Breast reconstruction following mastectomy is a deeply personal choice. Reconstruction options span from no reconstruction, to breast mound formation, to complete breast reconstruction with a pigmented nipple. Reconstruction can be immediate (at the time of breast removal) or delayed (after recovery from breast removal). The timing and type of reconstruction options available to the patient are based on a number of factors including tumor location and treatment protocol.
The following images are an artistic representation of procedure results and are intended for educational purposes only. These are not actual patients and are not intended to guarantee results that may be obtained with surgery. Out of respect for patient privacy, Dr. Vial does not publish patient photos on the internet.
Free Flap Reconstruction
Free flap reconstruction is available to patients who have undergone radiation, or patients who do not want or cannot tolerate implants. The breast is reconstructed with the patient’s own tissues from another part of her body. Illustrated is a post mastectomy and radiation patient with extra abdominal tissue.
Free Flap: Procedure
“Free” refers to the donor tissue being apart, or free, from the body, so that it can travel to its final home on the chest to become a breast. The flap is brought back to life by connecting the donor tissue to very small blood vessels in the chest.
Free Flap: Common Types
TRAM: A modified tummy tuck is used to collect donor tissue. Taking muscle can make the abdomen weak and create a bulge (image above).
DIEP: Similar to a TRAM, but leaves the abdominal muscle intact, reducing bulge formation (image below).
Free Flap: Intermediate Result
Following the flap procedure the patient is left with a donor site abdominal scar from hip to hip, a scar for the creation of a new belly button, and a scar where the free flap was inset to make a new breast. The skin island on the reconstructed breast is abdominal skin.
Free Flap: Final Result
If the patient chooses, she can enhance the reconstruction with additional procedures. Depicted is a right sided breast lift preformed to match the reconstructed breast. A nipple reconstruction is done on the reconstructed breast; options include surgical nipple creation with or without areola tattooing for pigment.
Latissimus Dorsi Flap (back muscle/skin flap)
Latissimus dorsi flaps are available to women who have undergone radiation. Radiation can damage breast tissues so that they are too delicate to maintain an implant. Additional support for the implant can be created with a flap from the latissimus muscle and back skin. The flap is tunneled from the back to the chest under the armpit. Once in place the back muscle, back skin, and implant are used to create a breast.
With fat grafting, fat is taken from one part of the body via liposuction and injected into the chest to create a breast. Fat grafting must be done over multiple operations, as the amount of fat “take” following grafting can be as low as 30%. Multiple fat grafting sessions are often needed to achieve desired breast size.