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The final shape of the breast mound will take many months to finish healing. In some cases, a permanent tissue expander is placed under the chest muscles. This type of implant requires that only the valve is removed (under local or general anesthetic) when the breast has achieved its desired shape and size. The drawbacks in using this prosthesis include the inability of the doctor to further refine the breast after the expansion has taken place either by altering the position of the prosthesis, repositioning the lower breast crease, or by substituting another implant. For those women who lack sufficient quantities of tissue despite tissue expansion, or those with poor quality tissues left after the mastectomy, healthy and plentiful skin, fat and muscle from other areas of the body can be transferred to the chest (tissue transfer). Tissue Transfer Areas of the breast that could not be rebuilt by the previous methods can be filled in and/or recontoured using tissues from the upper back, abdomen or buttocks (tissue transfer). One of the tissue transfer procedures rotates the back (latissimus dorsi) muscle to the mastectomy site. The muscle carries the overlying fat and skin which is maneuvered into its new position on the upper chest. Still attached to its original blood supply, this blend of tissues can build up the hollows created by some radical mastectomy operations. This enables a prosthesis to be inserted, thus reconstructing the breast mound. The transferred portion of muscle and skin does not leave behind a significant deformity or weakness of the back. It does, however, add a scar to the upper back which some women may object to. The Transverse Rectus Abdominis flap (TRAM) is a blend of tissues taken from the abdomen or lower portion of the belly. This, too, relies on a blood supply still attached to the muscle. Portions of fat, muscle and skin are transferred to the upper chest leaving behind a long lower abdominal scar. Unlike the other procedures, a prosthesis is not always needed if this tissue transfer method is used, as the lower abdomen usually has more than ample amounts of fat and skin to build the breast mound. But do not be misled--more is not always better, and the fat in this region must be firm. Illnesses such as diabetes or vascular disease, and even having had prior operations on the abdomen, can prevent you from being a suitable candidate for this type of reconstruction. A third tissue transfer method uses portions of tissue from the buttocks. http://www.dermayouth.org/bust-pro

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However, the other nipple may be too small to be used, and there is a risk that sensation in the existing nipple will be diminished. The nipple from the original breast containing the tumor can rarely be used on the reconstructed breast. There is concern that some cancer cells will be transferred to the newly formed breast. Besides, with the available technology, nipple and areola formation has been elevated to a refined art. Often, two operations can be combined so that the nipple and areola are fashioned simultaneously with the remolding of the opposite breast. The newly fashioned nipple and areola transforms the reconstructed breast to appear more like the original. Unfortunately, though, the new nipple and areola will not have the original nipple's unique sensitivities. Sometimes a false nipple can be used. These are made of soft plastic and simply adhere to the peak of the new breast. The false nipple will give an authentic projection under your clothes but, again, will not have the original nipple's sensitivity nor will it be a permanent part of the breast. Nipple and areola formation is usually regarded as the final step which completes the reconstruction. Many women see this step as an ending to the struggles, physically and psychologically, which began with the initial diagnosis of breast cancer. Questions For You and Your Plastic Surgeon 1. Does breast reconstruction interfere with other treatments (for example, chemotherapy or radiotherapy)? Both treatments can start fairly soon after the reconstruction; however, a slight delay may be necessary to allow the surgical wounds to start healing. Neither therapy is made less effective by the breast reconstruction. Radiotherapy for cancer prior to the breast reconstruction can affect the quality of the remaining skin. This may mean you will need a tissue transfer or tissue expansion operation. 2. Does the breast implant cause cancer? No. Medical research to date does not indicate that the implant causes cancer. 3. Will a recurrence of breast cancer be hidden after the breast is reconstructed? Normally, a local recurrence is first seen in the skin of the chest or the scar tissue left behind after the operation. Both of these areas can usually be seen or felt by your doctor during your follow-up examinations. Tissue transfer techniques may be a slight hindrance to physical examinations, as new skin and muscle are brought to the chest. Continued follow-up examinations by your physician will help to detect any changes. 4. Will my reconstructed breast feel normal? The gel or saline-filled implant matches the breast tissue that has been removed in weight, size, and consistency.

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