BREAST RECONSTRUCTIONNEWPORT BEACH, CA

Eligibility for breast reconstruction is determined by several key factors. The patient's overall health, stage of breast cancer, and treatment plan play crucial roles. Women with early-stage breast cancer who don't require radiation therapy are often good candidates.

As a board-certified plastic surgeon, Dr. Richland takes into consideration if the patient has any chronic medical conditions or suppressed immune systems that may impact healing. Smoking and high BMI can increase surgical risks, so these factors are also evaluated when determining eligibility.

The best candidates for breast reconstruction are women who have a positive outlook and realistic expectations. They should be in good overall health, non-smokers, and maintain a stable weight. Patients with early-stage breast cancer who haven't required radiation therapy are often excellent candidates.

Having a strong support system and the ability to cope with the emotional and physical challenges of the surgical process is also important. The best candidates communicate and express their goals clearly, and are committed to following pre- and post-operative instructions for optimal healing and results.

The main difference in breast reconstruction between mastectomy and lumpectomy patients is the amount of breast tissue removed. With a mastectomy, the entire breast is removed, requiring more extensive reconstruction procedures to recreate the breast mound. Options like implant-based reconstruction or autologous tissue flaps are commonly used for mastectomy patients.

In contrast, a lumpectomy involves removing only the cancerous portion of the breast, preserving most of the natural breast tissue. Reconstruction after a lumpectomy typically focuses on restoring the shape and symmetry of the breast, often using techniques like fat grafting or local tissue rearrangement. The reconstructive process is usually less extensive and has a shorter recovery time compared to mastectomy reconstruction.

Typically, patients who undergo a lumpectomy may not require reconstruction, as the procedure aims to preserve as much of the natural breast tissue as possible. However, some patients may still opt for reconstruction if the lumpectomy results in significant asymmetry or a noticeable deformity in the breast shape.

Factors like the size and location of the tumor, as well as the amount of tissue removed, can impact the need for reconstruction. In some cases, oncoplastic techniques can be used during the lumpectomy to minimize deformities and maintain breast shape, reducing the need for additional reconstructive procedures.

Ultimately, the decision to pursue reconstruction after a lumpectomy is a personal choice of the patient. Dr. Richland assesses the individual case and provides guidance on whether reconstruction is necessary or beneficial for achieving the best aesthetic outcome.

Yes, weight and body type can significantly affect a patient's candidacy for breast reconstruction. Patients with a high body mass index (BMI) or those considered obese may face increased risks of complications during and after the reconstructive surgery.

Obesity can lead to slower wound healing, increased risk of infection, and potentially compromised results. Dr. Richland often recommends that patients maintain a stable, healthy weight before undergoing reconstruction to minimize these risks and ensure optimal outcomes.

Additionally, body type can influence the available options for reconstruction. For example, patients with insufficient abdominal tissue may not be suitable candidates for autologous reconstruction using abdominal tissue flaps. In such cases, Dr. Richland might recommend alternative techniques like using tissue from other areas of the body or implant-based reconstruction.

There are several breast reconstruction options available. The choice of reconstruction technique depends on factors such as the patient's body type, overall health, personal preferences, and my recommendation based on the patient's individual circumstances.

Some of the most common techniques include...

Implant-based reconstruction:

This method uses silicone or saline implants to recreate the breast mound. It is suitable for patients with adequate skin and chest wall tissue. Patients with thin skin or limited tissue may require a tissue expander before the permanent implant placement.

Autologous tissue reconstruction:

This technique uses the patient's own tissue from other parts of the body to reconstruct the breast.

DIEP (Deep Inferior Epigastric Perforator) flap:

Uses skin and fat from the lower abdomen.

Latissimus dorsi flap:

Uses tissue from the back.

GAP (Gluteal Artery Perforator) flap:

Uses tissue from the buttocks. Autologous reconstruction is ideal for patients who prefer a more natural look and feel, and have sufficient donor tissue.

Fat grafting:

This method involves transferring fat from other parts of the body to the breast area to improve shape and symmetry. It is often used as a complementary procedure to refine the results of other reconstruction techniques.

Yes, the breast reconstruction options can differ depending on whether the patient underwent radiation or chemotherapy.

Radiation therapy can significantly impact the tissues and skin of the breast, making them less pliable and more prone to complications. In patients who have received radiation, autologous tissue reconstruction is often preferred over implant-based reconstruction. The transferred healthy tissue from other parts of the body can provide better healing and more natural-looking results in radiated areas.

On the other hand, chemotherapy generally does not affect the choice of reconstruction options as directly as radiation therapy. However, chemotherapy can delay the timing of reconstruction, as Dr. Richland would prefer to wait until the patient has completed their treatment and allowed sufficient time for recovery, in order to have the best results.

