Breast cancer reconstruction is a challenging component of Plastic & Reconstructive surgery. Breast cancer reconstruction is frequently performed in several stages. The first stage of reconstruction involves placing a tissue expander at the time of mastectomy. I usually prefer to place a minimal amount of volume of saline at the time of mastectomy as this often minimizes pain post-operatively. Minimal filling of the expander also placed less stress on the already “devascularized” mastectomy skin. This allows the skin to recover, heal, and “neovascularize” in terms of arterial inflow and venous outflow. When possible, I prefer to place the tissue expander beneath the pectoralis major and variable amounts of the serratus anterior. This gives stable and durable coverage which can help mitigate against sequala of radiation as well as prevent early and late cellulitis. Placing the implant beneath the muscle helps prevent seroma formation as well as possible wound dehiscence. Breast reconstruction is challenging and humbling. Optimizing success and minimizing complications requires thoughtfulness, patience, and direct involvement.
