Mark Burke Plastic Surgery, Logo

American Board of Plastic Surgery Logo American Society of Plastic Surgeons American Head & Neck Society Logo American College of Surgeons Logo

For Appointments Call: (716) 898-5530

To Speak with our Office Call: (716) 898-3073

Breast Reconstruction

Reconstruction of the breast usually follows partial or complete removal of the breast(s) secondary to cancer. There are many options for breast reconstruction regarding the type of reconstruction (autologous vs. tissue expanders and/or implants), technique, and timing. Many patients will tell us that they “just want the one that’s the best” in an attempt to simplify the process. Unfortunately, there is not a “best” option per se and only with thorough examination and consultation including consideration of a patient’s medical history, surgical history, and goals for reconstruction can the best option for you be elucidated. Breast reconstruction can be simplified by first breaking it into three broad categories: expander/implant and autologous (using the patient’s own tissue to reconstruct the breast) as well as a hybrid of the two.  

Tissue expander/implant reconstruction involves using prosthetic devices to recreate the breast mound. A tissue expander can be placed at the time of mastectomy or at a later date. The tissue expander is essentially a balloon that gets completely buried in the footprint of the breast or breasts to be reconstructed. Once implanted , the wounds are allowed heal for approximately 1 month, following which the expansion process starts.  Expansion involves slowly adding fluid to the tissue expander to allow for stretching of the remaining breast skin to create a pocket in which to eventually place a permanent implant. The patient comes into the office once per week, and a small amount of fluid added to the expander each time until the desired volume is reached. This usually takes 2-3 months depending on the amount of fluid that can be added comfortably each time and the breast volume desired. Following the completion of expansion, the breast is allowed to “rest” for at least 3 months to give a more permanent stretch of the tissue, after which the patient is brought back to the operating room for removal of the tissue expander(s) and placement of the permanent implant(s). This process involves small steps spaced out over time with shorter operations and little (if any) time admitted to the hospital. There is no surgery anywhere other than the breasts, and therefore no pain or risk of complications outside of the breasts. Some potential downsides to expander/implant reconstruction include risk of malposition (implant not in good position), and exposure or infection of the device. These may require unplanned additional operations to correct. Patients understand that complication rates are high using this form of reconstruction in for those who smoke cigarettes or have had radiation, and while many surgeons will still perform this operation in these cases I typically advise patients against it.

Autologous reconstruction involves the use of the patient’s own tissue to reconstruct the breast, with no implants. There are several choices for tissue to be transferred but in our hands the abdomen is overwhelmingly the most common site. This form of reconstruction involves the harvesting of the lower abdominal skin and fat (similar to what would be removed in a “tummy tuck” operation) and varying amounts of rectus muscle depending on the case (no muscle is typically included and a DIEP (Deep Inferior Epigastric artery Perforator) flap is our technique of choice). This operation is longer (5-8 hours in our hands), and involves a hospital stay on average about 5 days and can be performed at the time of mastectomy or at a later date. Advantages are mainly the lack of a prosthetic device which removes much of the concern of infection, and that this form of reconstruction tends to hold up better over time. The biggest concern with this form of reconstruction involves blood supply to the transferred tissue, which if inadequate can result in partial or complete necrosis of the reconstructed breast. If there is major tissue loss it is possible another reconstruction utilizing another technique would need to be performed. Additionally it is possible to have complications at the abdominal donor site.

A third reconstructive category can be included that is a hybrid of expander/implant and autologous.  This involves the rotation of latissimus dorsi muscle with its overlying skin from the back, tunneling it forward into the breast defect. There is not enough volume with this flap alone and it usually requires the addition of an implant as well to provide enough fullness to the breast. This is an excellent reconstructive option both as a primary option as well as a salvage option following complications of other methods of reconstruction.  This is our go-to option for patients who desire expander/implant reconstruction but have had (or will require) radiation therapy. 

The biggest concern with this form of reconstruction involves blood supply to the transferred tissue, which if inadequate can result in partial or complete necrosis of the reconstructed breast. If there is major tissue loss it is possible another reconstruction utilizing another technique would need to be performed. Additionally it is possible to have complications at the abdominal donor site.

A third reconstructive category can be included that is a hybrid of expander/implant and autologous. This involves the rotation of latissimus dorsi muscle with its overlying skin from the back, tunneling it forward into the breast defect. There is not enough volume with this flap alone and it usually requires the addition of an implant as well to provide enough fullness to the breast. This is an excellent reconstructive option both as a primary option as well as a salvage option following complications of other methods of reconstruction. This is our go-to option for patients who desire expander/implant reconstruction but have had (or will require) radiation therapy.