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Reconstructive Breast Surgery Review: Best in the Business

Published by Dr. Brandon Richland, MD

“Dr. Richland is the BEST in the BUSINESS. I just left my Oncology Surgeon’s office and my Doctor said she could not tell I had reconstructive breast surgery. I love Summer and Tarry. They are so helpful and kind. Everyone is very professional! I will be back for a facelift soon.”

Read the full Google Review here.

Understanding Breast Reconstruction

Breast reconstruction is a surgical procedure aimed at rebuilding the shape and appearance of a breast following mastectomy removal of the breast, often due to cancer or lumpectomy, which is the removal of a part of the breast tissue. This section explores various techniques and timing considerations involved in breast reconstruction, helping patients to understand the available options.

Types of Breast Reconstruction Procedures

Breast reconstruction can be achieved through different methods, primarily using implants or the patient’s own tissue. Implant reconstruction involves the placement of a silicone or saline implant to form the breast shape. On the other hand, autologous or flap reconstruction uses a piece of tissue transplanted from another part of the patient’s body, such as the abdomen or back, to rebuild the breast.

  • Implant Reconstruction:
    • Silicone implants
    • Saline implants
  • Autologous Reconstruction (Flap Procedures):
    • TRAM flap (from abdomen)
    • Latissimus dorsi flap (from back)

Immediate vs. Delayed Reconstruction

Breast reconstruction timing is crucial and can be categorized into:

  1. Immediate Reconstruction: Breast reconstruction is performed during the same operation as the mastectomy.
  2. Delayed Reconstruction: Breast reconstruction is performed at a later date, allowing for time between cancer treatments and the reconstructive surgery.

Factors influencing the decision between immediate and delayed reconstruction include the patient’s health, cancer treatment plans, and personal preferences.

Nipple-Sparing vs. Total Mastectomy

When a mastectomy is required, patients might choose between two primary types of mastectomy:

  • Nipple-Sparing Mastectomy: This procedure saves the nipple and areola, and it is often followed by immediate reconstruction to maintain the natural appearance of the breast.
  • Total Mastectomy: This procedure removes the entire breast, including the nipple-areola complex. Patients may opt for either immediate or delayed reconstruction based on their individual case and advice from their medical team.

Reconstruction Techniques and Options

Reconstructive breast surgery after mastectomy or lumpectomy offers a pathway toward reclaiming one’s body image. With advancements in surgical methods, the techniques and options are varied, allowing individualized approaches suited to each person’s needs and circumstances.

Implant Reconstruction

Implant reconstruction is a common method for rebuilding the breast shape using prosthetic materials. This typically involves placing a tissue expander beneath the skin and chest muscle to make room for a breast implant. Over time, this expander is gradually filled with saline to stretch the skin and create sufficient space. Once the area has stretched adequately, a second surgery replaces the expander with a silicone or saline breast implant. This method may involve a series of procedures, and in some cases, nipple and areola reconstruction or tattooing can be performed to enhance the aesthetic results.

Autologous Tissue Reconstruction

Autologous tissue reconstruction uses the patient’s own tissue skin, fat, blood vessels, and sometimes muscle to create a new breast. This eliminates the need for foreign materials and can produce more natural results. There are various techniques within this category:

  • DIEP flap: uses skin and fat from the lower abdomen while preserving the muscle.
  • TRAM flap: transverse abdominal muscle, fat, and skin to the chest.
  • TUG flap: utilizes upper thigh tissue to reconstruct the breast.
  • SIEA flap: similar to DIEP, but involves different abdominal blood vessels.
  • IGAP, SGAP, and PAP flap: employ tissue from the buttocks or thighs, without disturbing the underlying muscles.

Each technique has its specific indications and considerations, and the choice is dependent on the patient’s anatomy and preferences.

Flap Procedures

Flap procedures are a subset of autologous tissue reconstructions that involve moving a complete piece of tissue from one part of the body to the breast:

  • Free flap: completely detaches the donor tissue from its original blood supply and reattaches it to blood vessels in the chest area. This requires microsurgery and is often used in DIEP or SIEA flap procedures.
  • Latissimus dorsi flap: involves muscle, fat, and skin from the upper back tunneled to the mastectomy site to recreate the breast mound.
  • Pedicle flap: maintains the tissue’s original blood supply, as seen in traditional TRAM flap reconstructions, where tissue remains attached to the donor site and is transferred to the chest.

Flap procedures are complex and may not be suitable for all patients, such as those with insufficient donor tissue or those with certain health conditions. However, they can offer a more natural feel and appearance compared to implant reconstruction.

Factors Influencing Reconstruction Choices

When considering breast reconstruction, women weigh various factors from health concerns to expected outcomes. Here’s how these considerations can shape a woman’s decision on reconstructive surgery.

Evaluating Risks and Lifestyle

Women considering breast reconstruction must assess the potential risks involved with the procedure. This includes evaluating personal health status and any complications that could arise. A woman who leads an active lifestyle may also consider how the surgery and the recovery time could impact her daily activities. Recovery time varies depending on the type of reconstruction and can influence a woman’s decision based on her lifestyle needs.

