Twenty-three percent of women know the wide range of breast reconstruction options available, according to the American Association of Plastic Surgeons. In a follow-up to her article on timing of breast reconstruction surgery, Plastic Surgeon Dr. Kathleen M. Meyer, discusses breast reconstruction options.

What are the basic options for breast reconstruction?

Main choices are between using your own tissue or using implants for reconstruction. Many patients have a strong preference. Factors may make one option a better choice or help you exclude an option. Some patients are so thin there is not enough of their own tissue to reconstruct the breast from their own tissue. A combination of the patient’s own tissue plus an implant could be best.

What is a TRAM?

Transverse Rectus Abdominus Myocutaneous (TRAM) involves using lower-tummy tissue (including muscle) to make a new breast. Doctors bring tummy tissue to the mastectomy site under nearby skin to make a new breast. Some describe it as getting a “tummy tuck” and using that skin to make a breast.

The area where muscle is taken from needs to be repaired, often with mesh to try to prevent a bulge in the tummy.

What are SIEP and DIEP flaps?

Superficial and Deep Inferior epigastric arteries can supply reliable skin and fat to move to the breast position. Using microsurgical techniques, surgeons can restore circulation to tissue by connecting arteries and veins to others in the chest area. Depending on the patient’s anatomy, one may entirely spare muscle or limit the amount of muscle needed for breast reconstruction.

What is the Lattissimus Dorsi flap?

The Latissimus Dorsi (LD flap) is a large muscle on your back that can be used with or without skin from the back to help with breast reconstruction. Unless the breast is very small, an implant is usually used with the Latissimus Dorsi flap for breast reconstruction.

What is a tissue matrix (like Alloderm)?

Tissue matrix is usually formed from a living being but processed to remove all cells. It provides a framework for the patient’s blood vessels to grow into and become the patient’s own live tissue. This has been helpful in breast reconstruction.

What are my choices for permanent implants?

Two choices are saline-filled and silicone-gel filled implants. Both are FDA approved. Each has advantages and disadvantages. Your surgeon can help you choose from among types of implants.

What is a tissue expander?

A tissue expander is a temporary breast implant filled over time to bring the breast size and shape safely to the right size and shape for the permanent implant. The implant is usually filled through injection with a needle into a port underneath the skin that may be part of the implant.

Why are some results better than others?

Many factors affect breast appearance after reconstruction. Some breast shapes are easier to reconstruct than others. Other factors include whether you received radiation treatment or lymph dissection, and whether your surgeon can spare the skin and sometimes the nipple.  All can affect reconstruction outcome.

All women have different skin and tissue characteristics. Your age and how you scar can change your appearance. All of these factors and more affect how the breasts will look after surgery.