Salt Lake City, Utah Breast Reconstruction after Breast Cancer
Salt Lake City-area women needing breast reconstruction following breast cancer surgery can find artful, natural results with Dr. Reuben. There are a number of breast reconstruction options for women who have undergone lumpectomy (breast-conserving cancer removal) or mastectomy (full breast removal).
Dr. Reuben can reconstruct breasts using either artificial implants or a patient's own tissue. During consultation, Dr. Reuben will help you determine which breast reconstruction technique is right for you based on your unique body type, preferences, and the state of your body following breast cancer surgery.
For post-mastectomy patients in particular, several procedures may be needed to fully complete breast reconstruction.
Free Flaps—DIEP & TRAM, SGAP & IGAP, SIEA
Autologous reconstruction uses "flaps" of a woman's own tissue to reconstruct the breast. Skin, fatty tissue and on occasion, muscle is transferred from one area of the body to the breast area. The breast mound is then sculpted to appear as aesthetically normal as possible. Dr. Reuben's superior microvascular skills allow him to transfer free flaps with remarkably natural results.
Using free flaps for breast reconstruction can give Salt Lake City women a more natural look and feel than an implant. While one positive of using the abdominal tissue is the improved contour of the abdomen with a "tummy tuck" incision, a drawback to free flap reconstruction, an additional area that must heal in the recovery process.
DIEP Flap and TRAM Flap
The TRAM (transverse rectus abdominis musculocutaneous) flap reconstruction procedure uses tissue from the lower abdomen to reconstruct the breast. Tissue from part of the stomach muscle is transferred as well. The TRAM procedure leaves a scar across the abdomen and tends to compromise abdominal muscle strength.
DIEP (deep inferior epigastric perforator) flap reconstruction improves upon the TRAM procedure because it spares all abdominal muscle. Instead, it restores the breast using skin and fatty tissue from the lower abdomen and blood vessels from under the abdominal muscles. This effectively results in a "tummy tuck". While it leaves a minor abdominal scar, it also improves the abdominal contour and preserves full abdominal strength. The DIEP flap is ideal for Salt Lake City women with an active lifestyle as well as those who have undergone double mastectomy. It is Dr Reuben's preferred method of breast reconstruction as the anatomy permits.
SGAP Flap and IGAP Flap
SGAP (superficial gluteal artery perforator) and IGAP (inferior gluteal artery perforator) flaps are often used when there isn't enough lower abdominal skin and fat to use for breast reconstruction. Instead, skin and fat from the buttocks and hips are collected without compromising the underlying muscle tissue. SGAP flaps come from the upper buttocks and hips, while IGAP flaps come from the lower buttocks and hips.
Following removal of the fatty tissue, the closure and any resulting minor scars can be concealed within the lines of undergarments.
Similar to the DIEP procedure, SIEA (superficial inferior epigastric artery) flap reconstruction takes fat and skin from the lower abdomen. However, SIEA reconstruction uses a distinctive blood supply that leaves the abdominal blood vessels untouched. Not all women have an adequate supply of vessels for this procedure. If a patient does not have enough SIEA vessels, she can undergo DIEP reconstruction instead.
The latissimus flap procedure involves taking skin and muscle (the latissimus dorsi muscle) from the upper back to create a new breast mound. Depending on the patient, this procedure may also require a small breast implant in addition to the tissue flap. An advantage of the latissimus flap procedure is that the transplanted skin tends to closely match the skin color of the breast. Additionally, the reconstructed breast will feel warm and somewhat flexible.
Expander and Implant Reconstruction
A tissue expander is a temporary device that is placed inside the chest muscle. The expander creates a pocket that will later contain a permanent implant. Tissue expanders come in many shapes and sizes. When the expander is first placed in the chest wall, it is partially filled with saline. A few weeks thereafter, the expansion process can begin at regular Salt Lake City office visits, during which saline is injected through a port in the expander. Expansions occur at one, two, or three week intervals over the course of several months. The number of expansions needed depends on the amount of fluid that is originally placed in the expander and the ultimate goal for the size of the breast.
Once expansion is complete, the expander is replaced with an implant, which creates a more refined breast shape. This is done in an outpatient procedure requiring one to two hours in the operating room.
Nipple reconstruction is usually performed along with breast reconstruction on women who have undergone a mastectomy. It recreates the nipple and surrounding areola tissue, or the nipple-areola complex. Using a patient's own chest tissue, Dr. Reuben carefully forms a "nipple mound". A medical tattoo artist then slightly darkens the areola surrounding the nipple to give it a natural appearance. Nipple reconstruction is generally the final step of breast reconstruction surgery.
The photos in this website feature models and are for illustrative purposes only, unless otherwise noted.