Abdominoplasty
Surgical procedure, commonly referred to as a tummy tuck, in which excess skin and fatty tissue are removed from the lower half of the abdomen. The scars that are associated with an abdominoplasty are almost identical to the flap donor site scars associated with a TRAM flap.

 

Adjuvant therapy
Medical term referring to the addition of radiation therapy, chemotherapy, or both to mastectomy as part of the breast cancer treatment regimen.

 

Anastomosis, anastomose
Connection of the ends of two blood vessels to reestablish blood flow into the tissue being transferred. (See Breast Reconstruction with a TRAM Flap.

 

Areola
The pigmented skin at the base of the nipple of the breast. Because the areola contains some breast ducts (milk-conducting tubes), it is generally removed with the breast tissue during mastectomy.

 

Aspiration
Technique of draining fluid from a surgical site using a needle and syringe, as in cases of seroma.

 

Asymmetry, asymmetric
Lack of symmetry, or sameness, between the left and right sides of the body, as in differences in size, shape, or projection between the two breasts or differences in body contour caused by removal of a flap from only one side of the body.


 

Autologous tissue-based breast reconstruction
Medical term referring to breast reconstruction using the patient’s own tissue to make the new breast. The TRAM flap is an example of an autologous tissue-based breast reconstruction.

 

Axilla
Medical term for the armpit.

 

Axillary dissection
Removal of lymph nodes in the armpit.

 

Bilateral
Medical term referring to both sides of the body, such as a procedure performed on both sides of the body or to both breasts, as in bilateral mastectomy or bilateral breast reconstruction. See Unilateral.

 

Breast augmentation
Surgical procedure in which a breast is enlarged by placement of a breast implant either behind the breast itself or under the pectoralis major muscle. Breast augmentation is also called breast enlargement or augmentation mammaplasty.

 

Breast implant
Device consisting of a silicone elastomer shell filled with either saline or silicone gel. The device is placed under the pectoralis major muscle and overlying breast skin of the chest wall or under an LD flap after it has been transferred to the breast area. A breast implant is also called a breast prosthesis. (See Implant-Based Breast Reconstruction.

 

Breast mound
Medical term referring to the main body of the reconstructed breast, usually before the nipple has been reconstructed.

 

Breast remodeling
Surgical procedure in which the breast tissue remaining after partial mastectomy is altered to give the breast a more pleasing shape. This technique is often more successful if the tumor was removed from the lower rather than the upper half of the breast.

 

Breast volume
Medical term referring to the volume of breast tissue removed after mastectomy.

 

Breast Contracture
Contraction or shrinkage of the scar tissue (capsule) that forms around a breast implant or tissue expander. The extent of the contracture can vary from undetectable (i.e., the breast maintains the same shape and softness it had just after surgery) to a grossly deformed and hardened breast.

 

Capsule
Layer of scar tissue that forms around a tissue expander or breast implant.

 

Chemotherapy
Treatment of cancer with chemical agents that are much more toxic to cancer cells than to normal cells.

 

Delayed breast reconstruction
Reconstruction of a breast some time after mastectomy. Delayed reconstruction can occur weeks, months, or even years after mastectomy.

 

DIEP free flap
Deep inferior epigastric perforator flap, a technique of autologous tissue-based breast reconstruction using a free flap of tissue from the abdomen that is essentially a sophisticated form of the TRAM free flap. Unlike the TRAM free flap, the DIEP free flap does not include any part of the rectus abdominis muscle.

 

Dissect, dissection
Medical term used to indicate the process of surgically separating tissues of interest from the surrounding tissues so that the tissues of interest can be used in some way.

 

Drain
Tubular device that is placed under the skin of the breast or the flap donor site and that exits through a small incision in the skin to a suction device (drain reservoir or canister). The drain is placed at the time of surgery to remove excess wound fluid and blood during the postoperative period.

 

Drain reservoir
Medical device that attaches to a drain (tube) to provide suction and collection of wound fluid or blood during the postoperative period.

 

External breast prosthesis
Device that fits into a brassiere to replace the missing form of the breast after a mastectomy. The device can be made of a foam rubber or silicone elastomer and silicone gel.

 

Fascia
Type of tough, flat, tendon-like tissue that surrounds the abdominal muscles.

 

Fat necrosis
Death of fat tissue due to inadequate blood supply. Fat necrosis can occur in a flap, in the skin remaining after a mastectomy, or at the flap donor site.

 

Fine-needle aspiration
Biopsy technique used to determine whether tissue contains cancer cells.

 

Flap
Unit of tissue composed of an island of skin and fat with or without its underlying muscle. Two examples are the LD flap and the TRAM flap.

 

Flap donor site
Location on a patient’s body from which a flap has been removed.

