IMMEDIATE OR DELAYED RECONSTRUCTION:
Immediate Reconstruction: The reconstruction process is started at the same time as the mastectomy.
Delayed Reconstruction: Mastectomy is performed first and after several weeks or months of healing then reconstruction is performed. Most patients require more than 1 surgery to complete their reconstruction process regardless of whether it is performed as immediate or delayed.
BREAST IMPLANTS OR NATURAL TISSUE:
Breast implants: Silicone or saline implants are used during a breast reconstruction to restore the volume of the breast.
Natural Tissue: Excess fat, muscle, blood vessels and skin can be used to recreate a breast.
TISSUE EXPANDER OR DIRECT TO IMPLANT
Tissue expander: A temporary implant device is used to expand the breast skin following a mastectomy. The expander is replaced by a permanent silicone or saline implant. The majority of women undergoing breast reconstruction have this procedure.
Direct to implant: Permanent silicone or saline implant is placed at the time of mastectomy and the expansion process is avoided. This is only possible in women with sufficient skin after mastectomy and is most commonly performed after a prophylactic mastectomy.
TRAM Flap: A natural tissue reconstruction where fat and skin from the lower tummy along with abdominal muscles are used to create the breast.
DIEP Flap: A natural tissue reconstruction where fat and skin from the lower tummy are used to make a breast. Unlike the TRAM flap, the DIEP flap spares all abdominal muscles
SIEA Flap: A natural tissue reconstruction where fat and skin from the lower tummy are used to make a breast. This procedure also spares all abdominal muscles, but is not always an available options due to the location of the blood vessels needed to transplant the tissue.
Latissimus Flap: A section of skin, fat and muscle is lifted off the back from below the shoulder blade region. This tissue is then tunneled to the front of the chest to create the new breast. The patient is then turned onto her back to complete the shaping of the new breast. The LAT flap is also sometimes combined with implant reconstruction to achieve desired breast size.
Thigh Flaps: Skin, fat and sometimes muscle from the thigh region can be used to reconstruct a breast after mastectomy. Tissue can be used from a variety of areas:
TUG/VUG flap: tissue from the inner upper thigh is used
PAP flap: tissue from the upper posterior thigh below the buttock crease is used
LTP flap: tissue from the top outer thigh is used.
ALT flap: tissue from the front outer thigh is used
Buttock Flaps: Skin and fat from the upper or lower buttock area can be used to reconstruct a breast. Depending on the location of the tissue, the procedure is referred to as iGAP (lower buttock region) or sGAP (upper buttock region).
TYPE OF IMPLANTS:
Saline: Silicone shell filled with sterile salt water during surgery.
Silicone: Silicone shell prefilled with silicone gel. FDA approved since2006.
Gihcome Shaped: aka gummy bears implants. Silicone shell prefilled with a more highly cohesive silicone gel.
FREE TRAM FLAP OR PEDICLED TRAM
Free TRAM: The muscle, fat, etc. is entirely removed from the abdomen and placed in the breast area, so the blood vessels must be re-attached.
Pedicled Tram: The flap stays connected to its original blood supply and is brought up through the abdomen leading to a shorter surgical time.
Fat grafting: Fat is liposuctioned from one part of the patient’s body, purified and then injected into the breast.
Flat closure: The decision to not reconstruct breast after a mastectomy.