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Breast Reconstruction Overview

Breast cancer impacts more than just a patient’s physical health. For women undergoing surgery for the disease – mastectomy or lumpectomy – the psychological challenges include coming to grips with a body that may not look the same after treatment. Breast reconstruction may help these women feel more confident about their appearance.

Breast reconstruction is most commonly associated with mastectomy, in which all breast tissue and some skin are removed. In general, the breast is reconstructed using a flap, a piece of tissue taken from another part of the body, or by stretching the remaining tissue with an expander and using an implant.

Reconstruction also is an option for women who undergo lumpectomy, which involves removing only cancerous cells and some breast tissue. Though this procedure does reduce damage to the breast, many patients are unhappy with the appearance of the breast after surgery or a lack of symmetry with the healthy breast. Reconstruction procedures for these patients include breast reduction, fat grafting, implants and the use of flaps.

Washington University plastic and reconstructive surgeons at the Siteman Cancer Center offer the latest innovations in breast reconstruction after mastectomy and lumpectomy. For implant-based reconstruction, this includes nipple-sparing mastectomy and reconstruction and the use of a substance called acellular dermal matrix to help refine results.

For reconstruction with flaps, our surgeons offer microvascular procedures that involve using microscopes to reconnect blood vessels and maintain blood flow. These highly technical procedures, which require specially trained physicians and operating room teams, preserve more muscle in the area where tissue is harvested for reconstruction.

At Siteman, our plastic and reconstructive surgeons work closely with surgeons who remove breast cancer. In most cases, plastic surgeons are brought in early during the consultation process, and together, the surgeons recommend the best approach. For 80 percent of our patients who undergo mastectomy, reconstruction begins when the mastectomy is performed. Nationwide, the rate is less than 10 percent.

The advantages of immediate reconstruction include fewer hospitalizations and an improved psychological outlook. In addition, more breast skin is preserved. This skin serves as an envelope that shapes the reconstruction so it more closely resembles the breast before surgery.

In many cases, the start of reconstruction is delayed so additional cancer treatment can begin immediately or because reconstruction was not offered or recommended at the time of surgery. Our plastic and reconstructive surgeons are skilled in treating these patients as well, even years after their initial breast cancer surgery.

Washington University’s breast reconstruction team is the most experienced in the St. Louis region, performing the largest volume and most comprehensive array of procedures for cancer and congenital breast deformities.


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