eMedicine Specialties > Plastic Surgery > Breast

Breast Reconstruction, Refinements & Finishing Touches

Author: Mark F Deutsch, MD, Consulting Staff, Department of Plastic Surgery, St Joseph's Hospital of Atlanta
Contributor Information and Disclosures

Updated: Oct 16, 2008

Introduction

Breast reconstruction is rarely considered a 1-stage procedure. Although some surgeons prefer immediate flap and nipple reconstruction during the same initial procedure, most divide this into 2 or more separate procedures. While the initial stage may provide no more than an amorphous mound of soft tissue on the patient's chest wall, refinements and finishing touches may transform this into a breast that can mimic the contralateral breast in terms of contour, symmetry, and projection.

History of the Procedure

Tremendous advances in breast reconstruction have occurred in the past 3 decades. Although breast reconstruction with tissue expanders and implants remains the most common form of reconstruction, autogenous tissue has grown more popular.1 In the past decade, breast reconstruction has advanced because of the popularity of skin-sparing mastectomy.1 When immediate reconstruction is performed following a skin-sparing mastectomy in a nonirradiated breast, the demands on the plastic surgeon are reduced, and the postoperative result is improved in terms of cosmesis.2,3

Problem

"Refinements" and "finishing touches" are generalized terms. Specificity is needed in addressing these topics. The refinements and finishing touches for breast reconstruction with expanders and implants may be far different than those for a transverse rectus abdominis myocutaneous (TRAM) flap for immediate reconstruction or a delayed latissimus flap in an irradiated mastectomy defect.

The deep inferior epigastric artery and vein (DIEP) flap arguably is a refinement of the TRAM flap; likewise, using the internal mammary vessels for a free TRAM flap procedure arguably is a refinement of the traditional use of the thoracodorsal vessels. The following paragraphs discuss some techniques and planning skills for all types of breast reconstruction with the goal of achieving the best result. Although refinements can improve small imperfections in a reconstructed breast, do not rely upon them to correct improper planning of the initial procedure.

For information on breast reconstruction techniques, see the Breast section of eMedicine’s Plastic Surgery journal.

More on Breast Reconstruction, Refinements & Finishing Touches

Overview: Breast Reconstruction, Refinements & Finishing Touches
Treatment: Breast Reconstruction, Refinements & Finishing Touches
Follow-up: Breast Reconstruction, Refinements & Finishing Touches
References
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References

  1. Grotting JC, Beckenstein MS, Arkoulakis NS. The art and science of autologous breast reconstruction. Breast J. Sep-Oct 2003;9(5):350-60. [Medline].

  2. Kroll SS. The value of skin-sparing mastectomy. Ann Surg Oncol. Oct-Nov 1998;5(7):660-2. [Medline].

  3. Chagpar AB. Skin-sparing and nipple-sparing mastectomy: preoperative, intraoperative, and postoperative considerations. Am Surg. May 2004;70(5):425-32. [Medline].

  4. Clough KB, Kroll SS, Audretsch W. An approach to the repair of partial mastectomy defects. Plast Reconstr Surg. Aug 1999;104(2):409-20. [Medline].

  5. Hartrampf CR Jr. Personal communication. 1997-1998.

  6. Vandeweyer E. Simultaneous nipple and areola reconstruction: a review of 50 cases. Acta Chir Belg. Nov-Dec 2003;103(6):593-5. [Medline].

  7. Vásconez HC, Holley DT. Use of the tram and latissimus dorsi flaps in autogenous breast reconstruction. Clin Plast Surg. Jan 1995;22(1):153-66. [Medline].

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Further Reading

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Keywords

breast reconstruction, flap and nipple reconstruction, tissue expanders, breast implants, skin-sparing mastectomy, transverse rectus abdominis myocutaneous flap, TRAM flap, delayed latissimus flap, irradiated mastectomy defect, breast surgery

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Contributor Information and Disclosures

Author

Mark F Deutsch, MD, Consulting Staff, Department of Plastic Surgery, St Joseph's Hospital of Atlanta
Mark F Deutsch, MD is a member of the following medical societies: American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Pankaj Tiwari, MD, Assistant Professor, Division of Plastic Surgery, Ohio State University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Saleh M Shenaq, MD†, Former Director and Founder, The International Brachial Plexus Institute; Former Chief, Section of Plastic Surgery, Methodist Hospital, Houston
Saleh M Shenaq, MD† is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Pediatrics, American Association for Hand Surgery, American Association for the Advancement of Science, American Association of Plastic Surgeons, American Burn Association, American College of Physician Executives, American College of Surgeons, American Congress of Rehabilitation Medicine, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Gene Therapy, American Society of Law Medicine and Ethics, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Trauma Society, Association for Academic Surgery, International College of Surgeons, Lipoplasty Society of North America, Plastic Surgery Research Council, Society for Neuroscience, Society of Surgical Oncology, Southern Medical Association, Texas Medical Association, and Texas Society of Plastic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
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