Tissue Expander and implant-Based Reconstruction
A common breast reconstructive technique is tissue expansion, which involves expansion of the breast skin and muscle using a temporary tissue expander. A breast tissue expander is an inflatable breast implant designed to save the unique breast skin and stretch the skin and muscle to make room for a breast mount. During the initial step, a tissue expander is placed following a mastectomy. Through a tiny valve mechanism located inside the expander, the doctor periodically injects a salt-water solution to gradually fill the expander over several weeks. You may feel a sensation of stretching and pressure in the breast area during this procedure, but most women find it is not too uncomfortable. A few months later, the expander is removed and the patient receives either the insertion of a permanent breast implant or transfer of her own tissues. This type of breast reconstruction requires at least two separate operations. Typically, the last phase of breast reconstruction involves creation of the nipple-areola complex followed by tattooing.
Autologous Tissue Transfer
When the breast is reconstructed entirely with patient’s own tissue, the results are generally more natural and there are no concerns about problems with implants. The metabolism of the new breast becomes similar to the rest of the body, for instance it undergoes same weight fluctuations following patient eight change. Using patient’s own tissues is usually associated with contour improvement of the area the tissue was taken from, for instance, a TRAM flap also has the added benefit of improved abdominal contour.
In TRAM (Transverse Rectus Abdominis Myocutaneous) flap surgery, the breast(s) is (are) created by transferring tissue from the tummy. During the operation, the tissue remains attached to its original site, retaining its blood supply within the rectus abdominis muscle (“the six-pack muscle”). The flap, consisting of the skin, fat, and muscle with its blood supply, is tunneled beneath the skin to the chest creating the breast mound itself. This operation was originally devised decades ago and has been since modified to increase its reliability and decrease related problems. Dr. Timek has a vast experience in free tissue transfer from the abdomen, such as muscle-sparing TRAM, DIEP, and SIEA flaps. These flaps spare the rectus abdominis muscle normally sacrificed during the traditional TRAM flap operation.
Free muscle-sparing TRAM, DIEP, and SEIA Flaps
The muscle-sparing free flap from the tummy is a technique where skin and tissue with minimal amount of muscle (muscle-sparing TRAM) or no muscle (DIEP, Deep Inferior Epigastric artery Perforator and SIEA, Superficial Inferior Epigastric Artery) is taken from the abdomen in order to recreate the breast. This procedure is commonly performed as women generally have excess skin and fat along the lower portion of their abdomen. Additionally, the patients like the benefit of a “tummy tuck.”
Fat grafting, also known as lipofilling or fat transfer, is a newer technique applied in breast reconstruction as an adjunct or sole procedure recreating the breast shape and form. Fat can be taken from another part of your body, like the abdomen, thighs or buttocks, through liposuction. The fat is purified and carefully layered within the new breast to create the desired shape. Fat graft is used to correct contour deficiencies of breasts after reconstructions with implants or flaps. Lipofilling is also the preferred reconstructive method for certain lumpectomy defects.
Latissimus Dorsi Reconstruction
The latissimus dorsi (LD) flap is one of the standard methods for breast reconstruction. The latissimus dorsi flap is most commonly combined with a tissue expander or implant, to give the surgeon additional options and more control over the aesthetic appearance of the reconstructed breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape as compared to an implant alone. During the surgery, the LD flap, consisting of the skin, fat, and muscle with its blood supply, is tunneled beneath the skin to the front chest creating the breast mound itself. Occasionally, for a thin patient with a small breast volume, the latissimus dorsi flap can be used alone as the primary reconstruction without the need for an implant. Many surgeons will resort to the use of a latissimus dorsi flap as a backup option if a patient has wound healing problems or soft tissue failure in the setting of an implant. The latissimus dorsi flap can also be used as a salvage procedure for patients who have had previous radiation, and are not candidates for other procedures using patient’s own tissues.
Breast cancer treatment may consist of multiple modalities including breast conservation surgery (lumpectomy). During lumpectomy, the cancer with adjacent breast tissue is removed to provide adequate margin around the tumor. Most commonly, the breast is subsequently treated with radiation. The combination of tumor excision resulting in creation of a cavity with scarring and radiation treatment may lead to alteration of breast shape. Location, degree of scarring, and thus resulting deformity can vary. Therefore, there is no uniform therapeutic strategy to recreate satisfactory breast shape. Doctor Timek has vast experience in management of breast deformities after lumpectomy including application of tissue rearrangement and fat grafting techniques.