Breast Reconstruction

Breast Reconstruction After Cancer

Being diagnosed with breast cancer forces you to make tough choices, including decisions about breast reconstruction. Whether or not to proceed with breast reconstruction after a mastectomy is a personal decision. Many women still choose to forgo reconstruction in an effort to move on and heal as quickly as possible. Others find regaining a more natural beast appearance to be physically and emotionally rewarding. Dr. Doezie is a plastic surgeon that specializes in breast reconstruction after a mastectomy. In his experience, patients experience an improved self-image, self-confidence and quality of life.

A note about symmetry: If only one breast is affected, it can be reconstructed alone. However, a breast reduction, breast lift or breast augmentation may be recommended for the unaffected breast to improve symmetry of the size and position of both breasts.

Initial Consultation

After meeting and discussing the procedure with you, Dr. Doezie will do a breast exam while his assistant takes notes of breast measurements and size. Before you leave a quote will be given to you at the end of your appointment.

The Procedure

Breast reconstruction can be achieved through different plastic surgery techniques in order to restore a breast to near normal shape, appearance and size following mastectomy.

Although a plastic surgeon can rebuild your breast, the results are highly variable: A reconstructed breast will not have the same sensation and feel as the breast it replaces. Scars will always be present on the breast, whether from the mastectomy or the reconstructive surgery. Certain surgical techniques, however, allow the scar lines to remain at the donor site, which is usually located in a less exposed area of the body such as the back, abdomen or buttocks.

Breast Reconstruction with your own tissue

Free flap techniques reposition a woman’s own muscle, fat and skin to create or cover the breast mound. This is sometimes necessary when a mastectomy or radiation therapy leave insufficient tissue on the chest wall to cover and support a breast implant. Flap techniques or the use of tissue expanders are almost always required when a breast implant is used for reconstruction.

A TRAM flap uses muscle, fat and skin from the abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or may be completely detached, and formed into a breast mound. Another technique, called a latissimus dorsi flap, uses muscle, fat and skin from the back. In this case the flap is tunneled to the mastectomy site but remains attached to its donor site, so the blood supply remains intact.

Usually, a flap can reconstruct a complete breast mound by itself, but sometimes a breast implant is necessary to give enough volume to the reconstructed breast.

Tissue expansion
The use of tissues expanders stretches the healthy skin so that the breast implant can be completely covered. The use of tissue expansion during reconstruction provides for easier recovery than flap procedures but is a much longer process. It will require several office visits over 3-4 months. After placement of the expander Dr. Doezie will slowly fill the device though an internal valve to expand the skin. The expander will then be replaced with a breast implant during a second surgery.

Immediate Reconstruction with Breast Implant
A breast implant surgery can either be an addition or alternative to flap techniques. Dr. Doezie will help you decide if saline or silicone breast implants are best for you. Silicone is generally recommended for reconstruction. Reconstruction with an implant alone usually requires tissue expansion, but recent advances allow implants to be placed immediately at the time of mastectomy in certain patients with smaller breasts.

Nipple Reconstruction
The last stage of breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola. These are usually performed under local anesthesia in the office. Once healing of the nipple has occured, Dr. Doezie will tattoo the color of the areola around it.

Recovery

Following your surgery using flap techniques and/or the insertion of an implant, bandages will be applied to your incisions. A support bra or elastic compression garment will minimize swelling and support the reconstructed breast. Dr. Doezie will place a small drain tube, which will remain under the skin temporarily. This will allow any excess blood or fluid to drain. A pain pump may also be used to reduce the need for narcotics.

Following Dr. Doezie’s instructions is key to the success of your surgery. You will need to be sure to keep motion minimal and that the surgical incisions are not subjected to any abrasion or excessive force.

Risks

Possible risks of breast reconstruction include:

• Infection, poor healing of the incisions and bleeding
• Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site
• The use of implants carries the risk of breast firmness (capsular contracture) implant leakage or rupture

Visit our photo gallery to see before and after breast reconstruction pictures of Dr. Doezie’s patients.

Learn more about breast reconstruction surgery and schedule my consultation with Dr. Doezie at Mission Plastic Surgery.