 

Free flap
Unit of tissue (flap) in which the blood vessels that conduct blood into and away from the flap are cut so that the flap can be transferred to the breast site. To reestablish blood flow to the flap, blood vessels at the breast site are connected to the flap s vessels with the aid of an operating microscope, a process called anastomosis. A free flap is also called a free tissue transfer or microvascular free flap. See DIEP free flap, Inferior gluteal free flap, Rubens flap, S-GAP flap, and TRAM free flap.

 

Gluteus maximus muscle
Muscle of the buttock. Part of this muscle is removed with tissue and skin to create the inferior gluteal free flap.

Immediate breast reconstruction
 

Immediate Breast Reconstruction

Reconstruction of the breast immediately after removal of the breast (mastectomy), while the patient is still under the same general anesthetic used for the mastectomy.

 

Implant-based breast reconstruction
Methods of breast reconstruction in which a breast implant is used to supply the missing breast volume.

 

Inferior epigastric artery and vein
Blood vessels that enter the rectus abdominis muscle from near the groin to supply blood to this muscle and, by way of perforators to the fat and overlying skin, to the TRAM flap and DIEP free flap.

 

Inferior gluteal free flap
Unit of tissue obtained from the lower part of the buttock and transferred using microsurgical technique to create a new breast. This free flap comprises skin, fat, and some of the lower part of the gluteus maximus muscle.

 

Inframammary fold
The fold or crease that forms the lower border of the breast.

Internal mammary blood vessels
 

Internal mammary vessels 

Blood vessels located just under the ribs along the sternum, or breastbone. These blood vessels are frequently used as recipient blood vessels for a free flap. These vessels also give rise to the superior epigastric artery and vein, which constitute the primary blood supply to the TRAM pedicled flap.

 

Latissimus dorsi muscle
Muscle from the back that is removed, along with tissue and skin, during an LD flap or ELD flap procedure.

 

Lumpectomy
Surgical procedure involving a wide local excision of the breast tumor. This procedure is usually performed in association with an axillary dissection and postoperative radiation therapy. See Quadrantectomy and Wide local excision.

 

Mastectomy
Surgical procedure in which part of the breast or the entire breast is removed. Types of mastectomy include partial mastectomy, segmental mastectomy, modified radical mastectomy, radical mastectomy, total mastectomy, and skin-sparing mastectomy. Each type of mastectomy is distinguished by removal of different amounts of breast tissue.

 

Modified radical mastectomy
Surgical procedure that involves removal of the nipple, areola, some breast skin, the breast tissue under the breast skin, and most of the lymph nodes in the axilla.

 

Nipple
Protuberance of the breast upon which the breast’s milk ducts (tubes) open and from which milk is drawn by a nursing infant.

 

Operating microscope
Microscope designed for use in the operating room and used in anastomosis. It is used in microsurgery to magnify objects, such as small blood vessels, so that they can be joined together with very fine sutures.

Partial flap loss
Death of skin and fat tissue of a flap due to inadequate blood flow.

 

Partial mastectomy
Surgical procedure in which the tumor and a surrounding cuff of normal tissue are removed. The amount of normal tissue removed can vary from small (as in a lumpectomy) to considerable (as in a quandrantectomy).

Pectoralis major muscle
Large chest wall muscle located just beneath the breast and to which the breast is attached. One pectoralis major muscle is located under each breast. These muscles are commonly referred to as the pecs.

Pedicled flap
Type of flap that includes skin, tissue, and a strip of muscle containing the blood vessels that supply blood to the flap. These blood vessels are not severed from their original location in the body when the flap is transferred to the chest during breast reconstruction. See TRAM pedicled flap and Vascular pedicle.

Perforator
Medical term for the small artery and vein in a flap that traverse the muscle and fascia to carry blood into and away from the flap. One or more perforators connect to the blood vessels forming the vascular pedicle of the flap.

Perforator flap
Unit of tissue and skin (flap) that is supplied by small blood vessels (perforators) that branch from the larger artery and vein that form the vascular pedicle of the flap. The perforators usually course through a muscle located between the flap and vascular pedicle. See DIEP free flap and S-GAP flap.

Prophylactic mastectomy
Surgical procedure in which a subcutaneous mastectomy, total mastectomy, or simple mastectomy is performed for patients who are at high risk for breast cancer.

Ptosis, ptotic
Medical term referring to the degree of drooping that a breast has when the patient is standing or sitting. The larger the patient s breasts, the more ptotic the breasts will tend to be, especially as she gets older.

Quadrantectomy
Form of wide local excision in which a larger part of the breast containing the breast tumor is removed than in a lumpectomy. Depending on the size of the breast, quadrantectomy usually causes a deformity of a small to medium-sized breast. This procedure is usually performed along with an axillary dissection and postoperative radiation therapy. See Lumpectomy, Wide local excision, Partial mastectomy, and Segmental mastectomy.

 

Radiation therapy
Treatment of breast cancer by ionizing radiation. This treatment is also called irradiation or radiotherapy.

