By Evan Katzel, M.D.
Many women who undergo a mastectomy to treat breast cancer opt for reconstructive surgery to help rebuild the shape and look of their breast.
And while reconstruction techniques vary greatly depending on the unique needs of each woman, the goal is largely the same – to restore self-image, self-confidence and quality of life.
At Penn Medicine Princeton Health, women have the option of reconstructive surgery that uses their own tissue to recreate the breast instead of using a breast implant. The procedure is called the Deep Inferior Epigastric Perforator Flap or free flap procedure for breast reconstruction.
Deeply Personal Decision
The choice to have breast reconstructive surgery after a mastectomy is a deeply personal one. A woman may choose reconstruction for many reasons, including to:
Make her chest look balanced when wearing a bra or bathing suit.
- Make her clothes fit better.
- Avoid having to use a breast form that fits inside the bra (an external prosthesis).
- Be happier with her body and renew self-confidence.
- Feel balanced playing sports or doing other physical activities.
As the American Cancer Society notes: If you are thinking about having reconstructive surgery, it is best to talk about it with your surgeon and a plastic surgeon experienced in breast reconstruction before you have a mastectomy. This helps the surgical teams plan the best treatment for you.
Implant Reconstruction
The most common form of breast reconstruction after mastectomy uses surgical implants to reconstruct the breast size and shape.
Implant reconstruction is almost always a two-part procedure. At the time of the mastectomy, a tissue expander, which is a balloon device, is placed underneath the skin and muscles in the chest wall. In the second stage, surgeons go in through the same incision on the breast, remove the tissue expander and place implants. Breast implants come in a variety of shapes and sizes to create a natural looking result.
There are two types of implants:
- Saline-filled implants, which contain silicone shells filled with saline.
- Silicone-filled implants, which are silicone shells filled with silicone.
The type of implant you choose depends on your anatomy and desired results. The whole process from time of mastectomy to the final implant takes anywhere from three to six months.
Free Flap Procedure
In contrast to implants, the free flap procedure uses the patient’s own living tissue to replace the breast tissue removed in a mastectomy.
During the procedure, a flap of tissue is removed from the abdomen similar to the area removed during a tummy tuck and the flap is shaped to recreate the breast. The flap contains skin, fat and blood vessels that bring healthy tissue and blood supply to the affected area. Little or no muscle is taken from the abdomen and by using the patient’s own tissue, the reconstructed breast incorporates naturally with surrounding tissue.
Studies have shown the risk of infection, hospital re-admission and future revision surgeries are reduced compared to other methods of reconstruction. Improved blood supply provided by the transferred tissues also helps the healthy tissue respond better to the effects of radiation treatments.
While a longer and more complex surgery, the free flap procedure leaves patients with a more natural looking and feeling breast, as the tissue will change as the body changes, and a flatter belly.
Free flap reconstruction can also reduce future visits to the doctor, and the patient can have the procedure at the same time as their mastectomy or as a delayed procedure any time after a mastectomy. Patients who had prior breast implant-based reconstruction and are not fully satisfied are also candidates for the flap procedure.
The procedure is well tolerated by many patients. Generally, if a patient is approved to undergo anesthesia, they can be cleared for the flap procedure.
Further, federal law mandates all insurances must cover any post-mastectomy breast reconstruction.
On the Forefront of Breast Reconstruction
The availability of the procedure at Penn Medicine Princeton Health means patients can have breast reconstruction surgery and their follow-up exams close to home, where they can heal with the support of their loved ones.
For more information or to find a physician with Penn Medicine Princeton Health, call 1-888-742-7496 or visit princetonhcs.org.
Evan Katzel, M.D., specializes in microvascular plastic surgery and is a member of the medical staff at Penn Medicine Princeton Medical Center.
