Your Options A Guide to Reconstruction for Breast Cancer Options In this booklet Introduction to Breast Reconstruction ................................................................ 3 How to Make a Decision .............................................................................. 4 UMHS Team .......................................................................................... 6 Reconstruction Options Implants ........................................................................................... 7 Natural Tissue and Implants ....................................................................... 10 Lat Dorsi (Latissimus Dorsi) Flap Natural Tissue Reconstruction .................................................................... 11 Abdomen • Pedicled TRAM (Transverse Rectus Abdominis Myocutaneous) Flap • Free TRAM (Transverse Rectus Abdominis Myocutaneous) Flap • Free Muscle-Sparing TRAM (Transverse Rectus Abdominis Myocutaneous) Flap • Free DIEP (Deep Inferior Epigastric Perforator) Flap • Free SIEA (Superficial Inferior Epigastric Artery) Flap Alternative Donor Sites ........................................................................... 15 SGAP (Superior Gluteal Artery Perforator) Flap TUG (Transverse Upper Gracilis) Flap Additional Surgeries After Reconstruction ........................................................ 17 • Nipple Reconstruction • Breast Lift, Augmentation, Reduction Terms to Know .................................................................................... 19 “I’m a wife and mother and I still have a beautiful future that awaits me.” A Personal Choice Reconstruction after breast cancer is a decision that will have a profound effect Linda’s Journey at University of Michigan on not only your body, but your emotional well being. This decision should reflect your health, your priorities and your lifestyle. The scars are a constant reminder that I’m a could be done right in Ann Arbor and at the survivor, and that’s OK. I call it my “new normal.” time of surgery. For my doctors, it wasn’t a Breast reconstruction is a personal journey clinical decision; they were helping me choose that takes into account many individual I’m a wife and mother. Life seemed to be rolling what was right for me. Our decision was the factors. While not every woman chooses along fine when I was suddenly stopped in my DIEP Flap. The fact that they could use my own to have reconstructive surgery after tracks. I was shocked to learn I had breast cancer tissue for the reconstruction was intriguing and breast cancer surgery, having the greatest and even more devastated to hear my doctor reassuring to me. number of choices can offer you significant say that word – mastectomy. To think that this psychological and practical benefits. was going to be my journey, was, well, really One of the hallmarks of getting me to a new frightening. I went through the typical phases. normal was running. Running has been kind of This guide was developed to help you and I was angry. I was scared. Frankly, I felt like I had a metaphor for me. Like cancer, running can be your family review the surgical choices for been hit upside the head. tough and I sometimes feel like I want to quit, breast reconstruction. In consultation with give up, just be done, but I know I need to just the U-M healthcare team, this will help The reality was I needed to listen to the experts keep going. with making a decision that’s best for you. and take action. After all, I am a wife and mother and I still have a beautiful future that awaits me. The treatment of breast cancer is a journey. A team of plastic surgeons at U-M explained At U-M, our highly skilled breast cancer Watch Linda’s story at: my options. There were so many and they all plastic surgeons believe that giving you www.UofMHealth.org/YourOptions the knowledge of reconstruction options can make for a smoother course. 3 Helping You Make a Decision The goal at Michigan Medicine is to use our care and Talk to your medical team about your options. expertise to make sure that every woman who undergoes Consider your lifestyle, your size and shape. This isn’t breast reconstruction surgery is given an unprecedented a decision that should be rushed. Make sure you are level of personal care. We tailor what we do to meet your making an informed decision; think about all of your goals for your appearance and sense of self. After a options, then decide on what is best for you. mastectomy, we make sure we have done everything we can to help you regain a sense of normalcy. Implant Reconstruction The decisions about having breast reconstruction Advantages Disadvantages will not be easy to make, but there are answers for your questions. Your surgical team will work right • Shorter surgery • Scar formation