Because several different surgical approaches are available to most patients, there are basic facts you should know before choosing a reconstructive procedure. Being an informed consumer will enable you to seek out treatment options that fit your priorities, needs and lifestyle. The information below is intended to promote a collaborative relationship between you and your plastic surgeon, empowering you to work with your provider to choose a reconstructive option that is right for you.

If you are considering breast reconstruction, there are fundamental points to bear in mind. First, a woman’s decision to proceed with reconstruction following mastectomy is a very personal choice. While friends and loved ones may offer important guidance, the reconstructive decision is ultimately up to the patient and her physician. Remember that breast reconstruction is primarily a “quality of life” intervention: Unlike cancer treatment, which often prolongs life, breast reconstruction primarily contributes to a mastectomy patients’ emotional and psychological well-being, body image, and self confidence.

The Michigan Breast Reconstruction Outcome Study (MBROS), a current project assessing the long-term results of these procedures, has noted gains in an array of psychosocial and quality of life indicators for patients electing to undergo reconstruction following mastectomy. However, breast reconstruction is not for everyone. Despite the potential benefits of recreating a breast, some mastectomy patients who decline reconstruction still function in their daily activities.

Women considering breast reconstruction should also be aware of the limitations associated with these operations. Although newer techniques produce cosmetically superior results, reconstructive surgery cannot exactly duplicate the previous breast. Furthermore, creation of a precise, “mirror image” of the opposite side is usually beyond the scope of even the most up-to-date procedures, and modern surgical technology has yet to provide reliable methods for creating a sensate breast. Following mastectomy, patients usually note a significant loss of feeling in the surgical site; this diminished sensation is usually permanent and is not significantly altered by reconstruction.

Despite these limitations, most reconstructive patients are pleased with their results. Surveying patient satisfaction one year following reconstruction, the MBROS project reported that the majority of women undergoing either implant or natural tissue procedures described themselves as satisfied with both the aesthetics and with the overall results of their reconstructions. The study also compared outcomes among the common types of breast reconstruction, finding that natural tissue techniques produced somewhat higher levels of patient satisfaction compared with implant procedures.

Breast reconstruction is classified as either “immediate” or “delayed”, depending on whether the procedure is performed in conjunction with mastectomy or at a later date (ranging from weeks to years following mastectomy). Traditionally, plastic surgeons and oncologists have preferred delayed reconstruction for a variety of reasons:

Until recently, it was thought that delayed reconstruction was a safer option compared with immediate techniques.

Pro-viders worried that immediate reconstruction was associated with higher complication rates and inferior aesthetic results. However, recent studies have disputed these views, reporting that immediate reconstruction produces comparable outcomes to those for delayed procedures.

Not surprisingly, many consumers prefer this approach: For those seeking breast reconstruction, the vision of living for months or years without a breast prior to reconstruction is a daunting prospect. Women undergoing immediate reconstruction appear to suffer fewer of the psychological and emotional problems commonly associated with mastectomies.

A variety of choices are currently available; however, two approaches–implant and natural tissue techniques–are most accepted. Although breast implants have stirred considerable controversy in recent years, the health risks thought to be associated with these devices have not been identified in ongoing epidemiological research. As a result, both silicone gel and saline-filled implants remain commonly used. Placement of a reconstructive implant is usually preceded by a process called “tissue expansion” in which remaining tissue at the mastectomy site is stretched and expanded by a temporary silicone balloon placed under the skin and muscle layers.

The tissue expander is inflated by a series of injections of saline (salt water solution) in the weeks following placement of this device. As the expander enlarges, the overlying skin and muscle layers grow, reproducing the skin removed with mastectomy. Following completion of this process, the expander is replaced with a reconstructive implant in a secondary surgical procedure.

The second approach to breast reconstruction uses the patient’s own tissue. This operation uses a “flap” consisting of skin, fat, and muscle that is transferred from a donor site to the area of the mastectomy. Several donor sites have been used, but for the past fifteen years, the most popular option has been the TRAM flap, short for Transverse Rectus Abdominis Musculocutaneous. The TRAM flap uses a segment of lower abdominal skin, fat, and muscle to reconstruct and sculpt a new breast. The donor area in the lower abdomen is then closed as a “tummy tuck.”

Obviously, both approaches to breast reconstruction have advantages and disadvantages. We recommend you thoughtfully examine the pros and cons of each procedure, choosing the option which best fits your preferences and needs. Depending on your age, health and a variety of other factors, your plastic surgeon may encourage you to choose one approach over the other. For example, smokers are not good candidates for TRAM flaps because of circulation problems associated with tobacco use.



The key to choosing which construction method is suitable for you is important. You should research all of your options and consider gathering additional information from physicians and other reliable sources including the Internet. Background on breast reconstruction options and on the MBROS project can be found at www.surgery.med.umich.edu/breastrecon.htm.