The decision for microvascular breast reconstruction is complex, and greatly depends on effective communication between the patient, the oncologic surgeon, the plastic surgeon, and the referring primary care physician or oncologist.
There are multiple options for breast reconstruction. The simplest nonsurgical solution after mastectomy has always been a breast prosthesis. However, these can get uncomfortable and sometimes burdensome to patients desiring a more permanent, natural solution.
Tissue expanders followed by permanent implants are the next option. They require a staged procedure in which a silicone expander is gradually inflated in the office over 4 to 6 weeks and then replaced in a second operative stage with a permanent saline or silicone gel implant. Tissue expanders are not indicated in an irradiated mastectomy patient as these are prone to extrusion and infection with a less than optimal cosmetic result.
There are many surgical options that involve a “flap”, that, is a piece of tissue attached to skin that may include underlying muscle. It is detached from its blood supply and moved and reconnected to another area. In this case, it is moved to the mastectomy site. Common flaps include the latissimus dorsi (from the back) and the abdomen (often called a TRAM). The disadvantages include lengthy procedure time and an arduous recovery period. The advantages are this is more ideal for irradiated patients and the patient is rewarded with a soft, natural breast that is completely from their own tissue.
Patients must find a surgeon that routinely performs these flaps with a significant degree of success.
A team approach involving two trained microsurgeons, the oncologic surgeon, and the oncologist is critical to providing the best results. Patients should seek out surgeons with additional experience in microvascular and flap surgery.
A successful breast reconstruction is enormously gratifying for everyone involved. Dr. Lakshman is a board-certified plastic surgeon with an accredited fellowship in microvascular surgery and with a high percentage of successful reconstructive breast cancer surgeries. He is honored to help women through this challenging time and is proud to note that his own mother is a breast cancer survivor.
To learn more about how breast reconstruction surgery could help you, please call our office at 626.683.9080 today.
Includes excerpts from a published article entitled “Microvascular Breast Reconstruction After Cancer” in Huntington Insights, November 2008