  • Risks: Infection, complications from anesthesia, and flap failure
  • Lifestyle: Impact on physical activity, work, and family life

Body Type and Cosmetic Outcomes

The woman’s body type plays a critical role in reconstruction choices. Plastic surgeons work with patients to determine the most suitable option that aligns with their body shape and the desired cosmetic outcome. Autologous tissue reconstruction, which uses tissue from the patient’s own body, such as the abdomen or back, may be preferred by some for more natural results. However, not all women are candidates for every type of reconstruction, and a surgeon’s expertise will guide this decision.

  • Body Type: Suitability for autologous or implant-based reconstruction
  • Cosmetic Outcomes: Expectations for symmetry, shape, and size

Cancer Treatment and Recovery

A woman’s cancer treatment plan, including whether she will have radiation therapy, influences her breast reconstruction options. Radiation therapy can affect the healing process and the aesthetic results of reconstruction. Therefore, the timing of reconstruction whether immediate or delayed until after cancer treatment is a critical decision. Women must consider how breast reconstruction fits into their overall cancer treatment and recovery journey.

  • Cancer Treatment: Coordination with chemotherapy and radiation therapy
  • Recovery: Integration of reconstruction with cancer healing process

In collaboration with their doctor and plastic surgeon, women must navigate these variables to make an informed decision on breast reconstruction that best suits their health and personal needs.

Potential Complications and Side Effects

Reconstructive breast surgery can offer hope and restoration, but it comes with inherent risks and potential side effects that patients need to understand. Recovery times and changes in breast sensation are common topics of concern, along with the possibility of surgical complications.

Managing Expectations for Recovery and Sensation

Post-operative recovery time can vary based on the type of reconstruction surgery performed. For example, surgeries using autologous tissue may involve a longer recovery period than those with implants. Patients may expect:

  • Recovery Time: Generally, one could expect a recovery period ranging from several weeks to a few months, with extensive surgeries requiring longer to heal.
  • Breast Sensation: Changes or loss of sensation in the breast are possible after surgery, as nerves may be severed or damaged. Some sensation might return over time, but it could also be permanently altered.

Understanding Surgical Risks

Surgical interventions carry several risks that patients should discuss with their healthcare provider. Key risks include:

  • Anesthesia: Complications related to anesthesia are rare, but risks increase if patients have other health issues, like heart disease or lung conditions.
  • Bleeding and Seroma: Some blood loss during surgery is expected, but excessive bleeding may require further intervention. Seroma, the collection of fluids in the breast or donor site, can cause swelling and pain.
  • Infection: Any surgery poses an infection risk. Symptoms typically include redness, fever, and swelling, and treatment often involves antibiotics and rest.
  • Increased Risk Factors: Smoking and diabetes may increase the risk of complications, such as poor wound healing and infection.
  • Scar Tissue and Necrosis: Scarring is inevitable, but excessive scar tissue can lead to complications. Necrosis, or the death of tissue, is a severe but rare risk.
  • Additional Considerations: Patients are advised to seek a second opinion to understand the risk of complications fully. Specific to implant-based reconstructions is a rare association with anaplastic large cell lymphoma (ALCL).

By understanding the potential complications and side effects, individuals can make informed decisions regarding their reconstructive breast surgery options and prepare for the recovery journey.

Planning and Preparing for Surgery

When planning for reconstructive breast surgery, patients should focus on selecting a qualified surgeon and understanding the insurance and financial aspects related to the procedure. These steps are essential for a smooth journey towards restoring one’s body shape and confidence.

Selecting the Right Plastic Surgeon

It is imperative to choose a board-certified plastic surgeon experienced in various types of breast reconstruction procedures. Surgeons who specialize in flap surgery, autologous fat grafting, or those proficient with implants can offer several reconstructive options. A patient might consider someone skilled in microsurgery to ensure precision and better cosmetic outcomes. For those opting for implants, knowledge about the differences between silicone and saline, as well as the risks of capsular contracture and silicone gel bleed, is vital during the decision-making process. When symmetry is a concern, discussing the options of surgery on the opposite breast or contralateral prophylactic mastectomy is wise to ensure a balanced silhouette.

Insurance Coverage and Financial Considerations

Understanding health insurance benefits and coverage is crucial since reconstructive breast surgery can be a significant financial undertaking. Most insurers are required by law to cover breast reconstruction if they cover mastectomy, including 3D tattoo of the nipple and areola, breast prostheses, and revisions for cosmetic outcomes.

Patients should confirm whether their insurance policy covers the surgery, including the cost of an acellular dermal matrix, used to support the breast mound, if necessary. It’s also essential to find out about coverage for treatment of the healthy breast to match the reconstructed one and any necessary post-surgery swelling and incision care. If insurance does not cover certain aspects, or if the patient is uninsured, exploring financing options or institutions that donate services could be alternative routes.

Schedule Your First-Class Cosmetic Consultation with Dr. Brandon Richland, MD

Contact Dr. Richland today by visiting RichlandMD.com, scheduling a cosmetic consultation, or by calling 714-844-0398 or 949-997-2958 directly.

Cover Image Illustration by: Dr. Brandon Richland, MD