Below you will find two tables intended to summarize information contained in this site. The two tables are:
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No Reconstruction |
Implant Reconstruction |
Natural Tissue Reconstruction |
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Prothesis |
No Expansion |
With Expansion |
TRAM Flap |
Latissimus Flap |
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Indications |
All patients who have had a mastectomy |
Patients with very small breasts who have had a mastectomy Very thin women who may not have enough excess abdominal tissue for a TRAM procedure |
Most patients who have had a mastectomy Very thin women who may not have enough excess abdominal tissue for a TRAM procedure |
Most patients who have had a mastectomy Patients in whom alternate methods of breast reconstruction have failed |
Most patients who have had a mastectomy Patients who lack excess abdominal tissue or who have had certain previous abdominal incisions |
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Contraindications |
None |
Patients who do not have adequate soft tissue or skin left after the mastectomy to safely cover the implant |
Patients who do not have adequate soft tissue or skin left after the mastectomy to safely cover the implant Patients who have had a mastectomy followed by aggressive postoperative radiation |
Patients who have had certain previous abdominal incisions Smokers Patients with significant pre-existing health problems |
Caution should be used if the thoracodorsal vessels have been ligated during an axillary dissection |
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Timing |
Can be used after the mastectomy site has healed (usually after a few weeks) |
The implant can either be inserted at the time of the mastectomy or anytime later |
A tissue expander is usually inserted at the time of the mastectomy Can be done anytime after the mastectomy Several weeks are needed for expansion before the permanent implant can be inserted |
The procedure can either be performed at the time of the mastectomy (i.e. immediate) or anytime after (i.e. delayed) |
The procedure can either be performed at the time of the mastectomy (i.e. immediate) or anytime after (i.e. delayed) |
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Scars |
No additional scars |
No additional scars |
No additional scars |
The breast scar becomes an ellipse and a new horizontal scar from hip to hip in the “panty line” is produced |
The breast scar becomes an ellipse and a new diagonal scar is produced on the back |
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Advantages |
A natural breast shape under clothes A more "balanced" look No additional surgery required |
As compared to natural tissue reconstruction: A shorter operative procedure, hospital stay, and recovery time Produces a predictable breast shape Fewer scars |
As compared to natural tissue reconstruction: A shorter operative procedure, hospital stay, and recovery time Produces a predictable breast shape Fewer scars |
The reconstructed breast is made of natural tissue No exposure to synthetic materials (i.e. breast implants) Patient gets a “tummy tuck” in the process |
May be a safer option for patients who are high-risk candidates for the TRAM procedure The blood supply is highly dependable No abdominal complications |
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Disadvantages |
May be heavy, feel hot, and move around inside the bra May need to wear a special bra. May be less convenient to do certain things while wearing a prosthesis Possibly less comfortable in revealing clothes |
May give a less natural breast shape and/or feel The implant may migrate, rupture, or form a capsular contracture |
May give a less natural breast shape and/or feel The implant may migrate, rupture, or form a capsular contracture The expansion process is time consuming and may be inconvenient The process requires more than one operation The final breast shape is not immediate |
It is a long surgical procedure May have decreased abdominal strength afterwardThe procedure leaves an additional abdominal scar It can be difficult to predict exactly what the new breast will look like |
Most individuals will require the addition of a breast implant A large and noticeable scar on the back A small proportion of patients may have less strength in their arm or shoulder |
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Risks |
None |
The implant may migrate, rupture, or form a capsular contracture |
The implant or tissue expander may migrate, rupture, or form a capsular contracture |
Possible asymmetry of the new breast Possibility of partial or total flap loss May have weaker abdominal muscles Abdominal hernias are possible later Fluid collections (i.e. seromas) may need to be drained |
Possible asymmetry of the new breast Fluid collections (i.e. seromas) may occur in the back area Possibility of arm or shoulder weakness If a breast implant is used, it may migrate, rupture, or form a capsular contracture |
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Recovery Time |
No additional recovery time required |
Usually may resume regular activities after about one week Two to four weeks before resuming more strenuous activities or returning to work |
For both the tissue expander and breast implant insertion: Usually may resume regular activities after about one week Two to four weeks before resuming more strenuous activities or returning to work |
May resume some arm exercises 2 to 3 weeks postoperatively
A full recovery is expected within a few months |
May resume some arm exercises 2 to 3 weeks postoperatively |
Summary of Possible Procedures After the Breast Reconstruction
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On the Reconstructed Breast |
On the Opposite Breast |
On the Abdomen |
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Nipple/Areola Reconstruction |
Breast Reduction |
Breast Lift |
Breast Augmentation |
Umbilicus Reconstruction |
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Indications |
Any woman who has had a breast reconstruction |
Any woman with large breasts |
Any woman with ptotic (i.e. droopy) breasts |
Any woman with small breasts |
Any woman who has had their umbilicus (i.e. “belly button”) removed during a TRAM flap |
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Contraindications |
None |
None |
None |
None |
None |
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Timing |
Usually done at least 3 months after the breast reconstruction |
Can be done at the time of the breast reconstruction Most commonly done months after the breast reconstruction |
Can be done at the time of the breast reconstruction Most commonly done months after the breast reconstruction |
Can be done at the time of the breast reconstruction Most commonly done months after the breast reconstruction |
Most commonly done at the time of the breast reconstruction, but can be done anytime after |
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Scars |
Nipple reconstruction: Small scars around the nipple area and possibly in areas from where a graft was harvested Areola reconstruction: No scars with tattooing Small scars around the areola and in distant donor areas with graft reconstructions |
Most commonly, a scar is produced around the areola, from the areola to the underside of the breast, and along the underside of the breast |
In all cases, a scar encircles the areola Most commonly, a scar is also produced from the areola to the underside of the breast and along the underside of the breast |
A small 3 to 4 cm linear scar is produced in the area that the breast implant is inserted from |
Small scars are produced in the area of the new umbilicus |
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Advantages |
More closely matches a natural breast shape |
More closely matches the size of the reconstructed breast May relieve back or shoulder strain |
More closely matches the size of the reconstructed breast Produces a higher and firmer breast |
More closely matches the size of the reconstructed breast |
Creates a new umbilicus in the midline |
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Disadvantages |
It is an additional operation which produces more scars Minimal or no sensation in the new nipple |
It is an additional operation which produces more scars |
It is an additional operation which produces more scars |
It is an additional operation which produces more scars |
It is an additional operation which produces more scars The new umbilicus may not exactly look like the original |
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Risks |
Possibility of loss of the new nipple |
The nipple area may be numb afterward May interfere with breast feeding |
The nipple area may be numb afterward May interfere with breast feeding |
The breast implant may migrate, rupture, or form a capsular contracture |
Minimal risk |
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Recovery Time |
May resume normal activities within a week or two |
May resume normal activities in 3 to 4 weeks |
May resume normal activities in 2 to 3 weeks |
May resume normal activities in 2 to 3 weeks |
May resume normal activities within a week or two |