If you or a loved one has just entered the world of breast cancer, mastectomy and breast reconstruction, I hope this page (which is the glossary from my book, Life Reconstructed) will help you understand some of the key terms. At the bottom of the page you will find links to some websites with more detailed information.
The definitions included in this glossary were collected and modified from a variety of sources including: Aesthetic Plastic Surgery, PC (https://www.aestheticplasticsurgerypc.com/), American College of Surgeons (https://www.facs.org/), American Society of Plastic Surgeons (plasticsurgery.org), BreastCancer.org (https://www.breastcancer.org/), Frankly Speaking About Breast Cancer: Spotlight on Breast Reconstruction (https://www.cancersupportcommunity.org/), and the input of Susan L. Beck, DO.
Autologous Tissue Flap Reconstruction: flap surgeries move healthy tissue from the abdomen to the breast. There are three types: the DIEP (deep inferior epigastric artery perforator) flap, Latisimus Flap and TRAM (transverse rectus abdominis muscle) flap.
Acellular Dermal Matrix – human tissue used for support and stabilization of the breast expander or implant. It’s incorporated into the surrounding tissue within three weeks.
Aesthetitist – medical tattoo artist.
Bilateral (Double) Mastectomy – surgery to remove the tissue of both breasts.
BRCA1 and BRCA2 – genes which, when damaged (mutated), place a woman at greater risk of developing breast cancer and/or ovarian cancer, compared with women who do not have this mutation. Men can also carry the gene mutation.
Breast Augmentation (boob job) – utilizes implants or fat to enhance the size and shape of already existing breasts. The woman’s natural breast tissue remains intact, and an implant is added to the breast tissue for aesthetic reasons. This procedure is completed using a small incision in an inconspicuous area like the armpit or the underside of the areola.
Breast Reconstruction – the rebuilding of breasts after a mastectomy.
Capsular Contracture – when an unusually large tissue capsule that forms around the breast implant, squeezing the implant. This can cause pain and distort the shape of the breast.
Delayed Reconstruction – when a woman chooses to wait months or even years after mastectomy to have her breasts reconstructed.
DIEP (deep inferior epigastric artery perforator) Flap – procedure that uses the fat and skin from the abdomen, leaving the muscle intact, to create a breast mound. This is a free flap surgery as the tissue is completely severed from the abdominal wall and moved, followed by the the reattachment of blood vessels.
Direct-to-Implant Reconstruction – reconstruction completed at the time of the mastectomy. It can be done by placing the implant underneath or above the chest muscle. Donated cadaver tissue (acellular dermal matrix) or an absorbable mesh is inserted in the shape of a sling to hold the implant in place.
Dog Ears – pockets of fat under the arms after mastectomy. This more commonly occurs in women who choose to go flat.
Doppler Probe (Doppler Blood Flow) Monitors – an implantable ultrasound probe attached to a wire leading from the reattached blood vessels to the outside of the body, where it is connected to a monitor that keeps track of blood flow.
Drain Bulbs – A bulb shaped container attached to tubing that is inserted in the body after a surgical procedure. The bulb collects fluid that drains from the body after surgery.
Ductal Carcinoma In Situ (DCIS) – a highly curable, non-invasive form of breast cancer that consists of cancer cells that are localized to the breast ducts. Also called Stage 0.
Expansion Appointment – an appointment where the plastic surgeon uses a long needle attached to a syringe filled with saline to increase the size of the tissue expander. This allows the breast skin (and sometimes muscle, depending on final implant placement) to slowly stretch over a period of time until the breast reaches the desired size.
Exchange Surgery – second stage of two-stage breast reconstruction surgery (generally outpatient) in which the expander is removed and replaced with a permanent implant. This surgery is significantly shorter and less invasive than the first phase (mastectomy and expander insertion reconstruction surgery,) but does require a couple of weeks to heal.
Fat Transfer – procedure that uses a person’s own fat to fill in irregularities.
