorter operating time, little abdominal discomfort after surgery and significantly less recovery time. The catch: Only about 30 percent of people have an SIEA vessel that can be reconnected with microsurgery, and your surgeon can’t discover it ahead of time.

Reliable Implants

If you prefer implants, you and your doctor typically can choose from two approaches. Single-stage reconstruction involves putting the permanent implant in place at the time of the mastectomy. This is not widely used because it has a higher complication rate and requires the implant to be put on top of the muscle. The more popular approach is to place a temporary tissue expander either during the mastectomy or any time afterward, and then add fluid to the expander every week or two to slowly stretch the muscle and skin in preparation for the permanent implant. The permanent implant is inserted during a second surgery.
Some women also opt to do fat grafting to help shape the reconstructed breast. Fat is removed from various parts of the body using a liposuction technique and then injected under the skin of the reconstructed breast. This helps improve the soft tissue envelope and the size and shape of the breast.