Breast RECONSTRUCTION & RESTORATION
With a full offering of breast reconstruction options, our physicians specialize in delivering the most innovative treatments, including DIEP, SIEA and SGAP flaps. During these procedures, the surgeon transplants excess abdominal tissue, which closely resembles breast tissue, and achieves results that surpass traditional implants in both durability and form.
Breast reconstruction takes place at the time of the mastectomy. In most cases, surgeons perform skin sparing during mastectomy, a technique that preserves the skin of the breast, and resect only the underlying tumor and affected breast tissue. Often, the nipple is resected because the ducts from which the cancer cells originate exit at the nipple. In this type of breast reconstruction, the volume of the breast, as well as a small skin patch must be restored.
In cases of high likelihood for radiation after mastectomy, reconstruction is usually performed at a later date. The delay is due to the fact that the flap, or tissue used for reconstruction, can adversely and unpredictably be affected during radiation. In this type of reconstruction, entire breast skin and volume are restored.
Breast restoration includes three stages.
- Stage 1: The surgeon performs a flap procedure to reconstruct the breast and restore sensation by microsurgically connecting the sensory nerve of the breast to the sensate nerve of the abdominal tissue. Three to six months following this initial procedure, the nerve grows slowly and offers the possibility of regaining normal sensation.
- Stage 2: Approximately three months following stage 1, the surgeon will perform a secondary symmetry procedure, usually completed in clinic with no hospital stay required. The reconstructed breast is "sculpted" to match the other breast. In many cases, the unaffected breast is lifted for a more youthful appearance.
- Stage 3: In the final stage, the surgeon reconstructs the nipple from flap tissue. The areola is tattooed onto the breast during an office procedure.
Risks and Benefits
Microsurgical reconstruction provides new treatment options with better results for patients affected by breast cancer. As noted, expendable segments of tissue are harvested from the patient and transplanted to restore form, function and sensation to the breast. The major benefit of the new microsurgical procedures is the restoration of a natural appearing breast without the patient losing any muscle from the abdominal or buttock donor site. Patients experience a relatively short hospital stay (four to five days) and can return to normal daily activities after approximately two weeks. Most patients are able to resume exercise and lifting in four to six weeks.
One risk of flap procedures is loss of the flap due to the complexity of the microsurgical techniques required to connect the tiny blood vessels. Flap loss occurs in less than three percent of cases. When an issue arises, the surgeon will perform a re-exploration procedure. All breast reconstruction and breast symmetry procedures, including the SIEA, DIEP, and SGAP, are covered by insurance.
Frequently Asked Questions about the DIEP and SIEA flaps:
Will a reconstructed breast have sensation?
The goal of breast reconstruction is to create a soft, symmetric breast with restored sensation. This can be achieved by microsurgically connecting the sensory nerve of the breast that is severed during mastectomy to the sensate nerve of the abdominal tissue. Over a period of three to six months, the nerve grows slowly and offers the possibility of regaining normal sensation.
What are the major benefits of the DIEP and SIEA procedures over other breast reconstruction procedures?
Unlike the traditional TRAM flap procedure, DIEP maintains the rectus abdominis (or "abs") muscle because the surgeon microscopically separates and harvests only the small blood vessels, leaving the abs intact. The rectus muscle acts as a counterbalance for the spinal muscles, and is important in straight posture as well as sitting activities. The SIEA procedure requires an even more superficial surgical dissection, leaving the deeper muscle layers undisturbed.
Who is a good candidate for these procedures?
DIEP and SIEA procedures can be performed on any patient with adequate abdominal tissue, provided that medical status allows for tissue to be taken from this area. These procedures are not recommended for older patients or those in poor health.
Can procedures be done immediately following mastectomy?
Both DIEP and SIEA flap procedures can be performed immediately after mastectomy or after radiation treatment is completed.
Do insurance companies cover breast reconstruction?
Insurance companies are required by law to cover breast reconstruction procedures after complete or partial mastectomy. This includes breast reconstruction at any time after mastectomy, as well as any surgery on the other breast, if required for symmetry.
How are the nipple and areola restored?
The final stage of breast restoration takes place approximately two to three months after the second stage procedure. Initially, the nipple is reconstructed using flap tissue. Then, the surgeon performs a medical tattooing procedure to restore the color of the areola. Both of these carried out in a doctor’s office.
How are procedural determinations made?
During initial consultation, a Houston Methodist physician will discuss all available options with patients. If a patient is a good candidate for DIEP or SIEA, the surgeon will then determine which flap will be used . This evaluation is made during surgery. Recovery and long-term results are similar for both flap procedures.
What is recovery like in the short- and long-term?
Patients return to normal daily activities after approximately two weeks and are able to resume exercise and lifting after six weeks in most cases.
Immediate single breast reconstruction with DIEP/SIEA: This patient's left breast reconstruction involved a DIEP flap, nipple reconstruction and right breast lift.
Immediate breast reconstruction with sensate DIEP: This patient had a previous left lumpectomy, but had to undergo a left mastectomy due to recurrent cancer. Her left breast was reconstructed at the time of the mastectomy using a Sensate DIEP flap.
Delayed single breast reconstruction with DIEP/SIEA: These patients underwent reconstruction at least six months after completion of their radiation therapy.
Immediate bilateral: This patient underwent reconstruction at the time of her surgery, following a skin-sparing mastectomy.
Delayed bilateral: This patient underwent reconstruction at a later date following a skin-sparing mastectomy.
Combined immediate/delayed: After undergoing a skin-sparing mastectomy for cancer of the right breast, this patient had a preventive left mastectomy at the same time as reconstruction.
Reconstruction using DIEP and implants: This patient's reconstruction utilized both a DIEP flap and implants to match the original volume.
DIEP/SIEA reconstruction with tissue expanders: This patient's reconstruction utilized tissue expanders due to a lack of excess abdominal tissue.
Reconstruction after implant problems: This patient was unhappy with the results of a prior implant-only reconstruction, and opted to have her breast reconstructed using her own tissue.
Will the reconstructed breast be made symmetrical to the existing breast?
Yes, a symmetry procedure is performed approximately three to four months after the initial flap procedure. During the second stage of treatment, the surgeon performs a refinement procedure on the reconstructed breast that can include lifting or reduction of the other breast to achieve optimal balance.
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