Breast Reconstruction at Shands at UF
University of Florida plastic and reconstructive surgeons work closely with UF surgical oncologists, medical oncologists, radiation oncologists and other medical experts at the UF Breast Center to provide women affected with breast cancer a comprehensive and coordinated treatment plan, which may include breast reconstruction.
UF reconstructive surgeons will discuss with you in detail the advantages and disadvantages of the different surgical procedures offered and help you make the best decision for your situation. Various circumstances that affect the type of reconstruction chosen include:
- overall health
- body type
- patient time constraints
- patient preferences
- need for further oncologic treatment
Reconstructive Surgical options
Different reconstructive options include:
Implant-Based Reconstruction
Implant-based reconstruction involves placing a tissue expander under the chest muscles to allow for gradual expansion of the muscle and remaining breast skin in order to make room for a permanent implant.
Over the course of several clinic visits in the weeks following the surgery, the expander is inflated with saline, and the expander eventually is replaced by a permanent implant (saline or silicone, depending on patient preference) during another outpatient surgical procedure.
This option typically is offered to women who have not had or do not expect to have radiation treatment, which may lead to difficult post-operative complications such as skin death or implant loss.
Good candidates for this procedure are lean patients with healthy chest wall skin and without donor-site tissue available for an autologous reconstruction.
The major disadvantage to implants is that they are man-made products that may fail with time.
Autologous Reconstruction:
Autologous reconstruction refers to the technique of using excess tissue from one area of your body and relocating it to another. UF cosmetic and reconstructive surgeons offer several types of autologous reconstruction, including:
Latissimus dorsi flap
The latissiums dorsi flap procedure is a very reliable reconstructive option that has been used since the 1970’s. Muscle and skin from the patient’s back are transferred to the chest wall. Most patients require an expander and a subsequent implant to give adequate volume. However, patients with a substantial amount of skin and fat on the back may be satisfied to go without an implant.
TRAM flap
The TRAM (transverse rectus abdominus myocutaneous) flap procedure uses excess abdominal tissue to recreate a breast, and is an ideal reconstructive option for many women. For many women who have had children, this excess abdominal skin—which might otherwise be removed via an abdominoplasty (tummy tuck)—is readily available.
The major advantage to the TRAM flap is that the reconstruction is purely autologous (i.e., using your own skin and tissue) and moves, looks and feels like a natural breast. As the surgical scars fade and time passes, the result looks and feels like your own breast.
Traditionally, tissue used during a TRAM flap was harvested and inset by rotating the rectus abdominal muscle along with the abdominal skin and fat during a three-hour procedure. However, refinements in techniques and technology have decreased the amount of muscle we have to use for this flap.
The TRAM flap procedure can be performed only once, and patients who have had an abdominoplasty or certain surgical scars may not be candidates for this procedure.
DIEP flap
DIEP (Deep Inferior Epigastric artery Perforator) flap is a cutting-edge microvascular reconstructive technique offered at Shands at UF. Using microsurgical techniques, UF surgeons spare the abdominal muscles and isolate the abdominal skin and fat on one or more blood vessels, known as muscle perforators. Surgeons then reconnect the flap’s blood supply to the vessels on the chest wall.
Major advantages of the DIEP flap versus traditional TRAM flap are:
- less post-operative pain
- decreased abdominal wall morbidity (particularly when bilateral reconstructions are performed)
- fewer post-operative abdominal bulges and hernias
DIEP flap surgery sometimes involves removing rib cartilage, and candidates need to have adequate donor-site tissue, as well as be in good enough health to tolerate a long surgical procedure. Patients can expect to stay in the hospital for four to seven days so physicians can monitor the flap.
SIEA flap
SIEA (Superficial Inferior Epigastric Artery) flap is a microsurgical option using the same tissue as the TRAM and DIEP flaps, except that the abdominal wall is spared completely. These vessels are typically explored during the DIEP reconstruction to determine if the patient has adequately sized superficial vessels to support this flap.
Timing of reconstructive surgery
Optimal aesthetic results typically are obtained when a patient is a candidate for “immediate” reconstruction (i.e., during the same operative time as the mastectomy). The surgical oncologist will perform a “skin-sparing” mastectomy if it allows for an adequate tumor margin.
The combination of a skin-sparing and immediate mastectomy results in more natural and pleasing post-operative appearance. However, due to medical or personal reasons, some patients prefer to postpone reconstruction. Patients who may be candidates for radiation treatment after the mastectomy are advised to delay reconstruction until their treatment is complete in order to ensure the optimal aesthetic benefit.
What about the other breast?
A contralateral (opposite side) reduction or augmentation is offered to obtain symmetry with the newly reconstructed breast. Some women prefer a prophylactic (i.e., preventative) mastectomy on the opposite side at the same time as the planned cancer surgery, and is a choice that will be discussed between the patient and the surgical oncologist.
Nipple Reconstruction
Nipple reconstruction usually is performed during an outpatient ambulatory procedure several months after the initial reconstruction. Skin is rearranged on the new breast mound to create a projection that serves as the nipple, and an areola is tattooed during a clinic visit (under local anesthesia) a few months later.
Insurance information
According to the Women’s Health and Cancer Rights Act of 1998, any insurance that covers a mastectomy also will cover the reconstruction and contralateral balancing procedure.
We strongly encourage patients to abstain from all forms of nicotine at least 4 weeks prior to any procedure to decrease the risk of postoperative complications.
UF reconstructive surgeons
- M. Brent Seagle, MD, professor and chief, division of plastic and reconstructive surgery
- Matthew H. Steele, MD, assistant professor, division of plastic and reconstructive surgery
- Loretta M. Coady-Fariborzian, MD, assistant professor, division of plastic and reconstructive surgery
- Mary D. Lester, MD, assistant professor, division of plastic and
reconstructive surgery
Contact information
For more information about the reconstructive surgical options at Shands at UF, contact the UF Breast Center at 352.265.7070. |
