Dr. Sarah Hammond discusses options and advancements in breast reconstruction after mastectomy in the following Q&A:

What are the most popular options for breast reconstruction after mastectomy?
The two most common pathways in breast reconstruction are implant-based (silicone or saline implants) and tissue-based (soft tissue flaps using the patient’s own muscle, fat, and skin). Autologous reconstruction takes tissue from the patient’s abdomen, inner thigh, buttocks, or back to rebuild the breast after a mastectomy. While this can yield beautiful, natural-looking results, not all patients are suitable candidates for microvascular surgery. The most common methods of reconstruction utilize implants. Sometimes the reconstruction can be done all at once right after the mastectomy. Sometimes the patient’s health, cancer treatment, or condition of the tissue precludes that, and the reconstruction is done in two or more stages. The first stage involves creating the implant pocket and placing a temporary implant, known as a tissue expander. The second stage is to exchange the expander for a more permanent breast implant while improving on the look and feel of the reconstructed breast with fat grafting or scar tissue revisions.

Is breast reconstruction the same thing as a breast augmentation?
Not at all. Although the two surgeries both involve breast implants, they are very different. A breast augmentation places an implant behind a normal breast gland to increase breast fullness. During a mastectomy, the breast tissue is completely taken away, along with most of the blood and nerve supply to the skin. We then recreate the anatomical boundaries of the breast with biologic or synthetic mesh to provide extra coverage and stabilization of the implant. A breast reconstruction is a more difficult surgery for the patient and surgeon; it is more complex than a cosmetic breast augmentation and has a higher rate of complications.

How is fat grafting used in breast reconstruction?
Fat grafting is the process of liposuctioning and processing fat, then carefully transferring it to the breast to improve the shape and feel of the reconstructed breast. Fat grafting can be used to smooth irregularities, improve balance, and soften the breast. This can be especially helpful to tissues after radiation. One amazing benefit of fat grafting is the adipose-derived stem cells that come with it. These are specialized regenerative cells that are proven to stimulate blood vessel ingrowth, soften radiated tissues, and improve survival of the fat.

What developments in breast reconstruction have you seen in the last few years?
In the last decade, we’ve seen so many improvements in breast reconstruction outcomes! It makes me so happy that, overall, mastectomy patients today have more natural, comfortable, and beautiful reconstructions than what I saw as a medical student.

  • Prepectoral reconstructions – better implant technology, mesh quality, and training of breast surgeons mean implants can often be placed above the chest muscles in the natural location of the breast. This means less pain and improved function after surgery.
  • More emphasis on cosmesis – improved imaging techniques and cancer data mean reconstructive surgeons are more comfortable performing fat grafting and designing more discreet incisions and nipple-sparing mastectomies.
  • Aesthetic flat closure – not everyone wants to have breast reconstruction! Patient and female empowerment has led to more medical societies and surgeons recognizing that not every woman “needs” breasts to feel normal and feminine and that a flat closure is a valid reconstructive option.

What new technologies are shaping breast reconstruction in the future?
Currently, studies and trials are looking at 3D-printed biodegradable material breast implants, scaffold-guided breast tissue engineering, cell-assisted lipotransfer to increase stem cells in grafted fat, AI and augmented reality tools to map blood vessels and tissue perfusion in reconstructive flap design, and nerve-sparing mastectomy techniques to preserve tissue sensation!

For more information, visit Plasticsurgeryrestore.com or call 901.673.9098. Sarah Hammond, MD, is a board-certified plastic reconstructive surgeon specializing in aesthetic and complex reconstructive procedures. She is known for her patient-centered approach and surgical precision, with a focus on delivering empowering, individualized results.

By Sarah Hammond, MD