Breast Reconstruction

WHO COULD BENEFIT?

Women who have undergone matectomy for the treatment of breast cancer or severe fibrocystic disease.

Women who have a sizable breast defect due to lumpectomy and postoperative radiation therapy for the treatment of breast cancer.

Women who have undergone prophylactic mastectomy for higher risk of breast cancer or severe atypia.

Young and older women with congenital breast deformity.

THE GOALS:

The provision of a breast that appears natural.

Breasts that are symmetric.

Feeling whole again.

THE PROCEDURE:

We offer three types of reconstruction: implant reconstruction, TRAM flap reconstruction and latissimus dorsi flap reconstruction:

For implant reconstruction, we initially stretch the skin with a tissue expander. We insert the tissue expander immediately following the mastectomy or weeks, months or years thereafter--whenever the patient desires. At least two weeks after we insert the tissue expander, we pass a fine needle through the skin and inflate the tissue expander with some saline. We repeat this minor office procedure every two to three weeks, until the skin is adequately expanded, at which point the tissue expander should be slightly larger than the envisioned reconstructed breast. Next, we bring the patient back to the operating room to replace the tissue expander with a permanent saline or silicone gel breast implant. In selected cases, the tissue expander can also serve as the permanent implant, which spares the patient a second major surgery.

During TRAM flap reconstruction, a five to seven hour procedure, we utilized skin and fat from the lower belly to form a breast. This procedure leaves a long scar but also produces a flatter belly with tighter skin. Some patients feel they have undergone a tummy tuck. Generally speaking, a TRAM flap-reconstructed breast appears and feels more natural than a breast reconstructed by either the implant or latissimus dorsi technique.

During Latissimus Dorsi Reconstruction, we elevate the latissimus dorsi muscle (on the back) with overlying skin and tunnel both to the chest. We then drape the muscle and skin over a saline or silicone gel breast implant. Since there is a thick layer soft tissue covering the breast implant, the reconstructed breast drapes well and therefore appears and feels more natural than a breast reconstructed with an implant alone. This approach does result in a large scar on the back.

There are other types of breast reconstruction available at the university setting. We would be happy to discuss these as well.

POST-OP RECOVERY:

The duration of the recovery period is dependent on the type of reconstruction. Following surgeries for implant reconstruction, most patients return back to work at home or the office within two weeks. Following latissimus dorsi or TRAM flap reconstruction, the recovery perior takes at least 4-6 weeks.

OTHER POSSIBILITIES:

Following successful breast reconstruction, most patients opt for reconstruction of the nipple/areola complex.

INSURANCE?

Following mastectomy or lumpectomy, health insurance companies usually cover their share of the costs of reconstructive surgery. For the correction of congenital defomities or gross asymmetry, some insurance companies cover reconstructive surgery and some do not.

NOTE

All procedures have risks. Minor complications do occur occasionally. Major complications are rare.