Flap Reconstruction – procedure where tissue is taken from another part of the woman’s body and reassigned to the breast. Skin, muscle and fat tissue can all be used. There are several places on the body that can be used as the donor sites for flap reconstruction, but the two most common sites are the abdomen and the upper back. (American Cancer Society)
Free TRAM Flap – in this procedure, tissue and muscle (but usually less muscle than the TRAM flap) are completely severed and moved to the chest where the blood vessels are then reattached. This procedure takes longer than the TRAM flap because of the time needed to reattach blood vessels, but there is less risk of losing abdominal strength in this procedure.
Gluteal Free Flap – uses tissue from the buttocks, and is similar to the free TRAM flap in that the tissue is cut out and moved to the chest where the blood vessels are reattached.
Going Flat – term used when a woman chooses not to undergo reconstruction after a mastectomy.
Guided Meditation – meditation in response to someone else through variety of possible means like in person, video, audio or written text.
Gummy Bear Implants – ulitizes a semi-solid silicone gel that holds its form even if the implant breaks. Because of the thickness of the gel, these implants feel less like natural breast tissue than regular silicone, but they don’t risk leaking if the implant is punctured.
Hematoma – a blood clot that forms in the tissues outside of the blood vessel
Hormone Therapy – type of cancer treatment for hormone receptor positive cancers. These hormonal drugs keep estrogen and progesterone from attaching to the receptors on breast cancer cells.
Implant – a silicone gel-filled or saline-filled flexible sac inserted either above or underneath the pectoral muscle in breast reconstruction and cosmetic breast surgery.
Implant Reconstruction – the breast(s) is rebuilt using a silicone or saline implant which can be placed under or over the pectoral muscle.
Immediate Reconstruction – see direct-to-implant reconstruction.
Invasive Ductal Carcinoma – cancer that originates in the milk ducts. Accounts for about 80% of all breast cancer diagnoses (breastcancer.org.)
Invasive Lobular Carcinoma – cancer that originates in the milk-producing glands (lobules).
Latissimus Dorsi Flap Reconstruction – is a tunneling procedure like the pedicle TRAM flap, but takes tissue from the upper back, tunneling it under the skin to the chest to make a pocket for an implant.
Lollipop Lift – a breast lift performed by creating an incision around the areola and another incision vertically from the areola to the breast crease creating a “lollipop” shape.
Lumpectomy – surgery which removes a tumor and a small amount of tissue surrounding it (margin), but does not remove the whole breast.
Margins – the edge or border of the tissue removed in cancer surgery. The margin is described as negative or clean when the pathologist finds no cancer cells at the edge of the tissue, suggesting that all of the cancer has been removed. (cancer.gov)
Nipple-Sparing Mastectomy – a procedure that removes the breast tissue while preserving the nipple and areola.
Non-Abdominal Flap Reconstruction – non-abdominal flap surgeries move healthy tissue from the upper back, buttocks or inner thigh to the breast area. These surgeries include: the latissimus dorsi flap , the gluteal free flap (GAP flap) and the transverse Upper Grasilis flap (TUG flap.)
ON-Q* pain pump – a type of pain relief system that utilizes a pump ball connected to a tube inserted at the surgical site that continuously delivers local anesthesia to block the pain in the area of the procedure.
Oophorectomy – surgical removal of one or both ovaries.
Pedicle (attached) TRAM Flap – procedure where the rectus abdominal muscle is tunneled underneath the skin of the abdomen to the reconstruction site, allowing the muscle to remain connected to its original blood supply. These are sometimes called “muscle-transfer” flaps because most or all of the rectus abdominus muscle is used.
Prosthesis – a breast form made to mimic a natural breast.
Previvor – a woman who undergoes a bilateral mastectomy prior to a cancer diagnosis due to testing positive for a mutation on their BRCA1 or BRCA2 gene which greatly increases future breast cancer risk.
Prophylactic Bilateral Mastectomy – mastectomy performed prior to a cancer diagnosis.
Round Implants – are a uniform shape all around. These are the most commonly used implants in breast augmentation because of the fullness they give the breast, and because the implant can rotate within the pocket without changing the contour of the breast.
Saline Implants – breast implant filled with saline (salt water) solution. They tend to be less malleable than silicone implants, but in the case of a punctured implant the body can naturally absorb the liquid unlike silicone.
Sentinal Lymph Node – the first lymph node where cancer will spread from the original tumor site.
