Breast Reconstruction

Published on 11/04/2015 by admin

Filed under Surgery

Last modified 11/04/2015

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 1124 times

CHAPTER 22 Breast Reconstruction


Breast reconstruction has become an essential component of the care of women with breast cancer. The goals of modern breast reconstruction are to recreate a natural-appearing breast mound that matches the opposite breast in size, contour, and degree of ptosis (i.e., droopiness). This chapter discusses a variety of alloplastic (implant-based) and autologous techniques for breast reconstruction after mastectomy.

Autologous reconstruction is defined as any form of breast reconstruction that uses a patient’s own tissues to recreate the breast mound. A variety of donor sites can be used for autologous breast reconstruction, including the lower abdomen, buttocks, and back. Alloplastic reconstruction refers to any form of breast reconstruction in which an implant is used. Implant-based reconstruction is typically performed in stages. The first stage involves placement of an inflatable tissue expander that permits the recruitment of additional skin and soft tissue. Subsequently, the expander is replaced with a permanent prosthesis.

Delayed breast reconstruction is defined as reconstruction that occurs after a patient has undergone a mastectomy. Delayed breast reconstruction is most commonly performed for patients who require postoperative radiation therapy. Immediate breast reconstruction, on the other hand, refers to any reconstruction that begins at the time of mastectomy.


There are various techniques for reconstructing the breast mound after mastectomy. The most common procedures involve using either autologous tissues (e.g., transverse rectus abdominis myocutaneous [TRAM] flap), tissue expander placement followed by a silicone gel prosthetic implantation, or some combination of the two (e.g., latissimus dorsi flap with implant).

Skin-Sparing Mastectomy

Mastectomy techniques have a significant effect on the outcome of autologous breast reconstruction. Since 1996, the skin-sparing mastectomy has been increasingly used in conjunction with immediate autologous breast reconstruction. A skin-sparing mastectomy is typically performed with a periareolar incision and is so named because the skin envelope of the breast is kept intact during the procedure (Fig. 22-1). Thus, the reconstructive surgeon must simply replace the volume of the mastectomy specimen with either autologous tissue or an implant. This approach avoids the challenges associated with shaping the breast during traditional delayed reconstruction.

Buy Membership for Surgery Category to continue reading. Learn more here