Breast Reconstruction

• Implant-based reconstruction
• Flap-based surgery

Many women want reconstructive breast surgery after having a mastectomy. Our highly skilled reconstructive surgeons work with patients before their mastectomy and then alongside their breast surgeons when immediate reconstruction is desired. They also work with women who choose to wait until later to undergo reconstructive surgery.

Some women decide to skip reconstruction altogether. They may choose to use clothing inserts, also called prostheses, or they may choose to simply go without. We want you to feel confident and good about yourself, and we support whatever choice works for you.

If you are interested in breast prostheses for clothing or want to learn more about your options, contact our Cancer Education Center at 206-386-3200.

We know that women who do want reconstructive surgery have their own individual expectations. That’s why our reconstructive surgeons tailor surgery to the desires and attributes of each patient for the best possible cosmetic outcome.

Implant-based reconstruction

Implant-based reconstruction is a multistep process that can start at the time of breast cancer surgery, or months or years later.

• A temporary implant called a tissue expander is often placed behind the chest wall muscles depending on the situation.
• Over time, saline (salt water) is injected into the expander until it reaches the desired breast size and shape.
• The tissue expander is then replaced with a permanent implant filled with either saline or silicone gel.
• In some cases, a woman can have her final/permanent implant placed directly at the time of mastectomy. Our reconstructive surgeons guide if this is an appropriate option for a patient who might desire it.

For patients who have had their nipple removed, the nipple areolar complex can be recreated in a separate procedure.

Flap-based surgery

Breast reconstruction with flap surgery involves using the patient's own tissue (skin, fat and/or muscle) to create a new breast mound. This tissue is referred to as a "flap." Flap surgery also may include a breast implant, depending on the needs of the patient.

There are several flap techniques, including:

TRAM Flap

This technique involves the transverse rectus abdominal muscle, or TRAM. In a TRAM flap procedure, skin, muscle and fat from the woman’s abdomen is used to create the new breast. The abdominal tissue, or flap, will either remain attached to the original blood supply, or be detached and formed into the breast mound. This is very rarely performed in modern practice.

Latissimus Dorsi Flap

The latissimus dorsi flap is like the TRAM flap but the skin, muscle and fat is relocated from the woman’s back by tunneling to the mastectomy site. This flap remains attached to the original blood supply.

DIEP Flap

This technique refers to a "deep inferior epigastric artery perforator" flap known as DIEP.  This is a type of free-flap technique. It involves microsurgery, a procedure in which surgeons use specially designed microscopes and precision instruments to move tissue from one area of the body to another.

Microsurgical reconstruction

Who is a candidate for microsurgical reconstruction?

Many patients who have lost a breast due to treatment for breast cancer or another debilitating disease may be candidates for microsurgical breast reconstruction. This procedure is particularly useful for women who have had radiation treatment to the chest.

How is microsurgical breast reconstruction performed?

Microsurgical breast reconstruction often is referred to as "free flap" reconstruction, and DIEP is one of the most common free-flap procedures. A surgeon removes skin and fat from the patient’s lower abdomen, along with an attached artery and vein, plus a sensory nerve if present. The surgeon transfers the tissue to the chest and uses microscopic sutures to connect the artery, vein and sensory nerve to corresponding structures in the chest. This restores blood flow and the opportunity for sensation. The living tissue is then expertly molded into a new breast. In addition to DIEP, other free flap options are available.

Due to its technical complexity, a typical single-sided breast reconstruction can take between six and eight hours, and a double-sided procedure between 10 and 12 hours.

Swedish Cancer Institute is a leader in microsurgical reconstruction

Our microsurgical reconstructive surgeons are among the few surgeons in the Northwest who perform microsurgical breast reconstructions. Since 2000, our surgeons have worked side-by-side as a team to perform 100 or more procedures each year. This high volume of microsurgical reconstructions assures patients that the surgeons and their highly-trained team have the skills and expertise to deliver exceptional care and excellent outcomes.

Timeline for breast reconstruction

Like many breast surgeries, microsurgical breast reconstruction requires a series of procedures and office visits that typically occur over a year, and after mastectomy and all breast cancer treatment have been completed.

A typical timeline for DIEP flap breast reconstruction would include:

• DIEP breast reconstruction inpatient surgery, with two to three days in the hospital. At four to six weeks, most women are able to return to work and most activities. At eight weeks, most are back to full activity.
• Revisional surgery, if needed, is performed four to six months later to improve symmetry and address aesthetic concerns. These procedures usually are performed as outpatient surgery and rarely require a hospital stay.
• Nipple reconstruction generally is performed eight to 10 months after the initial operation, again in the outpatient surgery center.
• Areolar tattooing is performed three to four months later, and the process is complete.

To schedule a consultation with a reconstructive surgeon, call 206-215-6400.

Microsurgery Breast Reconstruction Support Group

A patient support group meets on the third Tuesday of each month, from 6:30 to 8 p.m., in our Nordstrom Tower office, which is located at 1229 Madison St. on our First Hill campus in Seattle. The group gives women a chance to share information, experiences and emotions before, during and after surgery. All breast reconstruction patients are invited to attend. For more information, call 206-860-2317. (Please note: This group was meeting remotely in the wake of COVID.  Please call for current information and availability.)