In some cases, patients who have undergone chemotherapy may experience changes in their weight or body composition, which can influence the decision-making process for reconstruction. Dr. Richland assesses the patient's overall health and discusses the most suitable options based on their individual circumstances and treatment history.

Radiation and chemotherapy can complicate breast reconstruction surgery in several ways:

Radiation therapy can damage the skin and tissues, leading to delayed wound healing, increased risk of infection, skin changes, and scar tissue formation. These factors can negatively impact the appearance and longevity of the reconstructed breast, especially with implant-based reconstruction.

Chemotherapy can weaken the immune system, making patients more prone to infections during recovery. It can also cause changes in weight and body composition, affecting the symmetry of the reconstructed breast.

To minimize these complications, Dr. Richland prefers to optimize the timing of reconstruction and ensure patients have sufficiently recovered from their treatments before surgery. Careful planning can help reduce risks and improve the overall success of the procedure.

The timing of breast reconstruction, whether immediate or delayed, depends on various factors and patient preferences.

Some pros and cons of immediate and delayed reconstruction...

Immediate reconstruction (at the same time as mastectomy):

Pros:

Allows time for focusing on cancer treatment and recovery.

Provides more time to make informed decisions about reconstruction options.

May be necessary if radiation therapy is required after mastectomy.

Cons:

Requires a separate surgery and recovery period.

May result in less favorable aesthetic outcomes due to scar tissue formation.

Can prolong the emotional and psychological impact of mastectomy.

Ultimately, the decision between an immediate or delayed reconstruction, is based on the recommendation Dr. Richland makes when consulting with the patient after a complete evaluation of the patient's individual circumstances, preferences, and treatment plan.

The healing process after breast reconstruction surgery varies for each patient, and depends on the type of procedure and individual patient factors.

Here are the multiple stages of the healing process...

Immediate post-operative period (1-2 weeks):

Pain, swelling, and bruising are common.

Drains may be placed to remove excess fluid.

Patients may be given pain medication and antibiotics.

Limited arm movement and activities are recommended.

Early recovery (2-6 weeks):

Pain and swelling gradually subside.

Drains are typically removed within the first few weeks.

Patients can slowly resume light activities and exercises.

Incisions will begin to heal, but may still appear red or raised.

Long-term recovery (6 weeks - several months):

Swelling continues to decrease, and the reconstructed breast settles into its final shape.

Scars will fade and flatten over time.

Patients can gradually return to normal activities and exercise routines.

Additional procedures, such as nipple reconstruction or fat grafting, may be performed after initial healing.

Sensation recovery (months to years):

Numbness or changes in sensation are common after reconstruction.

Sensation may improve over time as nerves regenerate, but may not fully return to pre-surgery levels.

Throughout the complete healing process, Dr. Richland will have multiple follow-up appointments with each patient to monitor progress and address any concerns. It is essential that patients follow post-operative instructions carefully and communicate any issues with me to ensure proper healing and optimal results.

There are several alternatives to surgical breast reconstruction for patients who may not be suitable candidates or prefer non-surgical options.

Prosthetic breasts (breast forms):

External silicone or foam breast forms that can be worn inside a bra or attached to the chest wall.

Available in various shapes, sizes, and skin tones to match the natural breast.

Provides a balanced appearance when wearing clothing.

Non-invasive and does not require surgery.

Custom breast prostheses:

Professionally fitted breast forms custom-made to match the natural breast shape and size.

Can be made from silicone, foam, or other lightweight materials.

Ideal for patients with unique chest wall contours or uneven skin surface after mastectomy.

Specialized mastectomy bras and clothing:

Designed to accommodate breast forms or prostheses.

Feature pockets to hold the breast form securely in place.

Can include built-in breast forms for a seamless appearance.

Available in various styles, colors, and sizes to suit personal preferences.

3D nipple and areola tattoos:

A skilled tattoo artist can create realistic-looking nipples and areolas on the reconstructed breast.

Can be done on the skin of the reconstructed breast or on a separate skin graft.

Non-surgical option to enhance the appearance of the reconstructed breast.

These alternatives provide options for patients who may not want to undergo additional surgeries or are not suitable candidates for surgical reconstruction. Dr. Richland always discusses alternative options with patients to determine the best approach for their individual needs and preferences.

Yes, all procedures related to your breast cancer and breast reconstruction are covered by insurance according to the federal Women’s Health and Cancer Rights Act (WHCRA). This includes not only procedures on the affected breast but also the other breast as well for symmetry. This may include an augmentation, lift, or reduction on the non-cancer side.

The number of surgeries will vary depending on the type of method for reconstruction and your individual goals. Most women have more than one surgery, though. A small subset of women will require only one surgery if the permanent implant can be placed at the time of the mastectomy. However, you may still wish to have minor revision procedures at a later time, including fat grafting, nipple reconstruction, and/or contralateral breast symmetry procedures such as a lift, augmentation, or reduction.