Shaping the Breast Mound in Delayed Reconstruction

Summary

Delayed breast reconstruction is more difficult than immediate reconstruction and requires more tissue, effort, and artistic judgment to achieve aesthetically good results. Because the inframammary fold and skin envelope have not been preserved, they must be reconstructed. The inferior breast panel can be created using the TRAM flap itself or the original mastectomy flap of native breast skin. Each approach has advantages and disadvantages. The choice of approach depends on the defect, the type of flap being used, and the surgeon’s judgment. If the inferior mastectomy flap is used to cover the lower pole of the breast, release of all scar tissue is essential to allow the remaining breast skin to reexpand to its original dimensions. If this is not possible, a releasing incision in the inferior mastectomy flap will often allow adequate expansion of the inferior pole.

Having a logical, step-by-step plan makes shaping the breast easier and faster, and leads to more consistent results. Nevertheless, each patient is unique, so the surgeon must be ready to modify the plan when necessary to attain the best possible results.