The past two decades have witnessed great strides in the treatment of breast cancer, not the least of which has been the dramatic improvements in breast reconstruction following mastectomy.

The two major advances in reconstruction are the use of skin expanders and the flap procedures. An expander is an actual implant that is inflated to a larger than normal size to stretch the surface skin. Several months following the successful expansion procedure, the final and correctly sized implant is inserted.

During the time that the expander is doing its work and gently stretching the skin, it creates a natural fold under the breast which allows for a softer, more natural appearance of the reconstructed breast.

A flap procedure is an operation where the tissue used to reconstruct has its own blood supply, whether the flap is left attached to the body or detached as the case may be in microvascular free flap procedures.

The two most common flaps used for the reconstruction of breasts are the latissimus dorsi flap which involves using a muscle and some skin from the back, on the same side as the affected breast. In the latissimus flap, we still use an implant, but a small one. The TRAM flap reconstructs the breast using lower abdominal skin and fat as well as muscle to build a new breast. This procedure does not use implants. This operation, though, has the added advantage of providing the patient with an abdominoplasty (tummy tuck).

It is important to get in touch with your plastic surgeon prior to going through the initial mastectomy. In this way, he or she will be able to work in concert with the general surgeon as to where the incision should be placed for optimum cosmetic results. Because of this awareness and the close cooperation between general surgeons and plastic surgeons, we have been able to see higher satisfaction levels with the cosmetic appearance of the reconstructed breasts. Unfortunately, in the past and due to lack of foresight, patients were often left with horizontal scars in the cleavage area. This was probably due to the fact that the general surgeon’s task was to treat and remove the disease without much regard to the psychological aftereffects often suffered by patients following such a debilitating surgery. In some cases, it might be even advisable for the plastic surgeon to manage the planning of this conjoint effort from the time the diagnosis is made.

When all these factors are addressed prior to surgery, the artistic and experienced input from the plastic surgeon can result in a very desirable and favorable outcome.