around the Plastic Surgery Clinic along side you to help you find the surgical path that • Shorter recovery implant over time best fits you and your lifestyle. • Shorter hospital stay • Difficulty in matching Domino’s Farms, Lobby A other breast • Provides more choices on size Suite A 1200 Whether you choose to have breast reconstruction of breast in smaller patients • Implant infection can result in loss of reconstruction 24 Frank Lloyd Wright Drive at the time of your surgery or sometime later, • Possibility of rupture over time Ann Arbor, MI 48106 your doctors will lay out your options. If you need radiation, your doctors will help advise you on Hours: 8 am - 4:30 pm Natural Tissue Reconstruction when it is safe to have reconstruction surgery. Some Clinic Phone: (734) 998-6022 other specific health problems are also carefully Advantages Disadvantages Clinic Fax: (734) 998-6403 considered during your consultation. • Most natural appearance • Provides some contouring www.UofMHealth.org/YourOptions While plastic surgeons at the University of Michigan and feel of abdomen are highly skilled in breast reconstruction, you should • Fewer problems in long-term • Potential donor site understand that a reconstructed breast will not look after reconstruction is complications and feel like your natural breast; however, every effort complete • Longer surgery is made to give you the most natural look and feel • Adjusts with patient’s • Longer hospital stay weight gain and loss possible. Ask your doctor to see before and after photos • Breast size limited by amount • Very effective in radiated of donor site tissue of women who have had breast reconstruction so that patients your expectations are in line with possible results. • Scars at donor site 4 Your medical team will help you make some of the decisions Talk to your medical team about your options. Consider your lifestyle, your size and shape. This isn’t based on your size, your shape and your lifestyle. a decision that should be rushed. Make sure you are making an informed decision; think about all of your options, then decide on what is best for you. Mastectomy Without Radiation With Radiation Immediate or Delayed Reconstruction Delayed Reconstruction Implant Natural Tissue Implant & Natural Tissue Natural Tissue Lat Dorsi/ Single Tissue Abdominal Alternative Abdominal Alternative Tissue Stage Expander Flaps Flaps Flaps Flaps and Implant Expander TRAM, DIEP, SGAP, TRAM, DIEP, SGAP, SIEA TUG SIEA TUG 5 Our plastic surgeons are nationally known for their experience in breast reconstruction after mastectomy. Our Breast Reconstruction Team Your experience with the University of David Brown, MD Theodore Kung, MD Michigan Health System comes with knowing Dr. Brown specializes in Dr. Kung specializes in micro- that University Hospital is ranked among the reconstructive and aesthetic surgical reconstruction top 100 hospitals in the United States. Our surgeries, including breast following cancer surgery, Comprehensive Cancer Center and Plastic reconstruction surgery. He aesthetic and reconstruction Surgery Center are nationally recognized for has a passion for the education breast surgery, lymphedema safety, and our doctors and surgeons are some of other plastic surgeons and surgery, extremity salvage, of the best in the country. has received awards for his teaching. and peripheral nerve injury. With breast reconstruction, our board-certified Paul Cederna, MD Adeyiza Momoh, MD plastic surgeons and oncologists work as a team, Dr. Cederna specializes in recon- Dr. Momoh is proficient in all utilizing each other’s strengths, as well as the structive and cosmetic surgery, forms of breast reconstruction, most current and emergent surgical techniques including breast reconstruction. with a particular interest in available. The advances in breast reconstruction He is dedicated to finding new, microsurgical procedures like surgery continue to move forward, and U-M innovative and minimally inva- DIEP and Muscle-Sparing surgeons remain leaders in this progressive sive approaches to plastic sur- TRAM Flaps. He also focuses movement. gery. He has been recognized by many groups on augmentation, lifts and other procedures and has received a “Patient’s Choice Award.” to restore form to breasts after mastectomy Surgical Support The surgeons at the University of Michigan Jeffrey Kozlow, MD Edwin Wilkins, MD are supported by a highly skilled team of Dr. Kozlow focuses on recon- Dr. Wilkins performs an array of nurses and clinical staff who help coordinate struction of oncologic and cosmetic or reconstructive pro- your care. This entire team is dedicated to traumatic issues. His training cedures with a focus on breast making your experience positive from your in microsurgery allows him reconstruction.