Silicone Implants – breast implant filled with a silicone gel. Fears about the silicone leaking into the body in the event of a puncture led the FDA to research the safety of these implants in the 1990s. (They were deemed safe and have been in use ever since the completion of that study.)
Smooth Implants – can move around within the implant pocket, acting more like a natural breast. They can cause a visible rippling under the skin.
Tear-drop Implants – shaped similarly to the natural breast, with more silicone or saline along the base of the breast than the top. The biggest risk with this type of implant is that if it rotates out of place it will change the contour of the breast
Textured Implants – allow scar tissue to stick to them limiting their movement in the breast pocket. These implants are less likely to get repositioned, but they also move less naturally. (Allergen BIOCELL Textured Breast Implants were recalled in July 2019 due to a link to Implant Associated Large Cell Lymphoma.)
Tissue Expander – a balloon-like temporary implant that is gradually inflated with a saline solution to stretch skin (and sometimes muscle) to make room for the permanent implant.
Tissue Flap Reconstruction – procedures that use tissue from the abdomen, back, thighs, or buttocks to rebuild the breast.
Triple Negative Breast Cancer – an aggressive form of breast cancer whose cells test negative for estrogen, progesterone and HER2, three things that drive the growth of common breast cancers. Because of this, it doesn’t respond to some of the common treatment options used for other breast cancer types. More likely to occur in pre-menopausal African-American women.
TUG (Transverse Upper Grasilis) Flap – procedure that takes tissue extending from the lower buttocks to the inner thigh. Good candidates for this procedure are women whose thighs touch. Like the abdominal flap surgeries, this is a less likely option for thin women.
Two-Stage Reconstruction – during the first stage, a mastectomy is performed, followed by the placement of an expander either under or over the chest muscle. Prior to the second stage, several expansion appointments occur. The second stage, where the expander is replaced by a permanent implant, generally occurs months after the first stage.
Unilateral (Single) Mastectomy – surgery to remove the tissue of one breast.
TYPES OF MASTECTOMY
A unilateral (sometimes referred to as single) mastectomy removes the tissue of a single breast.
A bilateral (sometimes referred to as double) mastectomy removes the tissue of both breasts.
A prophylactic mastectomy is when a woman chooses to undergo the surgery prior to diagnosis. Mastectomies are often performed after a breast cancer diagnosis, but are also a treatment option for women who are cancer-free, but have tested positive for the genetic mutation for the disease on their BRCA1 or BRCA2 gene. The genetic mutation greatly increases the risk of a future breast cancer diagnosis. A woman who undergoes a prophylactic mastectomy is called a previvor.
BREAST RECONSTRUCTION VS. BREAST AUGMENTATION
Breast reconstruction is done to restore breasts after a mastectomy. Though in some cases the woman’s nipple is spared during mastectomy, the goal of the surgery is to remove all the breast tissue. Depending on how advanced the cancer, sometimes some or all of the chest muscle is removed as well. The surgeon is tasked with creating something out of nothing, and the nature of the surgery generally necessitates long incisions that leave prominent scars. Reconstruction comes from a place of sadness and loss. It’s something women undergo to regain a sense of normalcy after one of the key feminine parts of their body is removed.
Breast augmentation (boob job), on the other hand, utilizes implants or fat to enhance the size and shape of already existing breasts. The woman’s natural breast tissue remains intact, and an implant is added to the breast tissue for aesthetic reasons. This procedure is completed using a small incision in an inconspicuous area like the armpit or the underside of the areola. It’s something women do to improve their look. I consider this a “happy procedure.”
In flap reconstruction, tissue is taken from another part of the woman’s body and reassigned to the breast. Skin, muscle and fat tissue can all be used. There are several places on the body that can be used as the donor sites for flap reconstruction. The two most common sites are the abdomen and the upper back. (There are a variety of flap procedures that are commonly performed.)(American Cancer Society)
In implant reconstruction, the breast is rebuilt using a silicone or saline implant instead of tissue from a different part of the woman’s body. This is sometimes immediately follows mastectomy – immediate reconstruction. It’s sometimes done in phases – immediate/delayed reconstruction.(This is what I did.) And it is sometimes done months or even years after mastectomy – delayed reconstruction.