Breast ReconstructionBreast Reconstruction
Breast reconstruction is a surgical process which involves restoring breast shape, volume and symmetry after mastectomy for cancer or cancer prevention. The decision to undergo breast reconstruction is a personal one, and there are a variety of surgical options. We are committed to providing you the highest quality care and support as you navigate your reconstructive options.
We take great pride in delivering natural results, and our goal is to recreate a breast mound that is similar to your native breast, to help you feel more balanced and symmetric both in and out of your clothing.
Timing of breast reconstruction
Immediate breast reconstruction can often be done at the time of mastectomy and involves a team approach by your oncologic surgeon and plastic surgeon. During the same operation, you will undergo breast removal followed by reconstruction with either an implant or using your own natural tissue. Preserving and restoring the breast mound provides emotional and psychological benefits that can enable you to feel whole throughout your cancer treatment. Your team of surgeons will consult and determine if this option is right for you.
Delayed breast reconstruction offers the option of undergoing reconstruction at a later time after you have healed from the mastectomy. Some women simply don’t feel ready to undergo reconstruction at the time of mastectomy and choose to take more time to make their decision. Other patients require additional therapy such as chemotherapy or radiation therapy to be delivered immediately after mastectomy. Thus, sometimes delaying reconstruction is advised to allow for timely medical treatment.
Type of reconstruction: implant, natural tissue, hybrid procedures
Implant reconstruction has evolved over the years and can now be performed safely in a single stage known as “direct to implant reconstruction”. We prefer this technique as it allows for placement of an implant to fill the empty breast pocket at the time of mastectomy. This technique offers faster recovery and less surgical steps, as well the psychological benefits of preserving the breast mound after it is removed.
Occasionally, when the mastectomy skin blood flow is compromised, a two-step implant reconstruction is performed. This involves placing a temporary device called a tissue expander tissue expander at the time of mastectomy. The mastectomy pocket is then carefully stretched during routine in-office visits over a period of 2-3 months. After the desired size is reached, the second step surgery takes place and involves replacing the tissue expander with a silicone or saline implant.
Natural tissue breast reconstruction
Breast reconstruction using your own tissue often comes from the abdomen, similar to the tissue removed during a tummy tuck. This procedure is called a Deep Inferior Epigastric Artery Perforator flap (DIEP flap), and involves transferring the lower abdominal skin and fat with its blood vessels to the chest to rebuild a warm, soft, living breast mound. This provides the most natural reconstruction in both shape and feel. The rectus abdominus (six-pack) muscles are spared in this procedure, which preserves abdominal wall function.
DIEP flap reconstruction is highly specialized as it involves transplanting living tissue and reconnecting the blood supply under a microscope. We are both fellowship trained in microvascular surgery with years of experience in DIEP flap reconstruction, and are passionate about optimizing your surgical outcome and recovery. We perform your DIEP flap reconstruction together as a two surgeon team to give you the benefit of our combined expertise, shorter length of surgery and shorter hospitalization.
Most women with sufficient skin and fat in the lower abdominal region are candidates for DIEP flap reconstruction. If not, then other areas of the body can be used for donor tissue such as the low back, buttocks, or thighs.
Hybrid breast reconstruction involves the combination of an implant and DIEP flap to create the desire breast size and feel. Women who want the benefits of natural tissue reconstruction, and desire more fullness and projection have the option of undergoing an implant augmentation of the DIEP flap. This is typically performed at a second stage outpatient procedure 3 months after the DIEP flap has healed.
Women who choose breast conservation with lumpectomy or partial mastectomy
Many women are candidates for and choose to undergo breast conservation therapy. In this case, only the area of cancer and a margin of normal breast tissue are removed surgically. All women who undergo lumpectomy/partial mastectomy will require radiation therapy.
Women with very large breasts who choose breast conservation, can undergo a breast reduction closure at the time of the partial mastectomy. This procedure is called oncoplastic reconstruction, and a breast reduction is usually performed on the non-cancer breast for symmetry. Radiation therapy begins after 4-6 weeks of healing.
In some cases of severe radiation damage, there may be significant hardening, deformity of the partial mastectomy breast that is best addressed with a more extensive procedure. DIEP flap tissue can be used to replace the damage tissue and rebuild the breast with a more aesthetic result.
The goal of breast reconstruction is to create a breast that matches the natural breast as closely as possible, or in the case of bilateral reconstruction, to make both breasts symmetric. Often, when trying to match a natural breast with a reconstructed breast, surgery must be performed on the natural breast as well. This is a covered benefit of all insurance companies.
This procedure can involve augmentation to increase your natural breast size, reduction to reduce your natural breast size, or a breast lift (mastopexy) to move your nipple up. This operation usually occurs at the second surgery (about three months after the first procedure). The reason for delaying your symmetry procedure is to allow the reconstructed breast time to settle and swelling to decrease, which ensures a stable size and shape.
Fat transfer in breast reconstruction
Fat transfer or grafting is an outpatient procedure used to improve and refine the cosmetic appearance of a reconstructed breast. Fat is harvested from the body via liposuction, and then processed and injected into the tissue above an implant or DIEP flap in order to improve the contour and shape or increase the size of the breast reconstruction.
Women who have undergone prior breast reconstructive surgery and are unhappy with their results, should consider revision surgery. We are committed to creating customized surgical solutions for women suffering from complications of their breast reconstruction so they can feel like their best self.
Corrective surgery is designed to improve breast appearance and symmetry, address deformity or firmness, and alleviate pain. The type of revision procedure varies from simple to multistep surgery and is covered by insurance.
Some women with implant reconstruction develop persistent issues requiring multiple revisions. Conversion of problematic implant reconstruction to natural soft tissue DIEP flap reconstruction is becoming increasingly more common. One of the benefits is that patients can avoid future revision surgery after they undergo conversion to a natural tissue reconstruction and are finally able to move past breast cancer and live a more meaningful life.
One of the final stages of breast reconstruction is to create a nipple for the breast mound. This procedure is usually performed in the clinic under local anesthetic about three months after your last operating room procedure. There are many techniques used, but most of them involve using skin from your breast reconstruction. In some women, tissue can be borrowed from the other nipple.
The areola can be created either with tattooing or skin grafting.