Radical mastectomy
Surgical procedure in which the nipple, areola, most of the breast skin, the breast tissue under the breast skin, the pectoralis major muscle, the pectoralis minor muscle, and the lymph nodes in the axilla are removed. If immediate breast reconstruction is not performed, a skin graft may be needed to close the large wound remaining on the chest wall after this form of mastectomy.

 

Rectus abdominis muscle
Abdominal muscle that is used, along with overlying fatty tissue and skin, for a TRAM flap.

 

S-GAP flap
Superior gluteal artery perforator flap, a free flap technique of autologous tissue-based breast reconstruction in which skin and fatty tissue (but not muscle) from the upper part of the buttock are used to make the new breast.

 

Saline
Sterile solution of salt and water that is made to the same concentration as body fluid or IV fluid.

Segmental mastectomy
Surgical procedure in which the breast cancer, a thin layer of normal breast tissue around the cancer, any breast skin close to the breast cancer, and some or most of the lymph nodes in the axilla are removed. See Partial mastectomy, Wide local excision, and Quadrantectomy.

 

Silicone
Complex, long-chain polymer molecule, poly(dimethylsiloxane), in which the main chain is composed of alternating silicon and oxygen atoms. The polymer is used to make the silicone elastomer shell of a breast implant filled with either saline or silicone gel. Silicone is used to make the gel in silicone gel-filled implants and for many other medical products.

 

Simple mastectomy
Surgical procedure in which the nipple, areola, minimal breast skin, all breast tissue, and in some cases, the lowest level of lymph nodes are removed. See Prophylactic mastectomy.

Skin-sparing mastectomy
Surgical procedure in which the nipple, areola, and entire breast gland are removed. The procedure is similar to a modified radical mastectomy except that all uninvolved breast skin is preserved.

Subcutaneous
Medical term meaning under the skin.

Superior epigastric artery and vein
Blood vessels that enter the rectus abdominis muscle from under the ribs to supply blood to this muscle and, by way of perforators to the fat and overlying skin, to the TRAM flap.

 

Suture
Strand or fiber used to close a surgical wound. Sutures are made of a variety of materials and are available in many sizes.

Symmetry, symmetric
Equivalent proportions on the left and right sides of the body. One goal of breast reconstruction is to ensure that the two breasts match, that is, are equivalent in terms of size, shape, and projection.

Tattooing
Process of adding pigment to a reconstructed nipple and areola to give a natural appearance. (See Nipple and Areola Reconstruction.

Tissue expander
Balloon-like device, consisting of a silicone elastomer shell, that is placed under the pectoralis major muscle. The device is slowly inflated by serial (usually weekly) injections with saline. This device hydraulically expands or stretches the muscle and overlying breast skin so that a breast implant can eventually be placed.

 

Tissue expansion
Gradual process of hydraulically expanding or stretching the pectoralis major muscle and overlying breast skin so that a breast implant can eventually be placed in the space created by the tissue expander.

Total mastectomy
Surgical procedure in which the nipple, areola, some skin, all breast tissue, and some or most of the lymph nodes in the axilla are removed; see Simple mastectomy and Modified radical mastectomy. Some forms of total mastectomy also involve the removal of the pectoralis major muscle, the pectoralis minor muscle, or both; see Radical mastectomy.

TRAM flap
Transverse rectus abdominis myocutaneous flap, a technique of autologous tissue-based breast reconstruction using a flap composed of skin, fat, and a part or all of the underlying rectus abdominis muscle. The skin and underlying fat are oriented transverse or perpendicular to the underlying rectus abdominis muscle.

TRAM free flap
Type of TRAM flap in which the blood vessels that supply the flap with blood are severed from the body and reconnected (anastomosed) to blood vessels at the breast (mastectomy) site. (See Breast Reconstruction with a TRAM Flap.

 

TRAM pedicled flap
Type of TRAM flap in which the blood vessels that supply the flap with blood traverse the length of the rectus abdominis muscle and enter the flap. A TRAM pedicled flap remains connected to the body at the upper part of the abdominal flap donor site near the sternum (breastbone).

Unilateral
Medical term meaning one side of the body and often used to describe a procedure performed on one breast (as in a unilateral mastectomy or unilateral breast reconstruction). See Bilateral.

Vessel thrombosis
Medical term referring to the formation of a blood clot on the inside of the recipient blood vessels, the blood vessels attached to the free flap (the vascular pedicle) or both blood vessels. A blood clot prevents the flow of blood into or out of the free flap. If a thrombosis is not removed from the blood vessel within a few hours of the clot forming, total flap loss will result.

Wide local excision
Surgical procedure in which the tumor and a surrounding cuff of normal tissue are removed through a skin incision. See Lumpectomy, Quadrantectomy, Partial mastectomy, and Segmental mastectomy.

 

Wrap-around flap (Skate Flap)
Surgical technique of nipple reconstruction in which a local flap is transposed from a part of the reconstructed breast and surgically manipulated to form the new nipple.

 

Glossary of Terms for Breast Reconstruction 

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