Undergoing a mastectomy after a breast cancer diagnosis can be a challenging experience, both physically and emotionally. For many women, choosing to restore one or both breasts via a reconstruction procedure can feel like a celebration of recovery and restored health. Breast reconstruction can renew a patient’s confidence, helping her to regain her sense of self or femininity, and furthermore aid in returning feelings of health and wholeness.
Many breast reconstruction options exist after mastectomy, and nearly all patients are candidates for some method of breast reconstruction. Reconstruction may be performed using traditional implant techniques or by a technique called autologous breast reconstruction that uses a woman’s living tissue to restore the breast without prosthetic implants. These techniques may also be combined in what is known as hybrid breast reconstruction.
Hybrid breast reconstruction rebuilds the breasts with natural skin and excess fatty tissue taken from a donor site on the patient’s body, combined with implant placement. This approach enhances the size and projection of the new breasts in women who have insufficient body fat to achieve the desired results from living tissue transplant alone. Dr. Christine Fisher offers both traditional and advanced breast reconstruction techniques, including multiple forms of hybrid breast reconstruction.
Benefits of Hybrid Breast Reconstruction
Hybrid breast reconstruction can be the most effective option for some women for restoring the breasts after mastectomy, depending on their goals and body type. For women who have less body fat and require a larger breast size than their fatty-tissue donor sites can provide, the hybrid procedure offers both the softness of natural tissue and the added volume of an implant. This combination of techniques represents the “best of both worlds” for some patients.
There are many potential benefits in choosing a hybrid reconstruction. The skin may be thin following a mastectomy, which can result in visible or palpable wrinkling in implant-only reconstructions. If capsular contracture occurs, the scarring around the implant may also be more noticeable. Adding a layer of natural fatty tissue reduces the size of the implant required, camouflages the implant and helps protect the fragile skin left by the mastectomy. For some patients, it may require less donor tissue to be used, potentially allowing for smaller incisions to be made at the donor site than a fully autologous breast reconstruction. The result is a long-term reconstruction that looks and feels more natural and requires less operation to other areas of the body.
Types of Autologous Breast Reconstruction
Dr. Fisher performs a range of breast reconstruction techniques that use the patient’s tissue, including:
Deep inferior epigastric perforator (DIEP) flap reconstruction uses excess skin and fat from your abdomen to create your new breast. An incision is placed low on the abdomen, similar to a tummy tuck, and then a flap of living tissue is transferred to the chest to reconstruct the breast. There is no removal of underlying muscle or damage to your motor nerves, and the scar from the abdominal incision is typically hidden in underwear. A secondary benefit of DIEP flap reconstruction is a flatter postoperative abdomen.
A superficial inferior epigastric artery (SIEA) flap is similar to the DIEP flap. However, a SIEA flap is a more technically demanding procedure that requires blood vessels in the flap to be connected to blood vessels found in the fatty tissues just below the skin of the chest wall or under the arm. A DIEP flap uses deeper vessels under the rectus abdominis muscle.
A gluteal artery perforator (GAP) flap reconstructs the breast from tissue taken from either the upper buttock or the lower buttock. The GAP flap is an appropriate option for patients who lack a sufficient amount of abdominal tissue for a DIEP flap or SIEA flap, or who have previously had liposuction or a tummy tuck. Changes to the donor buttock are typically slight, and liposuction can be used to improve shape and symmetry.
A profunda artery perforator (PAP) flap uses tissue from the inner thigh for breast reconstruction. Dr. Fisher removes a flap of skin and fat (no muscle) from the donor site.
A latissimus dorsi myocutaneous (LD) flap uses skin, fat and underlying muscle from the back, specifically the area below your shoulder and behind your armpit, to reconstruct the breast. The critical difference between this and other flap techniques is that the blood vessels remain connected to their original site and do not need to be reconnected; the flap is rotated from your back to your chest.
Implant Breast Reconstruction
Hybrid breast reconstruction combines one of the above autologous breast reconstruction techniques with traditional implant reconstruction. Dr. Fisher uses silicone breast implants due to their more natural look and feel. You will be able to discuss your preferred implant size, shape and texture with Dr. Fisher.
Getting the Results You Want
Dr. Fisher is a skilled plastic surgeon experienced in both traditional and advanced breast reconstruction techniques, including hybrid breast reconstruction. The best option for you will be determined by your health, any expected future cancer treatments, the prior size and shape of your breasts, and your desired results from the reconstruction procedure. Contact our office at 512-815-0123 to schedule a consultation to learn more about your breast reconstruction options.
Christine Fisher MD