Saline-filled implants

A tissue expander is placed under the pectoralis muscle and expanded slowly over months with saline injections. The expander is removed and replaced with a permanent saline implant. The expander may be the adjustable type, serving a dual purpose of expanding and permanent implant.

Autologous tissue

Surgical procedure uses the woman's own tissue to form a breast mound.


In two procedures (latissimus dorsi flap of the transverse rectus abdominus muscle [TRAM]), the surgeon tunnels a wedge of muscle, fascia, subcutaneous tissue, and skin to the mastectomy site. In free-flap reconstruction (free tissue transfer), the surgeon uses a microvascular technique to transfer a segment of skin and subcutaneous tissue with its vascular pedicle to the chest wall.

Almost all patients who have mastectomies are candidates. It can be immediate (at the time of mastectomy) or delayed for several years.

Postoperatively, use a flow sheet every hour and assess adequate blood supply to the flap and donor site by evaluating the following: color (to verify that it is the same as skin from the donor area [not opposite breast]); temperature (warm); tissue turgor (to verify that it is not tight or tense); capillary refill (well-perfused flap will blanch for 1 to 3 seconds); and anterior blood flow using ultrasonic or laser Doppler. Unusual pain or decreased volume of drainage may indicate vascular impairment to the flap. Early detection of impaired circulation can be treated with anticoagulants or antispasmodics and possibly prevent further surgical interventions. Provide emotional support for the patient who is distraught over her appearance to reassure her the breast will look more normal with healing. The nipple and areola can be added 6 to 9 months later.

Pharmacologic Highlights

Medication or

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