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What Are my Options for Filling an Indentation Left After Lumpectomy?
Breast reconstruction after lumpectomy is becoming increasing common as breast conservation in the face of breast cancer becomes more sophisticated. Many times lumpectomy defects can be very challenging to reconstruct. The first issue involves whether you have had radiation. Irradiated breasts are more common in people who have had lumpectomies and make reconstruction more complicated. Typically radiation will require the usage of "autologous" tissue (meaning your own). The benefit of this tissue is in this situation it would typically be taken from an area outside of the field of radiation and would not have radiation issues. Many times patients who have had radiation will also require some amount of skin on the tissue that is transported. The tissue that can be used includes lat. dorsi (back skin and muscle) or microsurgical breast reconstruction techniques including DIEP, SIEA or SGAP. All these letters stand for different microsurgical flaps that are commonly used for breast reconstruction. If you haven't had radiation local tissue rearrangement or custom implants might be used for reconstruction. In addition fat transfer can be very useful for filling in small defects with the qualification being sometimes the scarring can create calcifications that make breast cancer more complicated. Typically injectables or alloderm alone would be an inappropriate choice for breast reconstruction, especially in a patient that had received radiation.
Clinical Context
Reconstruction choice depends on tissue quality and prior radiation. Local tissue rearrangement and fat grafting are simpler with shorter recovery, but work best for smaller defects, especially since irradiated skin heals less predictably. Flap procedures (latissimus, DIEP, SIEA, SGAP) bring in tissue with its own blood supply, which helps in radiated areas, but involve longer surgery and a second healing site. Fat grafting can also leave small calcifications in the breast that may need extra attention on future mammograms.
