Breast Reconstruction (TRAM Flap) in Westchester County, NY

When a woman loses one or both of her breasts to cancer, she often struggles with feelings of loss including a sense of lost femininity, powerlessness, and so on. Breast reconstruction surgery is an option for women who have undergone a mastectomy following breast cancer treatment to regain the look and feel of her lost breast(s). The procedure can be done as an integral part of cancer treatment, and may be done immediately after the mastectomy or later.

The reconstruction itself is accomplished by plastic surgeons using breast implants, autologous (or natural) tissue, or both. Flaps are the method for reconstructing the breast that relies on natural tissue; they consist of fat, skin, blood vessels, and muscle from various parts of the body. The transverse rectus abdominal muscle (TRAM) flap is taken from the abdomen, the deep inferior epigastric perforator (DIEP) and latissimus dori flap are both taken from the back, and the superior gluteal artery perforator (SGAP) from the buttocks.

These flaps can be designed as either pedicle flaps that are attached to their original blood supply, or as free flaps that are disconnected from their blood source at the donor site and reconnected to the recipient site with microsurgery.

When is Breast Reconstruction an Option?

Women who have undergone a mastectomy or other breast-conserving surgery like a lumpectomy are candidates for breast reconstruction. However, it is essential that that cancer has been eliminated by mastectomy before breast reconstruction can be planned.

Other important qualifications include:

• Asymmetry or loss of contour, shape or volume caused by mastectomy
• Emotionally ready for surgery
• No remaining cancer after mastectomy

How is Breast Reconstruction Conducted?

Tissue expansion is often the first stage in the creation of the breast mound. The tissue expander, a tool designed to stimulate skin growth, is placed under the skin and gradually filled with saline to stretch the skin for the implant beneath the chest muscle. The breast mound is usually restored when the implant is inserted, and the nipple is usually reconstructed later.

During the latissimus dorsi flap procedure, muscle from the back is tunneled under the skin to the front of the chest. The placement of the muscle creates a pocket in which the implant will sit.

Approaches that rely on autologous methods, like the TRAM flap, are complex procedures that can take between 4-6 hours to conduct. During the TRAM flap, tissue is removed from the lower abdomen as in the tummy tuck procedure. One abdominal muscle is removed to form the base of breast mound, and the tissue — skin, fat, and/or blood vessels — is then used to reconstruct the breast.

What Are My Options If I Am Going to Have a Lumpectomy?

If you are to undergo a lumpectomy, Dr. Goldberg can actually work with your oncologist to perform a procedure called Oncoplastic Breast Reconstruction. In this procedure, Dr. Goldberg will team with your oncologist to cosmetically enhance your lumpectomy result by performing a breast surgery, like a lift or reduction, before or after the lumpectomy procedure. This process will leave you with the most aesthetically-pleasing result possible.

Post-Surgery Care

Patients should expect to be both tired and sore for approximately 1-2 weeks following breast reconstruction. Your plastic surgeon may prescribe medication to help you control your pain. Stitches are generally removed within 7-10 days following surgery. Extra steps that may be taken to complete the breast reconstruction include: adding the nipple, changing breast shape/size, and operating on the opposite breast to match the newly reconstructed breast. Patients should also know that it takes time to readjust — emotionally and physically — to the new breast.

Dr. Neal Goldberg welcomes your questions and concerns about breast reconstruction. Please call us at 914-722-1600 if you would like to receive more information or set up an appointment. Our plastic surgery offices are located in Scarsdale and Dobbs Ferry in Westchester County, New York.