Breast Cancer patients can find comfort in knowing that a breast reconstruction is an option, and for many patients immediately after the cancer is removed. The final goal in breast reconstruction is to recreate a breast and to improve a women’s body image. Our goal is to see every patient before they undergo a breast cancer procedure, so they are aware of their reconstructive options. Each patient will be offered a safe and individualized treatment plan. Patients also have the option to perform a symmetry procedure on the other breast to create a more balanced result, which could include a breast lift, breast reduction or breast augmentation.
The two main types of breast reconstruction involve using either a breast implant or your own tissue. In some patients, both are required to achieve the optimum result. The type of reconstruction you choose will depend on many factors, including your lifestyle, body type, and personal preferences. Most patients will require at least 2 surgeries, one to create the breast, and a second to create the nipple.
The timing of breast reconstruction varies as well. Some patients can undergo immediate reconstruction while others may opt to delay their reconstruction.
- Breast Implants
- TRAM Flap
- Latissimus Dorsi Flap
- Nipple Reconstruction
- Breast Reconstruction After Lumpectomy
Dr. Carpin will discuss the best options for you during your consultation.
Breast Reconstruction With Breast Implants
Breast reconstruction using breast implants is a popular reconstructive option.
Who is a candidate for Breast Implant Reconstruction?
Patients who plan to have a mastectomy may opt for implant-based reconstruction immediately after the breast removal. Other patients may delay reconstruction and later decide to have an implant placed once they healed from the surgery. Patients who have previously undergone breast radiation therapy or plan for breast radiation therapy are typically poor candidates. Patients must also refrain from smoking during the reconstructive process.
Breast implant reconstruction has the optimal cosmetic result when it is performed immediately after the mastectomy is complete when the skin is supple. The skin can shrink after a mastectomy, and delayed reconstruction will require placement of tissue expanders to expand the skin before an implant is placed.
Pro’s of Breast Implant Reconstruction
- Shorter surgery
- Shorter hospital stay
- Less invasive reconstruction
con’s of Breast Implant Reconstruction
- Implant required
- Typically requires 2 surgeries, one for tissue expander placement to expand the skin, and a second procedure for permanent implant placement
- Larger size breast reconstruction may be limited
Breast reconstruction surgery is performed in the hospital operating room while you are asleep. Once the mastectomy is completed, the reconstruction can be completed in the same surgery. The procedure length is approximately one hour. Using the same incision as the mastectomy, the pectoralis muscle is gently elevated from the chest to create a pocket under the muscle. The tissue expander or breast implant is then placed under the muscle. If additional implant coverage is needed, a graft is placed to cover the implant. A small drain is placed to collect fluid after surgery. The incisions are sutured closed and a light dressing and bandage is applied. Patients often stay overnight in the hospital before going home.
Patients will need about one to two weeks free from their normal schedule to recover. If tissue expanders are placed, tissue expansion begins two weeks after surgery, where the skin is slowly stretched by inserting fluid into the expander on a weekly basis. The tissue expander is a temporary implant which stretches the skin and creates a pocket for the permanent implant. Patients refrain from heavy exercise for about 4 weeks after surgery. Complete breast expansion may take 2 months. Around 3 months after mastectomy, the tissue expanders are replaced with permanent breast implants. Nipple reconstruction can be performed about 3 months later.
Risks of implant-based reconstruction include infection, bleeding, pain, capsular contracture, implant device failure, implant exposure or visibility. Other implant related risks will be discussed during the consultation.
Cost of Breast Reconstruction
Breast reconstruction and breast symmetry procedures are covered under health insurance plans. Our office staff will help you understand your insurance benefits.
TRAM FLAP BREAST RECONSTRUCTION
TRAM Flap breast reconstruction uses your own abdominal tissue to recreate the breast. TRAM flap stands for Transverse Rectus Abdominus Myocutaneous Flap. Essentially the skin and six-pack muscle are used to reconstruct the missing breast tissue, resulting in a more natural looking and feeling breast reconstruction.
Who is a candidate for TRAM flap reconstruction?
