Breast Implants:
Breast implants are a saline solution or gel pack prosthesis placed under your skin behind your chest muscle. Breast reconstruction with implants is different from breast augmentation because the skin is left very thin following a mastectomy. To compensate for this, the implant is placed under the pectoral muscle. Another muscle is often taken from your back due to lack of coverage using this method. This surgery will leave a scar across your back and may show in swimwear and low back gowns. If you have had radiation therapy or may need radiation in the future, prosthetic implants are a poor choice. Most doctors will recommend reconstruction from your own body tissue.
Body Tissue:
There are several places to remove your own body’s tissue for breast reconstruction called “Flaps”.
- TRAM (Transverse Rectus Abdominus Myocutaneous)
- DIEP (Deep Inferior Epigastric Perforator)
- SEIA (Superficial Inferior Epigastric Artery)
- GAP (Gluteal Artery Perforator)
TRAM FLAP:
This uses excess fat in the lower abdomen to reconstruct the breast. The fat is collected with an incision like a tummy tuck. The excess skin and fat will need a new source of blood supply once moved. This supply runs within the frontal abdominal muscles, which are removed with the fat and skin and unfortunately sacrificed to be moved to the breast. The result of lack of “6 pack” abdominal muscle can lead to weakness in the abdominal tissue and can herniate or bulge.
DIEP FLAP:
This is an advanced procedure of the TRAM FLAP. It uses the same skin and tissue without sacrificing the abdominal muscles. If there is not enough abdominal fatty tissue to restore the breast tissue then the GAP procedure is an option. The skin and fatty tissue can be taken from excess fat in the buttocks/hip area along with supplying blood vessels without sacrificing underlying muscle. The tissue is then sculpted into new breasts.
SEIA FLAP:
This is when superficial vessels in the abdomen provide the dominant source of blood flow. In this case the superficial inferior epigastric artery may be chosen as the new source of blood supply to reconstruct the breast.. This procedure is otherwise the same procedure as the DIEP.
GAP FLAP:
For women who do not have enough abdominal tissue to be reconstructed may have tissue taken from their gluteal region (buttocks) to reconstruct the breast tissue. Skin, fat and blood vessels are taken along the panty line without loss of underlying muscle tissue.
The best option for you should be discussed at length with your surgeon. All of these options should entail nipple reconstruction, refinement of the breast shape, reduction, lift or augmentation of breast symmetry to achieve the best possible aesthetic result of both breasts.