BRIGHT IDEAS

What are the Different Breast Reconstruction Options (ie Nipple Sparing, Diep, Flap)?

Bright Idea provided by Michael Howard, M.D.

In the past, a “successful” breast reconstruction consisted solely of replacing the missing breast volume with little attention to the resulting breast aesthetics. Fortunately, breast cancer treatment continues to evolve and many exciting advances have recently been made in the field of breast reconstruction.

For many years, surgery for the treatment of breast cancer consisted of disfiguring procedures such as the radical mastectomy. In the past decade, acceptance of procedures such as the skin-sparing mastectomy improved reconstruction outcomes. Today, in select patients, consideration is even being given to “Nipple-Sparing Mastectomy”, a procedure where the skin and nipple-areola complex are preserved and immediate reconstruction is performed, further enhancing aesthetic outcomes.

Although there are several options in breast reconstruction, all methods ultimately involve the use of an implant or the patient’s own tissue. In most situations, reconstruction is viewed as a staged effort, directed towards ultimately achieving an attractive, symmetrical outcome. The first stage is a “rough draft” reconstruction where the breast mound is recreated. The second stage procedure(s) is aimed at improving breast symmetry and fine-tuning the reconstructed breast in terms of size, shape, and position as well as nipple reconstruction.

Today, implant-based reconstruction utilizes either saline or silicone gel-filled implants. In most patients, following mastectomy, a temporary implant is inserted to create or “expand” a pocket for the final implant. The expander is exchanged for a permanent implant a short time later. In some patients, a one-stage implant reconstruction may be utilized.

Alternatively, a patient’s own tissue may be used for reconstruction. Most commonly, the abdominal tissue is utilized to replace the breast tissue. This method is known as a TRAM, DIEP or SIEA flap – specific names for various techniques using this abdominal tissue. Alternatively, back, buttock or inner thigh tissue may also be options for reconstruction.

In short, there is no single, “best” method of reconstruction applicable to all women. Patients are encouraged to seek consultation with a board certified plastic surgeon, experienced in breast reconstruction, to discuss the options available to her. Then, a specific reconstruction plan may be tailored to each individual’s situation.