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Breast Reconstruction

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Breast reconstruction surgery by Dr. Waitze restores the appearance of a woman’s breast, usually after mastectomy for breast cancer. There are several breast reconstruction options available ranging from implants to “autologous” techniques which use the patient’s own tissue to recreate a “natural”, warm, soft breast. The nipple and areola (the darker area surrounding the nipple) can also be restored.

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Immediate vs. Delayed Reconstruction

Breast reconstruction surgery can be performed as an “immediate” or “delayed” procedure. As the term implies, immediate reconstruction is performed immediately after the mastectomy while the patient is still under anesthesia. Once the general surgeon has completed the mastectomy, the plastic surgeon begins creating the new breast. Advantages of this approach include preservation of most of the breast skin (“skin sparing mastectomy”) and a shorter scar. The patient also wakes up “complete” and avoids the experience of a flat chest.

Delayed reconstruction generally takes place several months or years following mastectomy. It is important that patients discuss all treatment options with both their general surgeon and plastic surgeon to determine the best treatment plan.

Latissimus Dorsi

The Latissimus Dorsi is a tissue flap procedure that uses muscle and skin from your back to create a new breast mound after a mastectomy. An ellipse of skin and your Latissimus Dorsi muscle will be tunneled from your upper back to your mastectomy area to create your reconstructed breast. Because the Latissimus Dorsi flap is usually thinner and smaller than the tram flap, this procedure may be more appropriate for reconstructing a smaller breast. The Latissimus Dorsi muscle flap may also be used in conjunction with a tissue expander for additional volume.

Latissimus Dorsi

Images from BreastCancer.org

Tissue Expander

Tissue Expanders are designed for use in two-stage breast reconstruction. Depending on whether one is dealing with an immediate or a delayed reconstruction, the tissue expander is either placed at the time of the mastectomy or during a subsequent procedure. As the tissue expander fills, the tissues over the expander begin to stretch, similar to the gradual expansion of a woman’s abdomen during pregnancy. The tissue expander creates a new breast-shaped pocket for a breast implant. The tissue expander is replaced with a permanent saline or silicone implant after it has been completely expanded.


The TRAM flap (transverse rectus abdominus myocutaneous) is a tissue flap procedure that uses muscle, fat and skin from your abdomen to create a new breast mound after a mastectomy. Most women have enough tissue in their abdomen area to create a new breast. But if there is not enough tissue, a small implant can be placed to fill out the size of the new breast. Two methods are used to move your tissue from your tummy to your chest — free flap and pedicle flap.

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For more information on Breast Reconstruction, visit the American Society of Plastic Surgeon’s website and Breast Reconstruction Matters website by Life Cell.