The goal of breast reconstruction is to restore the breast(s) to near normal shape, appearance, symmetry and size following mastectomy, lumpectomy or other trauma. Reconstruction is also a good option for women who lack breasts due to a congenital or developmental abnormality.
At Plastic Surgery for the Face and Body in Wall Township, NJ, Dr. Michael Nagy and Dr. Rahul Vemula are specifically trained in breast reconstruction, and will be a vital part of your care team as you navigate and explore your reconstruction options. We are proud to offer patients not only our highly experienced surgeons, but individualized care, compassion and commitment in seeing you through the reconstruction process. Our surgeons have successfully performed hundreds of breast reconstructions and have worked closely with many of the prominent breast surgeons in Monmouth and Ocean County.
Making the decision to undergo breast reconstruction is personal; we strive to make all our cancer patients aware they do have a voice and a choice.
Am I A Good Candidate?
Breast reconstruction is a good option for you if:
- You are able to cope well with your diagnosis and treatment
- You do not have additional medical conditions or other illnesses that may impair healing
- You have a positive outlook and realistic goals for restoring your breast and body image
About Your Consultation
Our surgeons will meet with you to fully evaluate and discuss your options. We happily encourage you to ask questions, as the more informed you are, the better we can work together to make the best decision for your treatment. During the consultation you can expect the surgeon to:
- Evaluate your general health status and any pre-existing health conditions or risk factors.
- Examine your breasts, and take measurements of their size and shape, your skin quality and nipple location
- Take photographs for your medical record
- Discuss your reconstruction options and recommend a course of treatment
- Discuss likely outcomes and any risks or potential complications from reconstruction
Types Of Breast Reconstruction
One of the first decisions a patient must make with her plastic surgeon is what type of breast reconstruction she will undergo. Reconstruction is performed on either an immediate or delayed basis and typically falls into two categories, implant reconstruction or reconstruction using a patient’s own tissue, which are commonly referred to as “flap” procedures. There are factors to consider when choosing what type of reconstruction option to pursue, such as the type of mastectomy you are having, cancer treatments and your body type. These types of reconstruction options will be discussed in greater detail below.
Immediate vs. Delayed Reconstruction
The decision regarding when to have breast reconstruction should be made with your plastic surgeon prior to your mastectomy. This is usually based on your risk factors and information provided during your diagnosis and in conjunction with input from other members of your healthcare team.
Immediate reconstruction takes place at the time of the mastectomy, and has become the standard of care for most patients. Again this is not always the case and is made in conjunction with your plastic surgeon, breast surgeon and oncologist depending on what type of treatments you may need. There are both advantages and disadvantages to immediate breast reconstruction, and these should be taken into consideration.
Delayed reconstruction is sometimes recommended, especially if there is advanced disease, or if you may require radiation as part of your treatment plan. You may want to delay reconstruction till you have completed all treatments to improve outcomes of your procedure.
The most common implant reconstruction technique combines skin expansion with implant insertion. First, the surgeon inserts a balloon expander beneath the skin and chest muscle where the reconstructed breast will be located. A saline (salt water) solution is then injected into the expander through a tiny valve beneath the skin over a few weeks or months, eventually filling it and stretching the skin. The expander may then be left in place or replaced with a permanent implant. A final procedure reconstructs the nipple and areola (dark area of skin around the nipple). Some patients do not require tissue expansion and begin immediately with the implant. This is called a direct-to-implant procedure.
Who Is A Good Candidate For Implant Reconstruction?
The ideal candidate for implant reconstruction is a woman who has no available flap options or no desire to have a flap operation, has no history of radiation to the breast or chest wall, is having a prophylactic mastectomy, wants bilateral reconstruction, or desires a surgery on the opposite breast to address an issue or problem with breast symmetry.
Recovery After Implant Surgery
Most patients are tired and sore for a week or two, and recovery can take up to six weeks, but you will be released from the hospital in two to five days. Stitches are taken out in a week to ten days. A surgical drain may be left in place to prevent a build-up of fluid in the reconstructed breast; this will be removed after a week or two.
The reconstructed breast will be numb following surgery, but it is possible that some sensation will return as time passes. Scars will fade, but not disappear. Periodic mammograms with a radiologist trained to examine breasts with implants are recommended.
