Autologus Tissue Reconstruction
This method of reconstruction is reserved for patients with large and aggressive cancer that requires significant skin removal and radiation therapy. It involves the transfer of muscle (for blood flow) and fatty tissue from various parts of the body (abdomen, upper back, and gluteus areas) to reconstruct post-mastectomy breasts. This can also be done immediately at the time of the mastectomy, however it involves a much longer operation (6-10 hours) and hospitalization. Many times the need to transfer muscle as part of these flaps leads to some loss of function. Patients typically return to normal function in 3-4 months. Some additional surgical revisions may be necessary for best results. The advantages of this type of reconstruction include the use of living tissue. The dissadvanges include a longer operation, hospitalization and a prolonged recovery. Careful discussion with the oncologist is required to avoid conflict with any necessary post-operative chemotherapy. With better implant options, this method of reconstruction has not been as popular.
Nipple Reconstruction
In the last two decades there have been tremendous advancements in the field of breast reconstruction, including in the area of nipple reconstruction. Nipple reconstruction once required a hospital surgery which involved harvesting a skin graft and using it to reconstruct a new nipple. Many times the donor site included the inner thigh, where chances of poor healing and infection were high. Today the nipple reconstruction is done as an office procedure utilizing the existing mastectomy scar, with small amounts of local anesthesia; a portion of the mastectomy scar is elevated and reconstructed in to a nipple. (PICTURE). Tattooing is then performed covering a significant portion of the scar. This leads to excellent cosmetic results with minimal scar visibility. Most patient walk away with what appears to be a biopsy rather than a mastectomy.
In some instances the mastectomies can be performed as nipple sparing, meaning that your natural nipple is not removed as part of the mastectomy. This eliminates the need to perform nipple reconstruction.