breast procedures

Breast Reconstruction

This is the creation of a new breast after cancer removal by using tissue taken from another part of the body such as the abdomen or back, or by using an implant, or a combination of these techniques. Each of these processes relies on multiple stages to achieve the best possible result. The various options to consider are normally discussed thoroughly at the first visit, including tissue-based reconstruction and implant-based reconstruction. This gives the patient time to consider her options and return with questions. Often non-surgical cancer treatments such as radiation are used and this affects the type of reconstruction chosen and quality of reconstructive results that are possible.

It is sometimes possible to insert a tissue expander in place of your breast at the time of breast cancer surgery, depending on the circumstances. This is known as “immediate” reconstruction. “Delayed” reconstruction refers to placement of the expander at a separate operation after mastectomy. If you have chosen to proceed with implant-based reconstruction, then the tissue expander is expanded in the office at one or two week intervals. This is followed by a period of 1-2 months of healing. Finally, your tissue expander can be removed and replaced with your selected implant, which might be saline or silicone, depending on your discussion with your surgeon and your preferences. At the same time, if desired, a matching procedure can be done by your surgeon with the other breast. This overall process typically takes 3-6 months, but can sometimes take longer or shorter, depending on your circumstances. The final stages are typically office-based procedures to create a nipple and to create an areola with tattooing sessions.

What to expect: During the office consultation you will discuss all aspects of the procedure with your surgeon in order to establish a thorough and well-informed plan. Your procedure will begin after consulting with your surgeon and your anesthesiologist or anesthetist. Your surgeon will mark and measure your breasts prior to surgery according to the plan discussed with you. For implant-based reconstruction, the pre-selected tissue expander is placed partly beneath your muscle tissue and partly beneath your skin, in order to set the stage for the expansion process. Next, the process of healing for several weeks begins, followed by expansion for several weeks, and finally exchange of the tissue expander for an implant.

The recovery: The breast will have some bruising and swelling that improves over several weeks. Your postoperative course is monitored in the clinic by your surgeon and staff. Sometimes small drains are used after the surgery and are removed at the clinic visit. Local anesthetic and pain medication are often used to manage any discomfort you might have after the operation. We ask that you avoid wearing an underwire bra, but a camisole or other soft bra is safe.

Some of the unlikely complications: Infection or hematoma (blood collection) can occur following any type of surgery, and may require surgical drainage. More rarely, tissue loss or damage can occur. Skin loss can require wound care or revision surgery. A more complete discussion of the risks, benefits, and alternatives will always be included at your visit. As always, our efforts are directed at minimizing the risk of these complications and optimizing your safety.

DIEP flap and Microvascular Reconstruction

This is the creation of a new breast after cancer removal by using tissue taken from the abdomen using a technique known as the Deep Inferior Epigastric Perforator Flap, or “DIEP Flap.” This approach takes skin and fat away from the abdomen in a similar fashion to a tummy tuck and uses the tissue to create a breast instead of an implant. Sometimes, the tissue needs to be taken with a small amount of muscle tissue from the abdomen using a similar technique called a muscle-sparing TRAM. These muscles are the “rectus abdominus” muscles that help you perform sit-ups. When possible, the muscles are spared and left in place during surgery. The advantages of the DIEP procedure include often a shorter abdominal recovery and less abdominal complications than traditional TRAM flap surgery. Increased total time (usually between 6 and 10 hours) is typically needed during surgery for connecting the artery and vein to create a new blood supply for the tissue.

This is followed by a period of 3 to 6 months of healing. Sometimes a second stage is used at this point to help shape the new breast. At the same time, if desired, a matching procedure can be done by your surgeon with the other breast. This overall process typically takes 3-6 months, but can sometimes take longer or shorter, depending on your circumstances. The final stages are typically office-based procedures to create a nipple and to create an areola with tattooing sessions.

What to expect: During the office consultation you will discuss all aspects of the procedure with your surgeon in order to establish a thorough and well-informed plan. Your procedure will begin after consulting with your surgeon and your anesthesiologist or anesthetist.

The Recovery: The breast will have some bruising and swelling that improves over several weeks. Your postoperative course is monitored in the hospital for 3-5 days by your surgeon and staff. Sometimes small drains are used after the surgery and are removed at the clinic visit. Local anesthetic and pain medication are often used to manage abdominal discomfort you might have after the operation. We ask that you avoid wearing an underwire bra, but a camisole or other soft bra is safe.

Some of the unlikely complications: Infection or hematoma (blood collection) can occur following any type of surgery, and may require surgical drainage. The reconstructed breasts need to be monitored after surgery during the hospitalization and if the blood supply is not adequate or is disrupted, then occasionally the flap needs to be revised in the operating room to correct the blood flow. More rarely, tissue loss or damage can occur. Skin loss can require wound care or revision surgery. A more complete discussion of the risks, benefits, and alternatives will always be included at your visit. As always, our efforts are directed at minimizing the risk of these complications and optimizing your safety.

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