Treatments

Breast Reconstructive Services

A doctor holds a breast implant in gloved hands

Overview

The Cancer Institute at The University of Tennessee Medical Center offers the most advanced breast reconstructive techniques in the region. If you’re looking for breast reconstructive services in Knoxville, Tennessee, the Cancer Institute will determine a personalized treatment plan that meets your specific needs.

During the initial visit your doctor, all of your options for breast reconstruction will be discussed with you by your doctor to determine the best approach to reconstructive surgery. Breast Services at the Cancer Institute offers a full-range of treatment options by high skilled multidisciplinary teams of board-certified plastic surgeons, specialized nurses and trained clinicians.

Breast Reconstruction

Breast reconstruction is often performed to restore the normal shape of the breast after a surgical procedure for breast cancer. If you have had a lumpectomy the normal shape of the breast may be distorted or unnatural, or there may be a contour irregularity where the surgery was performed.  If you have had a mastectomy, the entire breast is removed.  Breast reconstruction after a mastectomy or lumpectomy restores the normal shape of the breast, and is an option to most patients with breast cancer.

You and your doctor will decide together about whether to have breast reconstruction, and when. Some patients decide to have reconstruction surgery during the initial procedure or after. The decision depends on many different factors that should be discussed with your doctor.

Reconstruction Options:

  • Deep  Inferior Epigastric
  • Perforator Flap (DIEP)
  • Superficial Inferior Epigastric
  • Artery (SIEA)
  • Tissue Expanders and Impants
  • Transverse Rectus Abdominis Musculocutaneous (TRAM) flap
  • Nipple Sparing
  • Fat Grafting
  • Oncoplastic Procedures
  • Microvascular Reconstruction

The Superficial Inferior Epigastric Artery Flap

The Superficial Inferior Epigastric Artery Flap (SIEA) is similar to the DIEP flap. However, the major difference is that the artery and vein used in a SIEA lie closer to the skin surface than the artery and vein of the DIEP flap. The ability to perform a SIEA flap depends on the diameter of the vessels and the amount of tissue required. Less than 15% of women are candidates for this type of flap secondary to limitations in vessel size or presence, or the amount of tissue required to reconstruct the breast.

Tissue Expanders and Implants

A tissue expander provides a more natural appearing breast. This method of breast reconstruction involves the transfer of the back tissues (latissimus muscle, fat and small amount of back skin) to your chest mastectomy site.

Breast reconstruction with implants is usually done in 2 stages. You will receive general anesthesia (asleep and pain-free). In the first stage: The surgeon will place a small tissue expander under your chest muscle and skin. The expander is a pouch made out of silicone, similar to a balloon. Your chest will still look flat right after this surgery. Starting about 2 to 3 weeks after surgery, you will see your surgeon every 1 or 2 weeks. During these visits, your surgeon will inject a small amount of saline (salt water) through your skin into the pouch through a valve. The pouch or tissue expander slowly enlarges the pouch in your chest to the right size for the surgeon to place an implant. When it reaches your desired size, you will wait 1 to 3 months before the permanent breast implant is placed (the second stage). In the second stage: Your surgeon will remove the tissue expander from your chest and replace it with a breast implant. This surgery takes 1 to 2 hours. Before this surgery, you will have talked with your surgeon about the different kinds of breast implants. Implants may be filled with either saline or a silicone gel.
The surgeon will make a surgical cut in your upper back, on the side of your breast that was removed. The surgeon will loosen skin, fat, and muscle from this area and then tunnel this tissue under your skin to the breast area. This tissue will be used to create your new breast. Blood vessels will remain connected to the area from where the tissue was taken. This tissue is then shaped into a new breast. Your surgeon will match the size and shape of your remaining natural breast as closely as possible. An implant may be placed underneath the chest wall muscles to help match the size of your other breast. If you would like a new nipple and areola created, you will need a second, much smaller surgery later.

The Transverse Rectus Abdominis Musculocutaneous Flap

The Transverse Rectus Abdominis Musculocutaneous (TRAM) flap, which consists of lower belly skin and fat, can be transferred from the abdomen to the chest to give the breast a mound-shape that matches other natural breasts.

The TRAM flap uses one of your rectus muscles to carry the blood vessels that keep the transferred belly skin and fat alive. The whole muscle is required to provide the blood supply for the skin and fat. With the TRAM flap method of breast reconstruction, natural, aesthetic outcomes can be achieved provided the patient’s anatomy is appropriate. For this procedure, patients will have  general anesthesia (asleep and pain-free)

The surgeon will make a cut across your lower belly, from one hip to the other. Your scar will be hidden later by most clothing and bathing suits. The surgeon will loosen skin, fat, and muscle in this area. The surgeon will then tunnel this tissue under the skin of your abdomen up to the breast area. Your surgeon will use this tissue to create your new breast. Blood vessels remain connected to the area from where the tissue is taken. In another method, the skin, fat, and muscle tissue are removed from your lower belly. Then the surgeon places this tissue in your breast area to create your new breast. In this method, the arteries and veins are cut and reattached to blood vessels under your arm. This tissue is then shaped into a new breast. Your surgeon will match the size and shape of your remaining natural breast as closely as possible. Your surgeon will close your belly cut with stitches. If you would like a new nipple and areola created, you will need a second, much smaller surgery later.

Nipple Sparing

The nipple sparing reconstructive procedure preserves the breast, skin and nipple area while removing all or most of the underlying breast tissue. Nipple sparing is a procedure performed through a small incision allowing for a more natural looking reconstruction and avoiding additional scars on the breast. Scars are permanent and are often more visible in the year after surgery. The scar location depends on the patient and will be determined during consultation with the plastic surgeon.

Fat Grafting or Fat Transfer

This procedure will remove a patient’s own fat to re-implant it where needed to reconstruct the breast to a normal shape and balance to the body. It is typically extracted from body parts like the abdomen, thighs, or buttocks.

Oncoplastic Surgery for Breast Reconstruction

Oncoplastic surgery is one of the latest surgical options for breast cancer patients . This technique combines removing the cancerous tumor with a breast reduction, or it can involve local tissue rearrangement all in one surgical procedure. This is often the preferred option for patients after receiving a lumpectomy and want to realign the symmetry in their breasts and fix any distorted tissue.

Having breast reconstruction does not make it harder to find a tumor if your breast cancer comes back.Many women choose not to have breast reconstruction or implants. They may use a prosthesis (an artificial breast) in their bra that gives a natural shape, or they may choose to use nothing at all.

Microvascular Reconstruction

The surgeon uses a microscope to connect the small blood vessels that feed the tissue that is being transferred with blood vessels at the site that needs reconstruction. These blood vessels are very small. The stitches used to join them are finer than a human hair.

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