Male Breast Reconstruction
Many people do not realize men have breast tissue and breast cancer isn’t limited to women. Men can get breast cancer too.
Most men undergo a modified radical mastectomy (MRM) as part of their breast cancer treatment. This includes removal of the breast tissue, nipple-areola complex, and one or more of the axillary lymph nodes. Many male patients will have chemotherapy and/or radiation therapy after mastectomy as the disease is often more advanced in men by the time it is diagnosed, primarily due to lack of awareness. Some male breast cancer patients may be candidates for nipple-sparing mastectomy or breast conservation (lumpectomy and radiation) depending on the breast cancer location and staging.
Just like any breast cancer patient, men can have chest wall deformities and concerns about their appearance following breast cancer surgery. Unfortunately, very little information is available on male breast reconstruction and few men know breast reconstruction is even an option.
Male breast reconstruction is almost always performed as a “delayed” procedure, after completion of all other breast cancer treatment.
Men interested in breast reconstruction have several options to help reestablish a natural chest contour. The best option will depend on the patient’s goals and symmetry needs. Reconstructive techniques include fat grafting, implants, tissue from other parts of the body (“flaps”), nipple reconstruction, and tattooing.
Fat grafting is the most common method of reconstruction in male breast cancer patients. It involves removing fat (using liposuction) from one area of the body, purifying it, and re-injecting it into the reconstruction site. It is important to note, some of the injected fat will be reabsorbed over time and this can vary depending on the exact clinical situation. Patients must therefore be prepared to require more than one procedure for the best results.
A small implant can be used to reconstruct a male breast after mastectomy. The implant is placed under the chest muscle in an operating room setting. Since the aesthetics of the male breast are usually quite different to the female breast, the best implant is often a custom silicone implant.
Some patients may require a more extensive type of mastectomy known as a radical mastectomy. This includes removal of the underlying pectoralis muscle(s). In these situations, tissue from the back (latissimus flap) can be used to reconstruct the chest muscle and overlying breast. In very rare cases, other tissue flaps can also be used depending on the size of reconstruction required.
Nipple reconstruction can be performed on its own or in conjunction with any other reconstructive procedure. Although there are many ways to perform nipple reconstruction, the bow-tie method, which gets its name from the bow-tie shaped incision, is the preferred method at PRMA. When performed alone, nipple reconstruction can be completed in the office setting under local anesthetic. The nipple and areola are later tattooed for a more natural appearance. 3D tattooing after nipple reconstruction provides the most natural looking results.
Scar revision can improve the appearance of breast surgery scars after mastectomy or lumpectomy, and can help reduce discomfort from severe scarring or scar tethering to the chest wall. Scar revision can also help improve chest contour defects, particularly when combined with fat grafting.
Various forms of tattooing can be performed, either alone or in conjunction with other reconstructive procedures. These include:
- A nipple-areola tattoo (2D or 3D), either alone or in conjunction with nipple reconstruction
- A decorative tattoo including the entire surgical site
Regardless of the type of tattoo, patients should seek out artists with the appropriate licensing and experienced in tattooing over surgical sites and scars.
Although breast reconstruction may not be for everyone, it is important for men undergoing breast cancer surgery to know all their options and discuss what option is best for them with their medical team.