Breast Cancer

Lesson 4: Breast Reconstruction & Prosthesis

Flaps

The other type of breast reconstruction uses your own body tissue. There are two variations of this procedure: the pedicle flap and the free flap. The pedicle flap uses part of your own muscle, such as the back (latissimus), stomach (rectus) or butt (gluteus). The tissue is removed, but the artery and vein is left intact. The area is sewn shut. The tissue is tunneled under the skin to the mastectomy area. This has the advantage of the blood supply staying viable. The most recent variation on this is the free flap. In this procedure, the artery and vein are cut and moved, along with the tissue, to the new location and reattached during microscopic surgery. The pedicle flap is a simpler operation and more plastic surgeons are skilled in this procedure. The disadvantage is that you can only use tissue that will reach to the breast area. The recovery time is much longer and you will weaken muscles invaded in the process (i.e. stomach muscles). With the free flap, the surgeon must be an expert, but the complications are generally not as encompassing. An advantage to using the rectus muscle (TRAM flap) is a free tummy tuck.

NOTE: There are textbook drawings to give you an idea of where the tissue comes from and actual photos of a woman with a mastectomy, both pre and post-reconstruction.

Not every woman will be offered all of the above options. In my case, I was offered implants. A TRAM flap was ruled out due to previous abdominal surgeries (a tubal ligation and a Caesarian section). My plastic surgeon suggested that we "redo" my remaining breast also, since he felt I was beginning to sag. (Imagine adding insult to injury – size 34A breasts – not only did I have to lose one, but the right breast was now losing its tone according to the good doctor!)

Many women love their newly constructed breast(s) and feel the additional time in the operating room and the discomfort during recovery are well worth the fact that they never have to worry about viewing mastectomy scars or worrying about how clothes will look on their new body. It should be noted that regardless of how gorgeous your new breasts are, they would not have any sensation of their own. Also, after your breast reconstruction you will have to make one more decision – to have new nipples constructed or not. Some women choose to have nipples formed; others have new nipples tattooed on; still others are happy to have new breasts sans nipples. The choice is yours. Whatever you decide, make sure it is the right decision for you, and made, primarily, by you. The doctors, your spouse, children, relatives and friends can offer suggestions and support, but it is ultimately your decision. It is your body. Please make sure that you are comfortable with your plastic surgeon. Make sure he does reconstructive surgery. Ask to see photos of his patients "before" and "after". Weigh the options and make an intelligent decision, based on your needs and desires. And then, the sky’s the limit – be it Audrey Hepburn or Dolly Parton – you get to choose the new you – make the most of it!

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