Dr. Daniel Enjay Wong, MD

There are a few different methods used to create the round shape of the breast on the chest. A flap of fat, skin, and muscle can be taken from the side, abdomen or buttock and implanted on the chest to create a breast from the patient's own tissue. Alternatively, the skin over the chest may be gradually stretched to allow for the placement of an implant. Stretching of the skin is done using expanders, which are similar to breast implants, except they increase in size when saltwater solution is injected into them. Many women also choose to combine the flap procedure with implant placement to achieve their desired result. Once the new breast shape is formed, a nipple can be created and even tattooed to match the other side.

Reconstruction may be done in a single surgery or broken up into multiple procedures:

• Immediate reconstruction rebuilds the breast right after mastectomy. This method is not recommended if additional chemotherapy or radiation is needed after surgery.
• Delayed reconstruction occurs after chemotherapy or radiation has been given. These treatments may decrease the volume or alter the color of the reconstructed breast, so they should be completed before the breast is rebuilt. This type of reconstruction may happen weeks, months, or even years after mastectomy.
• Staged reconstruction splits the reconstructive process into two parts. The first part inserts temporary expanders to stretch the skin and is done immediately after breast removal surgery. The second part replaces the expanders with implants after chemotherapy or radiation treatments have been given.

Breast reconstruction is not perfect. The two breasts may not always look exactly identical, although they will be close. There may be small scars, and a loss of sensation in the reconstructed breast. A reconstructed breast will not produce milk, so patients may have trouble breastfeeding. Still, reconstruction is a great option for women who want that part of their appearance back.

In all cases, the skin graft may either be full-thickness or partial-thickness. While thicker grafts make recovery more difficult for the donor site, they heal more easily than thinner grafts.

Before skin graft surgery, patients are given anesthesia so they cannot feel any pain. If using an autograft, the surgeon carefully measures and removes the skin from the donor site. Sometimes the graft is cut in a mesh-like pattern, to allow a small piece of donated skin to stretch and cover a larger area. This also helps oxygen pass through the graft. The site where the skin graft will go is cleaned well to remove any dirt, bacteria, or dead skin cells. Then the skin graft is placed and attached with stitches or staples. It is often covered with antibacterial ointment and supportive bandages for the first few days.

As the skin graft heals into its new position, new blood vessels grow to reach and support the skin. Depending on the thickness of the graft, oil glands, sweat glands, and hair follicles may also regrow. Recovery time depends on the thickness of the graft and the overall health of the skin in the grafted area, but it generally takes from two to four weeks.