The goal of reconstructive breast surgery is to restore a woman's sense of "wholeness" and self-image following surgery for breast cancer. Frequently, from the time of breast cancer diagnosis, a team treatment approach is used, involving the patient, a primary surgeon, an oncologist, and a plastic surgeon. Of this team, the patient and the primary surgeon are key, as their goal is the successful treatment of the cancer.

The timing and option of breast reconstruction after successful cancer surgery should be discussed with the primary surgeon. Few patients are not candidates. As a result of increasing experience with all reconstructive methods and their beneficial aesthetic and psychologic effects, more and more patients are opting for reconstruction at the time of the initial cancer surgery.

Current popular options in breast reconstruction are: tissue expansion followed by placement of an implant; TRAM flap (abdominal tissue) reconstruction; latissimus dorsi flap (back muscle) reconstruction with or with out an implant; and free tissue transfer from other areas using microsurgery.

Tissue expansion takes advantage of the skin's remarkable stretching capabilities. At the time of surgery, a tissue expander, similar to a balloon, is inserted. Over the course of several weeks, sterile salt water is injected to increase the volume of this balloon and stretch the overlying skin. The expander is removed in a separate operation, and a permanent implant (usually saline) is placed. This technique is dependent upon the quality and quantity of the tissue that will remain, and the postoperative therapy planned, such as chemotherapy or radiation treatment.

The TRAM (transverse rectus abdomins myocutaneous) flap reconstruction involves the transfer of an abdominal muscle (the rectus abdominus) with the skin around and below the umbilicus (belly button), to recreate the breast. This technique has the added advantage of a simultaneous "tummy tuck", and correction of any hernias or abdominal bulging. (see image at right)

Latissimus dorsi flap reconstruction involves the use of an expendable muscle located on the back. It is an especially useful option when there is insufficient tissue for a TRAM flap. In this procedure, the latissimus muscle, with or without skin, is transposed onto the chest to recreate the breast mound. There are several variations of this technique which may or may not require an additional incision on the back, or the placement of a saline implant at the time of reconstruction.

Free tissue transfer involves taking tissue from another area of the body (e.g. the buttocks, thigh or abdomen), detaching the blood supply, and reattaching it to the blood vessels on the chest. It requires the use of an operating microscope, and may be indicated in certain circumstances. These microsurgery techniques may even be applied as an adjunct to the TRAM or latissimus flap procedures mentioned above. Reconstructive methods may require minor adjustments over time. Typically, the nipple is created six weeks after breast reconstruction.

Each patient should discuss the issue of reconstruction with her primary surgeon. Consultation should then be sought with a plastic surgeon to discuss, in detail, all reconstructive methods and the appropriateness of each. No one procedure applies to all patients, and one should be chosen that specifically meets each patient's needs.

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