Breast Reconstruction Using Your Own Tissue

Andrea Pusic, MD FACS

Associate Professor of Surgeon

Memorial Sloan-Kettering Cancer Center

Breast reconstruction is important!

Improvements in body image and

sexuality

Decreased anxiety and

depression

Avoid external prosthesis

Immediate reconstruction has

a number of benefits:

• Psychological

• Avoid multiple operations

• Smaller incisions

• Improved aesthetics

Reconstruction can be performed at the same

time as the mastectomy (or later)

Immediate Delayed

Timing of Reconstruction

Patient’s own tissues

(most commonly from lower

abdomen)

Implants

Combination of implants and

own tissue

Several different types of reconstruction available

Most women are candidates for reconstruction

Type of reconstruction guided by:

Medical risks and smoking

status

Previous radiation/surgery

Body habitus

Breast cancer stage

Motivations/goals

Implant Reconstruction has some Disadvantages

Not as natural feeling/looking as normal breast

Infection may require removal

May require replacement (leak)

Does not age with patient

Scar tissue can form (capsular contracture)

Satisfaction with Breasts

Hu et al, PRS 2009

Tissue reconstruction is useful in some patients

1. Previously radiation

2. Overweight patients

3. Large breasted patients

4. Patients having only one

breast removed

Pedicled TRAM flap

• Advantages

• Produce a softer, ptotic breast mound

• Better control in matching the

contralateral breast

• Greater volume of tissue transfer

• Enhanced flap perfusion

• Avoids disruption of the medial

inframammary fold

DIEP Free Flap Reconstruction

Unilateral TRAM flap

Can provide best match to the other breast

Nipple-sparing with DIEP

Less commonly performed but can provide

excellent results

Delayed TRAM Reconstruction

After nipple reconstruction and reduction of the

other breast

What are the main potential problems with TRAM and DIEP flaps?

• Longer surgery with longer recovery

• Flap loss (not enough blood flow)

• Abdominal problems

(Seroma, hernia or bulge, weakness, pain)

• Noticeable Scars

Initially the scars are very noticeable

But they fade considerably with time

Delayed TRAM flap Reconstruction

Note increased scarring and color differences

Questions?

www.breast-q.org