Breast reconstruction has not been proven to affect the recurrence of cancer or other diseases, chemotherapy or radiation treatment.
Nevertheless, in addition to the complications possible from any surgical procedure (bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia), there are some risks inherent in breast reconstruction, including infection around the implant, if an implant is used, and capsular contracture, when the scar (capsule) around the implant tightens, causing the breast to feel hard. Treatment for capsular contracture varies from “scoring” the scar tissue to removing or replacing the implant. Some patients may need time to come to terms emotionally with their new breasts.
Types Of Flap Reconstructions
Tissue flap breast reconstruction is also known as autologous tissue reconstruction, as the tissue used to recreate the breast comes from your own body. These breast reconstructions use tissue from different parts of the body, such as the tummy, back, thighs or buttocks. The surgeon will than recreate the breast where your original breast once was. Since the patient’s own tissue is used, the result is typically a very natural looking breast that tends to behave more like a natural breast would versus a breast implant. For example, the breast may enlarge or shrink if you gain or lose weight. This type of reconstruction is a good option for some women-and should be discussed thoroughly with your surgeon to best understand the benefits and risks before you make any decisions.
The most common types of flap reconstructions are listed below.
TRAM Flap Reconstruction
This very common type of breast reconstruction uses the transverse rectus abdominus myocutaneous (TRAM) flap. In this reconstruction, the skin, fat, abdominal muscle and tissue is taken from the abdomen and is used to recreate the breast. A “perk” of this reconstruction is that the patient may have a flatter looking abdomen. The scar is usually low on the abdomen and can extend from hip to hip. This method can be used to reconstruct one or both breasts. For patients only having one breast reconstructed, the TRAM flap reconstruction may offer better symmetry with the existing breast.
An ideal candidate for TRAM flap reconstruction may:
- Want reconstruction using their own tissue
- Either do not want or are not a candidate for implant surgery
- Have enough abdominal wall tissue to create the breast(s)
- Have not had abdominal surgery before
- Have previously had chest wall radiation
Abdominal Free Flap Reconstruction or DIEP Flap
This type of reconstruction has really evolved with the advances in microsurgery, and is a relatively newer procedure available to women compared to the TRAM flap. The deep inferior epigastric perforator (or DIEP) flap is used to recreate the breast. This type of microsurgical procedure can provide women with a very natural looking breast using the abdominal tissue. Only the abdominal tissue is used, and very little, if any, muscle. This type of reconstruction may allow for good results with few donor site complications. The DIEP flap is a longer procedure as microsurgical techniques are utilized, and this reconstruction should be performed by a plastic surgeon that has been trained in this advanced type of surgery. We are very proud to offer our patients this type of reconstructive option with Dr. Rahul Vemula, a board-certified plastic surgeon who has performed many of these flap reconstructions and has specifically trained where this type of surgery was developed. Again it is important to understand all options available to you to ensure you make the best decision.
You may be an ideal candidate for a DIEP flap if you:
- Want reconstruction with your own tissue with minimal loss of abdominal muscle
- Do not want or are not a candidate for implant surgery
- Have enough of your own abdominal tissue available to recreate the breast(s)
- Have previously had chest wall radiation
The LD Flap Reconstruction
The latissimus dorsi flap (or LD flap) is another type of autologous flap surgery that utilizes the muscle on the back to create a soft tissue pocket that often holds an implant to recreate the lost breast. The muscle combined with the implant typically makes a more natural looking breast than the implant alone. There are many options with flap surgeries, and these should be discussed with your surgeon to determine which type of flap would give you the best result.
You may be a good candidate for a LD flap if:
- You are thinner with a smaller breast volume
- You have excess back tissue that would make this option a good choice
- Are not a good candidate for other flap choices
- You desire a more natural appearance than implant alone
- Are having partial breast reconstruction to correct a defect caused by lumpectomy
Recovery from Flap Breast Reconstruction
Depending on the type of flap surgery you are having, the amount of time you will be in the hospital can vary. In general a hospital stay can be between 3-5 days can be expected. Complete recovery from flap breast reconstruction can be from several weeks to several months. Again this will vary from patient to patient. All of these concerns will be discussed more in depth during your consultation with your plastic surgeon.