Glossary of Definitions

Types of Breast Surgery

Single Mastectomy: Removing breast tissue on one side


Bilateral Mastectomy: Removing breast tissue on both sides


Lumpectomy: Excising a portion of breast tissue where the tumor resides


Nipple-sparing: Mastectomy and saving the nipple 


Skin-sparing: Mastectomy and removing the nipple, but saving the skin

Types of Reconstruction

Implants: Implant filled with salt water (saline), silicone, or a combination. Can be textured, or smooth.


DTI (Direct to Implant): Patients receive implants immediately during the mastectomy surgery, removing the need for expanders.


Delayed/Staged Reconstruction (with Exchange Surgery): Patients undergo a two-staged process, where the mastectomy is done first. Expanders or a flap are placed at a later date. Patients undergo ~weekly fills to stretch the skin around the expanders, and then another surgery (exchange) is done to exchange the expanders for implants or flap reconstruction. 


Expanders: Inflatable breast implant placed at the time of the mastectomy surgery to stretch the skin and muscle to make room for the implant.


Fills: Periodically fill the expanders with a salt-water solution on a ~weekly basis in between the mastectomy and exchange surgery. There’s typically several weeks or months in between surgeries.


Autologous tissue Reconstruction (Free-Flap Reconstruction): Surgeon transfers a section of skin, fat, and blood vessels from one part of the body to your chest to create “breasts”. Sometimes involves muscle and nerve transfer, but not always. (Tissue from belly: DIEP, SIEA, TRAM, tissue from back: Lattisimus Dorsi Flap, tissue from hip/butt: IGAP, SGAP, tissue from thighs: PAP, TUG, hybrid flap: Stacked DIEP, Stacked GAP Flap)

Placement of Implant/Expander

UTM (Under the Muscle): The pec muscle is cut to create a space for the implant (or expander) to go under the pec. The implant is then covered by the pec + serratus (a side muscle) or the pec + Alloderm (cadaver skin).

 

OTM (Over the Muscle): Implant (or expander) is placed above/over the muscle. Chest muscles are left intact, and the expander or implant is placed on top of the muscle where the breast tissue originally was. Often, Alloderm (cadaver skin) is then used to create the breast pocket by getting placed over the implant and then sewn into the chest wall muscles. 

Other Procedures

Fat grafting: Removing fat from other parts of the body (abs, butt, thighs) and transferring it (either via injection or surgery) to the breasts to make them appear softer and fuller, and decrease the appearance of ripples and other indentations. Sometimes done at the time of reconstruction, otherwise done as a separate outpatient procedure several months post-reconstruction (and exchange), after the implants or transferred tissue have ‘settled”


Breast reduction/lift (Mastopexy): Sometimes done to reduce breast size before the mastectomy/reconstruction in order to maximize chances of retaining the nipple and sensation post-mastectomy. Also helps to prep the pocket for the mastectomy and reconstruction, to help ensure excellent aesthetic results (e.g. symmetry).


Revision Surgeries: Replacing old implants with new implants, switching from UTM to OTM (or vice versa), reshaping the pocket, changing size and shape, fix capsular contracture, etc. 


Nipple Reconstruction: If saving the nipples isn’t an option, you can do nipple reconstruction ~3-4 months after reconstruction. The reconstructed nipple will be taken from a donor site (surrounding skin, tummy, etc.). Typically outpatient with a local anesthetic.


Nipple Tattoo: There are both traditional nipple tattoos, 3D nipple tattoos, and stick-on nipples to give the appearance of a natural nipple and areola. Traditional nipple tattoos are mostly made with dermabrasion. 

Complications with Implant Reconstruction

Rippling: Appearance of ripples/ridges in breasts. Can occur in both OTM and UTM reconstruction.


Hyperanimation: Appearance of muscle/implant moving up/down with chest movement. Relatively common with UTM.


Hematoma: Significant bleeding around the implant during/after surgery. 


Nipple necrosis: When the tissue around/in the nipple has poor blood circulation, the tissue and nipple can die. Some treatments include local wound care, freezing the nipple, and hyperbaric oxygen. Sometimes additional surgery is needed to remove the dead tissue. 


Capsular contracture: A tightening (“contracture”) of scar tissue that forms around the breast implant after it’s placed. Will feel firm to the touch. Severe contractures can be painful and distort the breast appearance. High risk can come from a hematoma that wasn’t removed, or biofilm (bacteria around the implant) that hardens scar tissue. Alloderm can help mitigate this risk 


Infection: Infection in/around the tissue around an implant or expander. Symptoms may include, but are not limited to: fever, breast pain, redness, swelling. Can be treated with antibiotics (oral or IV) and potentially another surgery to clean out the infected tissue and replace/remove the implant/expander.

Sensation

Allograft nerve tissue: Human nerve tissue that provides scaffolding for the nerves.


Nerve grafting: Depending on the skill of the surgeon and whether they’re trained in microsurgery, nerves can be reconnected with allograft nerve tissue to bridge large nerve gaps to help preserve sensation. 


Nerve preservation: Depending on the patient’s anatomical configuration and skill of the surgeon, nerves around breast tissue (often near the armpit, called T4 or T5 nerves) can be preserved during the mastectomy to preserve sensation.


ReSensation: Depending on the skill of the surgeon, a technique of breast neurotization (nerve repair) that can restore feeling either during or post-mastectomy with delayed reconstruction. Used with autologous tissue reconstruction. Uses allograft nerve tissue to reconnect nerves to help preserve sensation. (Check out www.resensation.com for more info and finding surgeons qualified in this technique.)