For patients who require a mastectomy (removal of the entire breast), there are new techniques in reconstructive surgery to restore the breast’s appearance. Surgery can reconstruct a breast, including the size, shape, nipple and areola. The initial reconstruction work can often can be performed immediately following the mastectomy, while you are still sedated, and is performed by a board-certified plastic surgeon. Additional surgeries to complete reconstruction are scheduled at a later date.
UC San Diego Health: A leader in breast reconstruction
At UC San Diego Health, well over 70% of women who undergo a mastectomy also undergo reconstruction, high above the state and national rates.
Why are reconstruction rates important?
Post-mastectomy reconstruction rates are used as a quality of care measure in many comprehensive breast centers. Why?
- Reconstruction after mastectomy has been associated with improved psychosocial and sexual function.
- It has been proven safe in terms of monitoring for recurrence, and preliminary data shows that it may even translate to better survival rates (although the reasons for this are not yet clear).
- Higher reconstruction rates also point to a cancer center with comprehensive services and close collaboration between your breast cancer surgeons and reconstruction experts
Types of Breast Reconstruction
Reconstructive Surgery Explained
For information on how each surgery is performed, or the differences between implants and autologous surgery, see
What Happens During Reconstructive Surgery.
At UC San Diego Health, we specialize in several types of breast reconstruction:
- Artificial implants: We use the best available and most well studied silicone implants.
- Autologous surgery: This method uses your own skin, fat and muscle from other areas of your body such as the back, abdomen, buttocks or area close to the chest. The types we most commonly perform are:
- Latissimus dorsi reconstruction, which uses muscle from your back to create a new breast mound
- Transverse rectus abdominus muscle (TRAM) flap, which uses muscle from from your abdomen
- DIEP flap, which uses blood vessels called deep inferior epigastric perforators, as well as the abdominal skin and fat connected to them, to reconstruct a breast. The DIEP flap is similar to the TRAM flap but does not remove any of the abdominal muscles.
- Complex reconstruction: This includes surgeries for cancer recurrence, radiation or wound damage, or other complex issues.
Contralateral symmetry surgery is performed on the unaffected breast, when needed, to assure a uniform size and shape. This applies to not only masectomies, but also lumpectomies and breast convservation surgery, when breast reduction surgery may be desired on the unaffected breast.
Surgical Collaboration Improves Outcomes
Our surgeons collaborate closely to coordinate cancer and reconstructive surgeries.
Dr. Anne Wallace, center director, is both a surgical oncologist and a reconstructive surgeon, and often performs the surgeries simultaneously. In other cases, our surgical oncologists partner with fellowship-trained plastic surgeons.
In all cases, plastic surgeons are closely involved in surgery planning—to ensure a high level of safety in terms of the ability to resect the tumor
and get an aesthetically pleasing outcome. Even for lumpectomies, plastic surgeons work with the oncology surgeon to help with markings so that the incisions fall into the natural reconstructive planes. All the necessary tissue is removed, but by preserving a good portion of the breast, it is often possible to preserve nipple sensation and prevent the nipple from being crooked.
New Developments for Faster Healing, Less Scarring
One of UC San Diego Health's areas of expertise is complex flap reconstruction after radiation. We use all available technologies, including oxygen and other treatments, to enhance healing and outcome. Dr. Wallace and the entire surgical team spend adequate time with patients to review their options and preferences and to explain the risks, benefits and projected outcomes of various procedures.