| Breast cancer is the most common form of | | | | need to be replaced (by surgery) periodically. |
| cancer in women and the second leading cause of | | | | In contrast to implants, autologous breast(s) |
| cancer deaths in American women. In 2009, | | | | reconstructed by one of the various flap |
| approximately 194,280 patients are estimated to | | | | procedures are meant to last "forever". Flap |
| be diagnosed with invasive breast cancer, and | | | | procedures generally require lengthy, more |
| 62,280 with carcinom. According to the American | | | | complex and costly operations, 4-5 day hospital |
| Society of Plastic Surgeons, nearly 79,500 women | | | | stays, and 4-6 weeks of outpatient rehabilitation. |
| underwent breast reconstruction surgery | | | | The patient's own tissue from the donor site |
| post-mastectomy in 2008. Approximately 70% of | | | | (abdomen, back or buttock) is brought in to fill the |
| these women had their breast(s) reconstructed | | | | void left by the mastectomy, above the |
| with expander/implant(s), whereas the other 30% | | | | pectoralis chest muscle. |
| had autologous breast(s) reconstructed by one of | | | | The choices are: |
| the various flap procedures. | | | | 1) free TRAM (transverse rectus abdominis |
| Expander/implant procedures are relatively safe | | | | musculocutaneous) flaps from the abdomen, |
| and simpler to perform, and take approximately | | | | 2) pedicled TRAM, |
| two hours of operative time per breast. During | | | | 3) free DIEP (deep inferior epigastric perforator) |
| the first surgery, often done at the same time as | | | | flaps from the abdomen, |
| the mastectomy, an expander is inserted | | | | 4) pedicled latissimus dorsi myocutaneous flaps |
| underneath the pectoralis (chest) muscle. Patients | | | | (from the back), and |
| usually stay overnight in the hospital for strong | | | | 5) free gluteal flaps (from the buttock). |
| pain medications (narcotics) given in the | | | | "Free" flaps mean that the flap blood vessels |
| intravenous line. The next day or the following | | | | have to be re-connected with blood vessels in the |
| day, when the pain can be controlled with pain | | | | chest using microsurgical techniques, and the |
| medications by mouth, then the patient may go | | | | plastic/reconstructive surgeon needs to have this |
| home. | | | | special training. "Pedicled" means that the flap |
| Over the next few months, the expander is | | | | tissue retains its original blood supply, and no |
| inflated gradually in the plastic/reconstructive | | | | microsurgical reconnection is needed. The patient |
| surgeon's office. Eventually, when the desired size | | | | then has one or more permanent large scar(s) at |
| is achieved, the patient returns to the operating | | | | the donor site(s) and depending on the type of |
| room to have the expander(s) removed and | | | | procedure performed, some experience physical |
| replaced with implant(s). Complications in breast | | | | impairment. |
| reconstruction are approximately three-fold higher | | | | The decision for reconstruction is complex, and |
| than in breast augmentation (implant done for | | | | highly individualized. The patient should be well |
| cosmetic purpose). Reconstruction patients, | | | | informed and think carefully about her priorities. |
| especially those undergoing radiation therapy, | | | | Sometimes, the patient may be better served by |
| experience numerous problems, with capsular | | | | dealing with the cancer first, and delaying the |
| contracture being the most common. In 2008, | | | | reconstruction surgery until all cancer treatments |
| more than 14,000 procedures were performed in | | | | are finished. Other times, it may be most |
| reconstruction patients to remove the original | | | | efficacious to combine mastectomy with |
| implants. Even in successful cases, implants do | | | | immediate reconstruction in one operation. |