October is Breast Cancer Awareness Month. Breast cancer can be treated with lumpectomy or with mastectomy.
Breast reconstruction is challenging. When the breast is reconstructed with tissue expanders and implants, there are two options of expander placement. Pre-pectoral (in front of the muscle) and sub pectoral (behind the muscle). Either plane is used today.
In some instances, the tissue expander is placed beneath both the pectoralis muscle and the serratus muscle. In this position, with total submuscular coverage, the stressed mastectomy skin is allowed to relax and regain some vascularity prior to tissue expansion. In some cases, if patients need chemotherapy in a timely fashion, we can delay skin expansion to avoid possible infection and interruption of timely chemotherapy.
If radiation is not necessary, we can then remove the tissue expanders after an appropriate interval to allow the bone marrow to generate functional red blood cells and white blood cells and insert a breast implant.
The photograph demonstrates bilateral breast cancer mastectomy reconstruction with implants in a total submuscular position.
