Breast Reconstruction

Breast cancer is a traumatic event for any woman and her family. The prospect of having breast surgery or even removal of the breast (mastectomy) can lead to significant anxiety. Dr. Miranda is skilled in all types of breast reconstruction surgery and is happy to discuss these options with any woman.

Implant Breast Reconstruction
Autologous (Flap) Breast Reconstruction (e.g DIEP or TRAM)
Other Breast Reconstruction Options
Second Opinions
Other Breast Procedures

Breast reconstruction can be done for both partial (lumpectomy) and complete removal (mastectomy) of the breast. In most cases it is possible to do the reconstruction surgery at the same time as the cancer is removed. Alternatively, based upon patient choice and/or expected treatment, breast reconstruction can be delayed until a later date.

Implant Breast Reconstruction

There are numerous choices for breast reconstruction. The basic choice is whether the woman desires to use her own tissues (autologous reconstruction) or to use an implant. This choice is not easy for many women. Implant reconstruction has the advantages of a much shorter operation and generally less pain than autologous reconstruction. However, in some cases, the final outcome does not look or feel as natural as one’s own tissue would. However, implant reconstruction is the most popular method nationwide due to the rapidity of recovery.

Autologous Breast Reconstruction: The TRAM and DIEP Breast Reconstructions

The breast can be reconstructed with a variety of the woman’s own tissues. Two of the most popular methods are the TRAM flap (Transverse Rectus Abdmominis Musculocutaneous flap) and the DIEP flap (Deep Inferior Epigastric artery Perforator flap). Both of these flaps use excess tissue from the woman’s abdomen to reconstruct the breast. There are two major differences between the TRAM and the DIEP flaps. The standard TRAM flap sacrifices one of the woman’s two rectus abdominis muscles (the “six-pack” muscles) which remains attached to the skin and fat to provide its blood supply. The muscle and abdominal tissue are tunneled under the skin to the chest where it is used to reconstruct the breast. There are generally minimal functional consequences of sacrificing one rectus muscle, but occasionally there is some weakness of the abdominal wall.

The DIEP flap does not sacrifice the rectus muscle or use it for blood supply. When Dr. Miranda reconstructs a breast with the DIEP flap, he meticulously separates the blood vessels that feed the tissue being used to reconstruct the breast from the rectus muscle. The entire flap (the skin and fat to be used in the reconstruction) is completely separated from the body and then the blood vessels are re-attached in the chest using advanced microsurgical techniques to allow blood and nutrients to feed the new breast.

When the reconstructed breast is made of natural fat and skin, it generally feels much more soft and natural than a breast reconstructed with an implant. Particularly when combined with skin-sparing mastectomy or nipple-sparing mastectomy, the best overall results can be achieved with the TRAM or DIEP flaps. Dr. Miranda is happy to recommend several breast cancer surgeons who are skilled in skin-sparing mastectomy and nipple-sparing mastectomy to each woman he sees in consultation for breast reconstruction. An added advantage of choosing a TRAM or DIEP flap reconstruction is that the excess tissue removed from the abdomen to reconstruct the breast gives a result similar to a tummy-tuck (abdominoplasty).

Other Options

A variety of other options for breast reconstruction is available which may be appropriate in certain situations. These options include combined implant and flap reconstruction, the latissimus dorsi flap, the gracilis free flap, the free-TRAM (similar to the DIEP), and gluteal free flaps (e.g. the SGAP flap from the buttocks). Dr. Miranda discusses the pros and cons of each of these options with his patients.

Second Opinions

Dr. Miranda understands that breast surgery is a very personal and often complicated decision. He is happy to assist each woman in consultation as a second opinion.

Other Breast Procedures

Often additional procedures are performed in the context of breast reconstruction in order to achieve the best result possible. These include:

Edward P. Miranda, M.D.
A Medical Corporation

3838 California Street, Suite 404
San Francisco, CA 94118
(415) 379-9015

Info@MirandaPlasticSurgery.com

Board Certified by the American Board of Plastic Surgery