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Breast Surgery

Breast Reconstruction

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Microsurgical Breast Reconstruction

With microsurgical breast reconstruction, the patient's own tissue (autologous-based reconstruction) is used to restore the breast after cancer. This contributes to achieving a more natural appearance. This method uses a free flap approach whereby the patient's own tissue is taken from the abdomen and placed in the chest area, using microsurgery to reconnect the tiny blood vessels.

Microvascular breast reconstruction includes:

Deep Inferior Epigastic Perforator (DIEP) Flap

In this procedure, plastic surgeons perform a tummy tuck and use the skin and fatty tissue from the abdomen to make a new breast. This technique has evolved over the past 3 decades from using all of the abdominal muscles, to its current minimally invasive form where the muscles are preserved resulting in less pain, faster recovery, and better long term abdominal strength.

In certain cases, surgeons can also increase the sensitivity of the breast through nerve transfer. During a mastectomy the nerve supply to the breast is partially removed and the breast becomes numb, by using natural tissue with its own nerve supply some sensation can be regained.

Lymph nodes can also be transferred at the time of surgery. This may be recommended for patients who previously have had an implant based reconstruction that has failed or who have had radiation therapy resulting in lymphedema (fluid build-up) in the underarm (axillary area). In these cases, the surgeon can transfer some lymph nodes from the abdominal tissue to the axillary area. Early studies have shown that this can decrease the fluid build-up

"The benefit of autologous tissue such as the DIEP flaps is that it replaces the breast tissue with similar tissue. The breast is made up of mostly fatty tissue and the DIEP flap is fatty tissue from the abdomen, therefore it feels more natural and integrates seemlessly with your body. As the body changes with time, the DIEP flap changes in a similar fashion; if weight is lost it will shrink, if weight is gained it will grow. Long term complications which can occur with implant based reconstructions do not occur. There are no issues with capsular contracture because the tissue is the patient's own and in the rare incidence of an infection it does not require a surgery as it can be treated with antibiotics. However, not everyone is a candidate for autologous reconstruction, but this should be discussed in consultation with your plastic surgeon." David Otterburn, MD

Posterior Artery Perforator Flap or TRAM Flap If the abdomen does not provide enough tissue to reconstruct the breast, tissue may also be used from underneath the patient's buttocks or from the posterior thigh.

"Our objective is to use donor tissue sites that are beneficial and inconspicuous and can enhance the aesthetic appearance and overall well-being of the patient," says Jason A. Spector, MD, Assistant Professor of Surgery (Plastic Surgery).

To help ensure the best possible outcome and minimize complications from poor blood flow to the breast tissue associated with breast reconstruction, Weill Cornell surgeons are using SPY -- an intraoperative imaging technology that allows surgeons to evaluate the quality of blood flow and circulation during surgery.

In patients whose nipple or areola cannot be preserved, our surgeons can reconstruct the nipple and/or areola using their own tissue followed by tattooing for a more natural appearance.

Revision or Secondary Breast Reconstruction The Breast Center can also offer revision breast reconstruction using microvascular techniques and tissue or fat transfer for patients who are not satisfied with their previous breast reconstruction or who have damaged tissue from radiation therapy.

Breast Reconstruction with Fat Transfer

Weill Cornell plastic and reconstructive surgeons are now using a novel approach called lipofilling, which involves taking fat from one area of the body, such as the abdomen, and using it to correct small defects or asymmetry during breast reconstruction. This is accomplished without any internal skin expanders or implants. Liposuction is performed to obtain fat cells that are then laid onto the breast. After the patient heals, an external expander, which looks like a suction cup, applies a negative force to create a stable platform for the reconstructed breast.

Implant-Based Reconstruction

Implant-based reconstruction involves the use of a tissue expander that is placed under the skin and chest muscle. Over four to six months, the surgeon injects a solution through a small valve under the skin to fill the expander, which in turn, stretches the skin to ready it for an implant.

The most common implant is a silicone shell filled with a sterile saline (salt water) solution. Silicone gel-filled implants are another option for breast reconstruction. Newer types of silicone implants use a thicker gel for safety purposes and are currently available through clinical trials.

Oncoplastic Reduction Surgery

In 2005, Weill Cornell Breast Center Surgeons pioneered a new surgical option for breast cancer patients that combines removal of the cancerous tumor with breast reduction in one surgical procedure. The benefits of oncoplastic reduction surgery include reduced risk of complications and improved cosmetic outcome. The procedure is designed for large-breasted women who have breast cancer and who experience back and neck pain associated with having large breasts. The reduced breasts retain sensation and have the potential ability to produce milk. The rates of cancer recurrence and survival with this type of oncoplastic surgery are equivalent to those of traditional breast cancer surgery. In addition, radiation therapy for large-breasted women brings complications that include skin breakdown, chronic swelling, and tenderness. By performing breast reduction, these complications are greatly reduced.

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