Breast Reconstruction

Breast Reconstruction Options

Breast Implants (Two Stage Technique)

The use of breast implants offers the simplest way of recreating the breast volume and shape. Traditionally, using implants involved a 2-stage procedure. In the first stage a tissue expander is placed under the pectoralis muscle. The purpose of this step is to place a device under the muscle, and this deviced is then inflated over time (fluid is injected once a week) to stretch out the existing muscle. This stretches a muscle that is normally tightly adherent to the chest wall and creates a space under the muscle where the permanent breast implant will be placed. Once the tissue expander has stretched out the muscle, it is allowed to sit there for 2-3 months to allow the skin and muscle to settle into it's stretched position. Then comes the second stage of the breast reconstruction. The expander is taken out and the permanent implant is put in its place. During this stage the breast shape is adjusted (because while the expander is in place, the goal is to stretch tissue not to shape the breast).

Breast Implants (Single Stage Technique)

A NEW option available to patients is a Single Stage Implant Reconstruction using Alloderm Regenerative Tissue Matrix. Alloderm is a dermal substitute (ie it is the deep layer of normal skin) that is used instead of the pectoralis muscle to cover the implant. Thus, there is no need to stretch out the tightly adherent small pectoralis muscle, skipping the Expansion phase (first phase) of the two stage technique. This new option provides exciting new alternative to breast reconstruction patients.

Implants offer a quick, simple, minimal complication breast reconstruction to patients who want to get back to regular activities as quickly as possible. The major downside of implant reconstructions is that you will likely need some form of a touch up at a later time. Capsular contracture, infection, and extrusion can develop.

Latissimus Dorsi Myocutaneous Flap

Latissimus Dorsi muscle is the muscle on the back that gives the back a V-shape. This muscle is used together with an implant or a tissue expander. It is moved from the back to the chest and is place on top of the implant or the tissue expander with the purpose of placing a healthy, well vascularized, and thick muscle on top of a breast implant. This technique offers a one stage breast reconstruction to patient who do not want to undergo a complex flap reconstruction and who need to bring a healthy tissue to the chest. This technique is also used to save implant reconstructions that develop healing problems due to infection, wound breakdown, or radiation.

TRAM (Transverse Rectus Abdominis Myocutaneous) Flap

TRAM was introduced in 1979 and revolutionized the field of breast reconstruction. It provides an option of using your own tissue for breast reconstruction. It avoids the need for an implant in patients who do not want implant reconstruction or who are not good candidates for implant reconstruction (previously irradiated chest). The downside of TRAM flaps is that the blood supply to the flap is relatively poor so the risk of fat necrosis (partial loss of fatty tissues) is significant. There is also a problem with the abdomen because the abdominal fascia and the rectus muscle has been removed, leading to a weakened abdominal wall. The problem then becomes that patients are prone to abdominal bulging, abdominal hernias, and weakness.

Free Flaps (DIEP, SIEA, SGAP, TUG)

Free Flaps are flaps that are 'transplanted'. Unlike a TRAM or Latissimus Dorsi flaps, which are moved while maintaining their blood vessels attached, free flaps are flaps that are cut out completely, the blood vessels to the flap are severed, and the flap is then transplanted to the chest/breast area. These blood vessels (that provide blood flow to the flap) must then be reattached to the chest vessels. This is called microsurgery (because a microscope is required to suture these tiny, 1 millimeter blood vessels together). Free flaps have a superior blood flow to a TRAM flap, and the donor site (site where the flap came from) problems are minimal compared to a TRAM flap. The major down side of free flaps is that because these are 'transplants' there is a risk that the blood flow to the flap is not restored and the flap fails. These techniques take longer and the recovery is longer. The benefit of these flaps, however, is that the breast reconstruction is more natural looking and feeling.

(DIEP = Deep Inferior Epigastric Artery Perforator)
(SIEA = Superficial Inferior Epigastric Artery)
(SGAP = Superior Gluteal Artery Perforator)
(TUG = Transverse Upper Gracilis)

Breast mound created with Implants:


Breast Reconstruction with 2-Stage Implant Reconstruction:
(Patient had right mastectomy and reconstruction and at a later date had left mastectomy and reconstruction)


DIEP Free Flap Breast Reconstruction:

Nipple Reconstruction

Nipple reconstruction is an optional procedure performed once the reconstructed breast had time to settle down. There are several ways of creating the nipple and areola.

Reconstructive surgery allows women to have their breasts recreated either using their own tissue, using an implant, or a combination of both. Its purpose is to restore breast shape so that when you're wearing clothes, no one can tell you've had breast surgery.

Dr. Jugenburg performs all types of breast reconstruction: using implants and using your own tissues. Each has their pros and cons. Dr. Jugenburg will sit down with you and discuss with you which type of surgery is more appropriate for you.Dr. Jugenburg has trained at the University of Manitoba and the Memorial Sloan-Kettering Cancer Center in New York City, two of the world's most advanced breast cancer training centers.

Using this knowledge and experience, Dr. Jugenburg performed highly complex reconstructive microsurgery on breast cancer. For more information on reconstructive procedures, visit our sister site www.microsurgeon.ca