Breast Reconstruction - Breast Mastectomy, Autologous, DIEP - UCLA
Clinical Update
 Free-flap microsurgery breast reconstruction offers dramatic advantages
Free-flap microsurgery — transferring a patient’s own tissues at the time of mastectomy with minimal or no muscle loss — is the most significant recent advancement in breast reconstruction.
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If you have been told that you will need, or if you have already undergone a mastectomy, breast reconstruction may be an option for you.
Breast reconstruction is a series of operations designed to recreate your breast to its original shape. The initial step in breast reconstruction is to evaluate the proposed or existing changes to your breast due to a mastectomy. The types of changes that often occur are the loss of skin surface, breast volume, the nipple, symmetry and contour. As you are already aware, being faced with the diagnosis of breast cancer forces you as a patient to make numerous difficult choices. Breast reconstruction is no different and is similar to an unfamiliar road with many different routes available. Although your physicians are there to help will guide you along the way by explaining the options, you must make the final decisions, which will direct you down the path best suited to your situation.
 Your first choice is whether or not to proceed with ANY reconstruction. For hundreds of years, mastectomies were performed without any chance of reconstruction. In fact, for a number of reasons, most women in the United States who undergo mastectomy DO NOT undergo reconstruction. The breast is removed and the remaining skin is simply closed. For many women, this option remains the most expeditious, safe, and reasonable choice. The missing breast tissue can be disguised with clothing or by inserting foam pads into a special bra - - this is called a "bra prosthesis". This method can be looked at as the "full assault war approach": the object of the game is to eradicate the enemy (the cancer) quickly with maximal survival, fast recovery and minimal casualties (the ability to move on with one's life very quickly. The disadvantage of NOT undergoing reconstruction, however, is obvious...the mastectomy defect is quite deforming and oftentimes disturbing to some patients.
Our experience in counseling many patients over the years reveals that all patients have a different sense of body image and importance. The question of whether or not to proceed with reconstruction is a very personal one that must be answered by each patient individually. For some patients, mastectomy without reconstruction is not a viable option as they are uncomfortable with the appearance of their body after the mastectomy and wish to pursue surgery as a means of regaining a more natural breast appearance.
When should you undergo breast reconstruction?
There are two paths to choose from when deciding to have reconstructive surgery.
Breast reconstruction may begin at the time of the mastectomy, in which case is known as "immediate breast reconstruction" or weeks, months, or years thereafter, also known as "delayed" reconstruction.
What are the advantages of immediate reconstruction?
Reconstructing the breast immediately following the mastectomy avoids additional operations and general anesthesia at a later date. Furthermore, the reconstructive process is generally easier due to the absence of scar tissue from prior surgeries with the breast skin retaining the size and shape of the original breast.
In our experience, immediate reconstruction has had no impact on the timing of postoperative chemotherapy or radiation therapy. This is important, as it means that in general, undergoing immediate reconstruction does not delay the necessary therapy for treating the cancer. There are, however, select cases where immediate reconstruction is not recommend. An example would be "inflammatory carcinoma" or widely metastatic disease that is not controlled by chemotherapy. Additionally, delayed reconstruction may be advisable if you as a patient need more time to make the numerous critical decisions associated with your disease or your surgeon anticipates other problems with the control of the cancer, wound healing problems, personal preferences, etc. Here again, it is imperative that you work with doctor to understand the pros and cons for all the available options so that you can select the optimal path for your situation.
What are my reconstructive choices?
If you decide to pursue reconstructive surgery, you must then decide between a breast implant, known as a prosthesis, or autologous tissue flaps (the use of your own tissue from another part of your body).
Autologous ( Flap ) Reconstruction
Autologous reconstructions can appear more natural than implant reconstructions and tend to be more durable over time, allowing patients to avoid revision operations.
The DIEP (deep inferior epigastric perforator) Flap Surgery
Surgeons remove only skin and fat from the patient, sparing the abdominal wall muscles, which results in a shorter recovery time. Surgeons may opt to perform this procedure instead of the more conservative TRAM flap procedure if a woman's anatomy and blood vessel quality are deemed appropriate.  Read more about breast reconstruction (PDF)
 View breast reconstruction surgery in 3D
Los Angeles plastic surgeons from UCLA Plastic Surgery offer all aspects of plastic surgery including breast lifts, breast augmentation, breast reduction, information about breast implants, breast reconstruction, and more. View before and after photos of these plastic surgery procedures, learn more about cosmetic surgery and schedule a consultation today.
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