After you have been diagnosed with breast cancer, one of the most important decisions is whether to have reconstruction surgery. Reconstruction can restore your confidence and improve your quality of life after cancer treatment.

Choosing the right option is personal and should be made in consultation with your plastic surgeon. Depending on your condition and preferences, you may need breast reconstruction at the same time as or after mastectomy surgery.

Mastectomy

A mastectomy is a surgical procedure that removes all or part of your breast tissue. It’s used for both treatment and prevention of breast cancer.

The surgery is usually done under general anesthesia. It takes about 90 minutes, and most people go home the same day.

It can take up to four weeks for your chest and arm area to fully heal after a mastectomy. Your doctor may put one or two drainage tubes in place to stop fluids from accumulating in the breast space.

A sentinel lymph node biopsy (SLNB) is sometimes done simultaneously with your mastectomy to check for cancer cells that have spread to the nearby lymph nodes. This will be done with a radioactive tracer and blue dye to help the surgeon see which lymph nodes need removal.

Breast Reconstruction

Breast reconstruction is restoring the shape of the breast after a mastectomy. This can be done at the same time as surgery (immediate reconstruction) or, many years later, at a separate procedure (delayed reconstruction).

The type of reconstruction a woman chooses will depend on her medical needs and personal preferences. Her gender will also influence whether she will need radiation therapy after surgery.

Reconstruction can take several procedures over many months to achieve the final result and may involve several visits to the hospital for further surgery and appointments. It can be a very difficult decision, and it is important to discuss this with your doctor, surgeon and specialist team in detail.

TRAM Flap

A TRAM flap is a procedure that uses parts of your skin, fat and muscle to reconstruct a breast after mastectomy. The Bellevue plastic surgeon takes a section of your rectus abdominis muscle (in the lower abdomen between your waist and pubic bone) and moves it to your chest wall.

The blood supply is then connected to the blood vessels in your chest or armpit area using microsurgery. This reduces the risk of a “bulge” and improves blood supply to your breast, lowering the chance of fat necrosis.

There are two main types of TRAM flaps: pedicled and free. A pedicled TRAM flap is the most common type of TRAM surgery.

DIEP Flap

A DIEP Flap is a type of natural tissue breast reconstruction surgery. It uses tissue from the lower abdomen to reconstruct a new breast.

It is similar to a TRAM flap, but only skin and fat are removed instead of the whole rectus abdominis muscle. This allows your abdominal muscles to be spared, helping you retain more strength after surgery.

Another benefit is that a DIEP flap can improve the shape of your abdominal area, giving you slimmer, more toned thighs or a tummy tuck.

A DIEP flap uses microsurgical techniques to reattach blood vessels from the donor site to the chest wall. This requires expertise in surgery through a microscope (microsurgery).

TUG Flap

The TUG flap is a relatively new breast reconstruction procedure that utilizes skin, fat and a small amount of gracilis muscle from the inner thigh to reconstruct a breast. Unlike other major body muscles, the gracilis power can be spared without significant functional deficits.

During the TUG flap elevation, the skin paddle and underlying fat are harvested from a horizontally oriented ellipse along the proximal upper one-third of the gracilis muscle in a myocutaneous flap perfused by the medial circumflex artery and its venue.

TUG flaps are ideal for patients who do not qualify for TRAM, DIEP or latissimus flap procedures and who have had problems with these reconstructions. They also offer a more aesthetically pleasing donor site closure than TRAM and DIEP flaps.