|Indication, part 1|
The normal female breasts are paired structures that contain fat and glandular tissue designed to secrete milk. Cancer of the breast is one of the more common cancers in women. Risk factors include a family history of breast cancer, early age at first period, and late menopause.
|Indication, part 2|
Breast removal (mastectomy) is one form of treatment for breast cancer. The operation has become less common as radiation and chemotherapy have proved effective for many patients. Women with a strong family history of breast cancer and genetic abnormalities that predispose them to breast cancer, may decide to undergo preventive mastectomies to prevent the future occurrence of breast cancer.
Reconstruction of the breast after mastectomy is performed in select patients who have very small tumors or who undergo prophylactic (preventative) mastectomy. First, tissue from the lower abdomen, including skin, muscle, and blood vessels, is removed. This is called a TRAM flap.
|Procedure, part 1|
The flap is then transferred under the skin between the two sites and sutured into place.
|Procedure, part 2|
Alternatively, a saline-filled prosthesis (breast implant) can be inserted under the skin and muscle after mastectomy. Over the next few weeks and months, the prosthesis is slowly filled with increasing amounts of saline by injection, which expands the overlying skin and creates a breast mound.
The final step is nipple reconstruction. One method involves taking a partial graft from the remaining nipple to create a new one. In another method, the surgeon raises a small area of skin on the reconstructed breast and tattoos it at a later date. The overall results of breast reconstruction, while not perfect, are usually excellent. Nevertheless, patients should discuss their expectations with their surgeon in detail prior to surgery.
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.
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