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Breast Reconstruction Techniques

Phoenix & Chandler, AZ

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Breast Reconstruction Techniques

Tissue Expanders

A tissue expander is a specialized type of implant that has a port located inside of it that allows fluid to be injected (Tissue Expander Expansion Completed In Office) so that the size of the expander can slowly increase over time, which will stretch the skin to create a “pocket” for the implant or the reconstructed breast under the skin. This creates space so that, in a second stage, a larger Implant can be placed in the breast, or Autologous-Based Reconstruction can be performed to complete the reconstruction.

Immediate tissue expander placement:

  • To IMPLANT-based reconstruction
  • To an Autologous-Based reconstruction

Implants

A breast implant is a round, flexible silicone shell filled with either saline (salt water) or silicone gel. Breast implants can be placed either over the chest muscle (pectoralis) or under part or all of the chest muscle. The implant replaces the breast tissue that is removed during the mastectomy, restoring the shape and volume of the breast.

  • Direct to implant
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Predicled Flaps

The majority of pedicled flaps classically utilized in breast reconstruction are the latissimus dorsi (from the back) or rectus abdominus (from the abdomen). A flap is tissue preserved on its blood supply. In pedicled flaps, the blood supply is not disrupted; it is reestablished. The disadvantages of commonly used pedicled flaps include donor-site morbidity when the rectus abdominis is used and partial flap loss. The disadvantages of the latissimus dorsi flap are mild weakness in arm flexion (or downward force), and this flap generally does not have ample tissue to recreate an adequate breast mound by itself.

Muscle

  • Latissimus Dorsi Flap
  • TRAM Flap

Muscle Sparing

  • Muscle-Sparing TRAM Flap

Free Flap Reconstruction

Immediate Free Flap Reconstruction Vs. Delayed Free Flap Reconstruction

The abdomen is the most commonly used area for free flap options.

  • Deep Inferior Epigastric Artery (DIEP) Flap: The DIEP is a mainstay in autologous breast reconstruction, even with surgeons who are well-versed in multiple donor sites. The DIEP flap involves tissue that is similar to the tissue usually removed in abdominoplasty procedures (aka “tummy-tuck”)

In the majority of patients, the DIEP flap exhibits the characteristics described above. When additional tissue is needed, the lateral (“love handles”) can be included using the additional vessels that supply the tissue in that area. This area is supplied by the deep circumflex iliac artery (DCIA). When we use the DIEP and DCIA arteries together, the resulting flap is referred to as the extended abdominal flap.

  • Superficial Inferior Epigastric Artery (SIEA): The superficial inferior epigastric artery (SIEA) is an additional flap option in select patients. The SIEA is variable in vessel size and length, which may not provide adequate blood flow in some patients.
  • Deep Circumflex Iliac Artery (DCIA) Flap: When additional tissue is needed, the lateral (“love handles”) can be included using the additional vessels that supply the tissue in that area. This area is supplied by the deep circumflex iliac artery (DCIA). When we use the DIEP and DCIA arteries together, the resulting flap is referred to as the extended abdominal flap.

Second Stage Autologous Breast Reconstruction

  • Optimizing Aesthetic Outcomes and Second Stage Surgery
  • The aesthetic outcome of the breasts is of high priority. In patients undergoing autologous reconstruction, we strive to improve the contour of the donor site from which the free flaps were harvested.
  • In implant-based reconstruction, a second-stage procedure is used to adjust results if you desire larger breasts or if there is any asymmetry between the breasts. At this stage, we also reconstruct a nipple. The implant pocket may be moved if needed,d and liposuction with fat grafting can be used to add volume and provide a more natural breast transition and contour.
  • In autologous reconstruction, a second stage is used to refine the breasts, achieving symmetry and adjusting size and positioning as needed. At this time, anyfine-tuningg of the donor site can also be addressed. This is most relevant when donor site scars need to be moved to achieve ideal scar placement and minimize visibility. We also use this opportunity to correct any contour irregularities at the donor site.

 

Botched Breast Reconstruction Repair Oncoplasty Reduction

For larger breasts that do not require a mastectomy and only a portion of the breast needs to be removed, a reduction can be performed. Generally, reduction techniques are used to lift the nipple position and to remove excess breast tissue and overlying skin.

Breast Reconstruction Techniques

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