Breast Reconstruction

Our surgeons provide a variety of Breast reconstruction  options for women with deformities secondary to trauma, infection, as well as  lumpectomy (partial removal of breast tissue),  mastectomy as a result of breast cancer. This surgery is tailored to each woman’s particular case to use implants and existing tissue to shape and contour symmetrical and aesthetically pleasing breasts.

The timing of your surgery is an important consideration. You have the option of having your breast reconstruction immediately after your mastectomy or waiting until after you have healed somewhat. In some cases, the surgery must be postponed for radiation after the mastectomy.

Prior to your procedure, we will examine you and consult with both you and your oncologist to devise a surgical plan that is most advantageous for you.

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What can breast reconstruction correct?

Breast reconstruction can:

• Reconstruct a breast that was removed during a mastectomy or lumpectomy / radiation.
• Correct deformities due to trauma or severe infection.
• Correct congenital or developmental deformities.

During this procedure, the breasts can be better matched in terms of size, shape, and placement, and they can be lifted, if desired. Breast implants are often used in breast reconstruction, and the nipples and areolas may need to be raised or lowered in order to provide a symmetrical and pleasing result.

Are there visible scars after breast reconstruction?

No two breast reconstruction surgeries are the same. While we do our best to place incisions in discreet areas, there are usually some visible scars after this surgery. They do fade a great deal over time, however.

What happens during breast reconstruction?

We will discuss pre-operative and post-operative instructions with you. These might include dietary restrictions before your surgery, and you may need to discontinue certain medications or refrain from smoking for a period of time.

Breast reconstruction is an inpatient procedure that requires a short hospital stay. The surgery is usually performed under general anesthesia with a certified anesthesiologist present to monitor you throughout the surgery. The procedure usually takes 1-3 hours depending on the individual case, but it can take longer for some patients.

Expander Procedures

The most common scenario requires placement of a tissue expander to stretch the skin so that there is enough to properly cover an implant. This process requires 4-6 months, during which time we gradually fill the expander during weekly office visits. Once the adequate size / space have been achieved, we allow 2-3 months for the tissues to stabilize before exchanging the expander for permanent gel implants. The decision about the size and type of implant will be made with you at that time.

Flap Procedures

If flap procedures are used, there are a variety of possible techniques depending on which one will provide you with the best result.

Latissimus dorsi flap – In this technique, the muscle, fat, and skin are taken from the back and tunneled to the chest area, where it is placed over an expander. This added skin, fat, and muscle can markedly improve the final outcome versus tissue expanders or implants alone, especially if the patient has undergone radiation.

TRAM (transverse rectus abdominus musculocutaneous) flap – In this case, the skin and fatty tissue from the abdomen (which would normally be discarded with a tummy tuck) are used to reconstruct one or both breasts. Most commonly, the tissue is left attached to a leash of muscle which carries the necessary blood vessels. In some cases, only a small segment of muscle and the critical blood vessels are detached from the abdomen and reattached to vessels in the chest with the aid of a microscope (known as a FREE TRAM).

A DIEP flap is similar to a muscle-sparing free TRAM flap, except that no muscle is used to rebuild the breast. (A muscle-sparing free TRAM flap uses a small amount of muscle.) A DIEP flap is considered a muscle-sparing type of flap. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen.

In a DIEP flap, fat, skin, and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. (In a properly performed DIEP, no muscle is cut or removed.) Our surgeon will carefully reattach the blood vessels of the flap to blood vessels in your chest using microsurgery. Because no muscle is used, most women recover more quickly and have a lower risk of losing abdominal muscle strength with a DIEP flap.

There are pros and cons to each approach, and we will be glad to go over those with you if you are a good candidate for either procedure. Obviously, this requires adequate fullness of the abdominal area. Although the abdomen is flatter after this procedure, the result is not quite the same as an aesthetic tummy tuck.

What can you expect after breast reconstruction?

Just as each breast reconstruction surgery is individualized, recovery time and experience also vary from patient to patient. However, you can expect to experience some pain, inflammation, and bruising post-surgery. We will provide you with a prescription for pain medication, and we will give you detailed after-care instructions, as well as see you several times for follow-up appointments.

You will be wrapped in bandages after your surgery, and you will be given a surgical bra to wear for a period of weeks. Your breasts will require some time – perhaps months – after your surgery to settle into their final shape. You can expect to be off from work for at least 2 weeks and perhaps longer depending on your health and the requirements of your occupation.

Many patients opt for nipple reconstruction which can be done in connection with other procedures or as a relatively simple outpatient procedure performed under local anesthesia.

Is breast reconstruction right for you?

If you are preparing to undergo a mastectomy, have had a mastectomy already, or have misshapen or injured breasts that require reconstruction, this procedure can restore your breasts to a normal appearance.

While breast reconstruction is permanent, aging, pregnancy, and weight gain can cause the breasts to sag and change shape over time. (That said, our patients have been very pleased with the results of breast reconstruction.)

Note that health insurance often covers breast reconstruction surgery. This varies depending on the carrier, however, so we will check with your insurance company for information.

Contact our office today for a consultation to discuss your candidacy for breast reconstruction surgery.