Division of Plastic and Reconstructive Surgery
Our Services - Breast Surgery Program
Reconstructive Breast Surgery
The emotional and physical stress of dealing with a diagnosis of breast cancer, or of the genetic predisposition to cancer, can be severe. A mastectomy often adds to the psychological trauma. Breast reconstruction following the surgical removal of a breast can help a woman cope with this stress and regain a sense of normalcy. Breast reconstruction specialists at the UPMC Division of Plastic and Reconstructive Surgery utilize state of the art techniques that create a natural-looking breast and help the patient regain a positive body image and improve her emotional quality of life.
Plastic surgeons at UPMC work as part of a multidisciplinary team alongside breast surgical oncologists, radiation therapists, and oncology physicians and nurses to provide reconstructive consultations and care for patients with breast cancer and other breast-related problems. There are two main treatment options: autologous (using the patient’s own tissues to reconstruct a new breast mound) and prosthetic implants. When recommending treatment, the breast reconstructive team considers factors such as:
- the patient’s preference
- whether the procedure should occur following mastectomy or be
- postponed for months or possibly years
- the need for adjuvant cancer therapy (chemotherapy or radiation)
- the medical history and the health of the patient
Reconstruction Techniques
Autologous (Flap) Reconstruction
Autologous or flap reconstruction techniques use a patient’s own tissues to recreate a natural-appearing breast after mastectomy. Autologous reconstructions can appear more natural than implant reconstructions and tend to be more durable, sparing patients revision operations.1
Transverse rectus abdominus myocutaneous (TRAM) flap – The surgeon relocates a flap of skin, fat, blood vessels, and muscle from a patient’s abdomen to the breast. This procedure can also be done as a free flap in which blood vessels are reconnected to vessels in the chest.
DIEP Flap Reconstruction
Deep inferior epigastric perforator (DIEP) flap – The surgeon removes only skin and fat from the patient, sparing the abdominal wall muscles, which results in a shorter recovery time and less abdominal muscle weakness.2 The surgeon may opt to perform this procedure instead of the more conservative TRAM flap procedure if a woman’s anatomy is deemed appropriate.
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Figure 1A:
Deep inferior epigastric perforator (DIEP) flap preparation for breast reconstruction.
Note the sparing of abdominal muscles. |
Figure 1B:
DIEP flap after microsurgical transfer to breast defect. |
Latissimus Dorsi Flap Reconstruction
Latissimus dorsi flap — The latissimus dorsi flap of the back, which incorporates skin, fat, and muscle, may be used for breast reconstruction. It can be used without a breast implant in some women with appropriate anatomy. Usually, however, it is used in conjunction with an implant to lend a more natural shape to an implant-based reconstruction. This technique may be appropriate when a patient's abdominal tissue is not available for use. Like other breast reconstruction techniques, the latissimus dorsi flap reconstruction requires several staged procedures of decreasing magnitude to achieve the final result. Donor site scars on the back are usually very well tolerated and cosmetically acceptable.
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Figure 2A:
Latissimus dorsi flap for breast reconstruction before transfer, posterior view. |
Figure 2B:
Latissimus dorsi flap for breast reconstruction after transfer, anterior view.
Note presence of implant under flap for appropriate volume. |
Prosthetic Implant Reconstruction
The use of saline or silicone implants can be an excellent option for breast reconstruction. Women who do not require adjuvant radiation therapy and who lack sufficient autologous tissue in their lower abdomen to create adequate breast volume are the best candidates for this type of reconstruction.
Following mastectomy, surgeons insert a skin expander beneath the woman’s skin and chest muscle. Over the course of several weeks, surgeons adjust the expander and eventually perform a second operation to insert the implant and reconstruct the surrounding skin and areola. Women who do not require a tissue expansion can receive a breast implant immediately following mastectomy. Up to half of patients with breast implants develop scar tissue that can alter the shape of the implant, which must be repaired with additional surgery.
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Figure 3A:
Tissue expander breast reconstruction
Left: deflated.
Right: inflated. |
Figure 3B:
Breast reconstruction after the tissue expander has been exchanged for an implant. |
Follow-up Care
Most breast reconstruction involves a series of procedures over the course of several months. Follow-up operations — to replace tissue expanders, reconstruct a nipple and areola, or adjust the opposite breast to match the reconstructed breast — are often required.
Our Breast Reconstruction Specialists
The philosophy of the breast reconstruction specialists in the UPMC Division of Plastic and Reconstructive Surgery is that every patient has her own special needs and that breast reconstruction treatment plans should be individualized for each patient.
Kenneth C. Shestak, MD
Carolyn De La Cruz, MD
Michael Gimbel, MD
Vu T. Nguyen, MD
Plastic surgeons at UPMC work as part of a multidisciplinary team alongside breast surgical oncologists, radiation therapists, and oncology physicians and nurses to provide reconstructive consultations and care for patients with breast cancer and other breast-related problems.
Contact Us
UPMC Aesthetic Plastic Surgery Center
Isaly Building, Suite 158
3380 Boulevard of the Allies
Pittsburgh, PA 15213
1-877-NEW-YOU8 (639-9688)
UPMC Shadyside
5750 Centre Avenue, Suite 180
Pittsburgh, PA 15206
412-661-5380
E-mail: PlasticSurgery@upmc.edu
http://plasticsurgery.upmc.com/upp/
1. Kroll SS, Evans GR, Reece GP, Miller MJ, Robb G, Baldwin BJ, Schusterman MA. Comparison of resource costs between implant-based and TRAM flap breast reconstruction. Plast Reconstr Surg. 2001 May;107(6):1413-6; discussion 1417-8.
2. Futter CM, Webster MH, Hagen S, Mitchell SL. A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap. Br J Plast Surg. 2000 Oct;53(7):578-83.