One in eight women in the United States will be diagnosed with breast cancer and the loss of a breast after breast cancer surgery can be psychologically devastating for any woman. However, advances in early detection of breast cancer and better techniques for breast reconstruction have dramatically improved not only survival rates, but the overall quality of life for these women. I feel that breast reconstruction is one of the most rewarding aspects of plastic surgery because it allows the reconstruction what cancer has taken away. Breast reconstruction is typically accomplished in one of three ways: an implant, use of the back muscle (latissimus dorsi) with an implant, or using the stomach fat (TRAM flap).

Implant reconstruction is a staged procedure, meaning that the final result requires several operations. Due to the nature of the mastectomy operation, there is a deficiency of skin which will not permit immediate implant reconstruction. A tissue expander must, therefore, be placed into the mastectomy skin flap. This expander is gradually expanded over time to accommodate later placement of a permanent implant. This option has become significantly more attractive due to our ability to use the newly redesigned silicone implants.

An alternative to the sole use of an implant for reconstruction is to use the muscle and skin of the back to fill the acquired tissue deficiency. This tissue coupled with an implant results in adequate post-operative breast volume. This technique is more invasive but can be accomplished in a single operation. Additionally, the fat and skin from the abdomen can be used to reconstruct the breast with the added benefit of partially thinning the abdomen. The method of reconstruction is highly specific for each individual patient is influenced by patient factors such as previous abdominal surgeries, smoking, or the need for postoperative chemotherapy or radiation.