Some of the different options for reconstruction after a double mastectomy are implants and tissue flap surgeries. Both of these options include surgery, so it is important for a woman to discuss them with her general and plastic surgeons. The type of surgery that is best for reconstruction after a double mastectomy depends on several factors including the woman's body type. Recovery time may also be a consideration. If a patient does not want to undergo any type of surgery for reconstruction after a double mastectomy, she can opt for a prosthetic breast instead.
Two types of tissue flap surgeries, the TRAM (transverse rectus abdominus myocutaneous) flap and the DIEP (deep inferior epigastric perforator) flap, involve moving tissue from the abdominal area. The result is a tummy tuck for the patient in addition to reconstructing the breast. Since the surgeon is removing tissue from the abdomen, these surgeries are usually best reserved for women with extra fat and tissue. Smaller women may not have these tissue flap surgeries available as options for reconstruction after a double mastectomy because they may not have enough excess tissue for it. These tissue flap surgeries may also not be a good choice for those who have severe scarring in the abdomen, those who smoke, or those without adequately healthy blood vessels.
The TRAM flap surgery is available in two forms: traditional and the free TRAM flap. In the traditional version of this surgery, a section of skin and tissue from the abdomen is cut, but the connection to the rectus abdominal muscle is kept intact. For reconstruction after a double mastectomy, the removed tissue is separated into two sections, one for each breast. The surgeon tunnels the flap of skin and tissue underneath the skin of the chest wall where it can be formed into a breast shape. The blood vessels are kept intact as much as possible to provide a blood supply to the new breasts.
During a free TRAM flap surgery, the surgeon completely detaches a section of the muscle from the abdomen. The blood vessels are also severed. Instead of tunneling, the surgeon can transplant the tissue into the chest wall. Reattaching the blood vessels to a blood supply in the arm is also necessary, a process that requires the surgeon to use a microscope. DIEP flap surgery is similar to free TRAM flap surgery except no muscle is removed. Another tissue flap surgery option is the latissimus dorsi flap surgery, which moves tissue from the back to the chest in order to make the breast shape.
Another option for breast reconstruction after a double mastectomy is implants. For some women, the procedure requires six months of stretching the skin in order to allow a place for the implants to go. For these occasions, a tissue expander is placed in the chest wall and then is injected with a saline solution over a certain period. After the skin is sufficiently stretched, the expander can be replaced with the implants. Though the surgery has a shorter recovery time than many tissue flap surgeries, implants do come with some drawbacks such as the risk of the implants rupturing.