What will happen during breast reconstruction surgery?

The Process for Silicone Implants 

If you are having breast reconstruction with a silicone implant or implants, your surgeon might recommend first placing a tissue expander into your chest area to make room for your new breast. The tissue expander, which stretches the skin and soft tissue, is a balloon-like device that your surgeon can place either behind or in front of your chest muscle. Once it’s in place, saline will be injected into the expander through a valve in your skin over the next few months. That will stretch the skin in increments over time. When the tissue is ready, your surgeon will perform a second surgery, replacing the expander with your breast implant, forming your new breast. 

But if you are having breast reconstruction with implants only, and no tissue expander, your surgeon will place a breast-shaped silicone pouch, filled with either silicone gel or saline, either behind or in front of your chest muscle and that will form your new breast.

The Process for Using Your Own Tissue 

There is a separate set of processes your surgeon will follow if you are having a breast reconstruction using your own tissue. The various techniques are listed below.

Abdominal Tissue 

  • Abdomen (pedicle transverse rectus abdominis muscle): Your surgeon uses the skin, fat, blood vessels, and muscle from your abdomen and tunnels under your skin, through your body to the front of your chest, where your new breast is created. In this method, the tissue stays attached to its original blood supply.  
  • Abdomen (free transverse rectus abdominis muscle): Your surgeon moves tissue—but less muscle—from the lower abdomen to the front of your chest to create your new breast. In this method, the tissue is detached so your blood vessels must be reattached, which requires microsurgery in which a microscope is used to connect the tiny vessels.
  • Abdomen (deep inferior epigastric perforator): Your surgeon moves fat and skin—but no muscle—from your abdomen to the front of your chest to create your new breast. While this method relocates the same tissue from the lower abdomen as the procedures described above, the tissue is detached so the blood vessels must be reattached. This requires microsurgery to connect the tiny vessels. (There is also a less-invasive version of this technique. It involves using the same abdominal tissue but it uses blood vessels that aren’t as deep in your abdomen.)

Back Tissue 

  • Back (latissimus dorsi): Your surgeon uses skin, fat, and muscle from your upper back and tunnels it under the skin to the front of your chest to form your new breast. In this method, the tissue stays attached to its original blood supply. In some cases, this procedure can include a breast implant.

Gluteal Tissue

  • Buttocks (gluteal artery perforator or gluteal free): Your surgeon uses tissue—but no muscle—from the buttocks to create your new breast. The skin, fat, and blood vessels are detached from the buttocks and moved to the front of your chest, where your new breast is formed. This also requires the use of microsurgery to connect the tiny vessels.

Thigh Tissue

  • Thigh (transverse upper gracilis): Your surgeon uses tissue from your inner thigh to create your new breast. Your skin, muscle, and blood vessels are detached from your thigh and moved to the front of your chest where your new breast is formed. This also requires the use of microsurgery to connect the tiny vessels. (A similar procedure, called a profunda artery perforator flap, does not remove muscle from your thigh.)

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