Breast Reconstruction After Mastectomy

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Acellular: having no cells, or having had cells removed. Some tissue supports used in breast reconstruction are human or animal tissues which have had the cells removed to reduce the risk of infection or rejection.

Anaplastic large cell lymphoma or ALCL: a rare type of non-Hodgkin lymphoma that might be slightly more common in women who have breast implants. ALCL is not cancer of the breast tissue, but develops in the scar capsule next to the implant.

Anesthesia: the loss of feeling or sensation caused by drugs or gases. General anesthesia puts you into a deep sleep. Local or regional anesthesia numbs only a certain area. Some operations use both.

Areola: the darker area around the nipple of the breast.

Breast conservation surgery: surgery to remove a breast cancer and a small area of normal tissue around the cancer without removing any other part of the breast. The lymph nodes under the arm may be removed, and radiation therapy is often given after the surgery. This method is also called lumpectomy, segmental excision, limited breast surgery, or partial or segmental mastectomy.

Breast implant: a sac used to increase breast size or restore the shape of a breast after mastectomy or partial mastectomy. The sac is filled with sterile salt water (saline) or silicone gel (which can be very thick to nearly solid.)

Breast reconstruction: surgery that rebuilds the breast contour or shape after mastectomy. A breast implant or the woman’s own tissue is used. If desired, the nipple and areola may also be recreated. Reconstruction can be done at the time of mastectomy or any time later.

Capsular contracture: scar tissue that forms around the implant and squeezes it. There are 4 grades of contracture (Grades I - IV) that range from normal and soft to hard, painful, and distorted.

Clinical trials: studies of new treatments in patients. They are only done when there’s reason to believe that the treatment being studied may be of value to patients.

Delayed-immediate reconstruction: see two-stage reconstruction

Delayed reconstruction: reconstructive surgery that’s done later, not at the time of the mastectomy

DIEP (deep inferior epigastric perforator, sometimes called deep inferior epigastric artery perforator) flap: a type of flap procedure that uses fat and skin from the lower tummy wall, but does not use the muscle to form the breast mound.

Free flap: in this kind of surgery the tissue for reconstruction is removed entirely from one area of the body and the blood and nerve supplies are surgically reattached to the chest with microsurgery.

Gluteal free flap or GAP flap: a type of flap procedure that uses tissue and gluteal muscle from the buttocks to create the breast shape. This is a free-flap procedure and requires microsurgery.

General anesthesia: drugs or gases that put you into a deep sleep.

Immediate reconstruction: see one-stage immediate breast reconstruction

Latissimus dorsi flap: this procedure tunnels muscle, fat, and skin from the upper back to the chest to create a breast mound.

Local anesthesia: using drugs to numb only the part of the body undergoing a procedure or surgery so that a patient is more comfortable; the patient generally stays awake.

Lumpectomy: surgery that removes only the breast lump and a rim (margin) of normal tissue around it.

Mastectomy: surgical removal of the breast, and sometimes other tissue. See also segmental mastectomy.

Microsurgery or microvascular surgery: a procedure that uses microscopes and fine surgical instruments to reattach blood vessels and nerves to tissues that have been taken from another area.

Necrosis: cell and tissue death from lack of blood supply to the tissue.

Nipple-sparing mastectomy: procedure that allows the nipple, areola, and much of the breast skin to be preserved during mastectomy to make reconstruction easier. It’s mostly used in patients with small, early-stage breast cancer that’s not near the nipple. A one-time dose of radiation is sometimes used on the nipple tissue to reduce the risk of hidden cancer cells.

One-stage immediate breast reconstruction (also called immediate reconstruction): reconstructive surgery that’s done at the same time as the mastectomy.

Pedicle flap: tissue that’s mostly removed from the donor site, but the blood vessels remain attached and are tunneled from the original site to the area where the tissue is to be attached.

Prosthesis: man-made body part to substitute for one that has been removed, such as an external breast form to fill out a bra cup.

Saline-filled implant: has a silicone shell and is filled with sterile salt water (saline).

Segmental mastectomy (also called partial mastectomy or quadrantectomy): surgery that removes more breast tissue than a lumpectomy; may remove up to one-quarter of the breast.

Silicone filled implants: breast implants filled with an inert, man-made polymer in gel form. Because of its flexibility, strength, and texture, it feels much like the natural breast. Silicone gel breast implants are now available for women who have had breast cancer surgery, but extra follow-up is needed to watch for possible rupture or leak from the implant.

Tissue expander: implanted balloons under the skin and pectoral muscle that are used to keep living tissues under tension. This forms new cells and stretches the tissue. The surgeon puts the expander beneath the skin, and over weeks or months, injects a saline solution to slowly expand the overlying skin to make space for an implant.

Tissue flap reconstruction: tissue for reconstruction that’s surgically removed from another area of the body. It can be a pedicle (left attached to its base and then tunneled) or free flap (cut free from its base and transplanted to the chest).

Transverse rectus abdominis muscle (TRAM) flap: a procedure that uses tissue and muscle from the lower tummy wall to reconstruct a breast mound. It can be a pedicle (left attached to its base and then tunneled) or free flap (cut free from its base and transplanted to the chest).

Transverse upper gracilis (TUG) flap or inner thigh flap: surgery that uses muscle and fatty tissue from along the bottom fold of the buttock extending to the inner thigh to rebuild the breast shape. This is a free-flap procedure and requires microsurgery.

Two-stage reconstruction or two-stage delayed reconstruction: a two-step procedure that’s done if your skin and chest wall tissues are tight and flat. A tissue expander is placed beneath the skin and chest muscle. It’s like a balloon that’s slowly filled with saline over time. It’s surgically replaced with an implant when it expands to full size. This is sometimes called a delayed-immediate reconstruction, because the expander can be placed when the mastectomy is done, but filling it can be delayed until radiation or other treatment is completed.

Last Medical Review: 12/05/2014
Last Revised: 10/20/2015