Patients who are non-smoking with a healthy body weight are optimal candidates for TRAM flap breast reconstruction. This procedure can be performed as an immediate or delayed reconstruction. It is recommended that breast radiation if needed, should be completed before to undergoing breast reconstruction.
Pro’s of TRAM Flap Breast Reconstruction
- More natural feeling breast and look
- Removal of excessive, hanging abdominal skin
- Ideal reconstruction for patients who require breast radiation
Con’s of TRAM Flap Breast Reconstruction
- Longer surgery
- Longer hospital stay and recovery
- 2 surgical wounds (breast and abdomen)
- Risk of abdominal weakness and or abdominal hernia/bulge
Patients undergoing TRAM flap reconstruction have the option to perform delayed or immediate reconstruction. The procedure length is approximately four hours. Once asleep, abdominal tissue including skin, fat, and part of the rectus muscle is elevated and transferred thru a pocket under your breast fold to recreate the breast mound. The abdominal wounds are closed with sutures, resulting in an incision around the belly button and lower waist, extending from hip bone to hip bone. In some instances, a mesh is needed to close the abdominal wall where the muscle was removed. To close the abdominal wound, excess skin from above the belly button is pulled down, tightening the abdominal skin. Drains are placed to collect fluid. A light dressing is applied to the wounds and an abdominal binder is placed. Patients require several days in the hospital for recovery. Nipple reconstruction is performed later, about 3 months after the breast is reconstructed.
Patients will need about 2 to 3 weeks free from work. Abdominal drains are removed after about 2-3 weeks. An abdominal binder is worn for about 4 to 6 weeks. Most patients can return to exercise by six weeks.
Risks of TRAM flap breast reconstruction include pain, bleeding, abdominal hernia, and weakness, or in rare instances flap loss. Additional risks will be discussed during the consultation.
LATISSIMUS DORSI FLAP
A Latissimus Dorsi flap, or LD Flap, use the skin, fat, and part of your back muscle called the latissimus dorsi. This expendable muscle is a broad, thin muscle. The LD flap is used to cover an implant when the breast skin is damaged or inadequate for reconstruction.
Who is a candidate?
Healthy non-smoking patients requiring a breast reconstruction. Thin patients with inadequate abdominal tissue for TRAM flap reconstruction or poor quality breast skin are also good candidates.
Patients can opt for immediate or delayed reconstruction. The LD flap is designed to create a scar along the length of your bra line, on one side of your back. Thru this incision, skin, fat, and part of the muscle is lifted and rotated to the chest. In some cases, an additional incision concealed in the armpit is needed to rotate the flap on the chest. The mastectomy incision is used to position the flap on the chest. If an implant is needed, it is then placed under the flap. Drains are placed on the back and chest. A light dressing is applied. Three months later, a nipple reconstruction can be performed.
Patients require several days in the hospital for recovery. Drains are typically removed 2 to 3 weeks later. Patients will need 2 to 4 weeks free from their normal schedule. Heavy exercise is resumed at 6 weeks.
Patients will experience pain, swelling, bruising, possible fluid collection or in rare instances flap loss. Additional risks will be discussed during your consultation.
Nipple reconstruction gives the women a more natural appearance to the reconstructed breast and improves the overall patient satisfaction with their reconstructed breast.
How it works
Nipple reconstruction is done about 3 months after your breast reconstruction is complete. This allows enough time for the swelling and tissue to settle before positioning the nipple. The procedure can be performed in the office under a local anesthetic. A nipple is created from a skin flap of your breast tissue. The skin just above your mastectomy scar is raised and folded to create a nipple. Most of the scar is concealed in the mastectomy scar. Sutures are removed in 7 days. About one month later, a tattoo is placed to create the areola. Some patents opt to have only the tattoo in which shadowing is used to create the visual appearance of the nipple.
Slight discomfort, swelling, bruising or loss of nipple projection over time.
BREAST RECONSTRUCTION AFTER LUMPECTOMY
Patients with breast cancer opting to undergo lumpectomy for treatment can also be candidates for breast reconstruction. If the lumpectomy is predicted to cause a deformity to the breast, compromise shape or size of the breast, reconstruction can be performed after the lumpectomy to correct the breast shape.
Reconstruction can be immediately after the lumpectomy or delayed. Incisions and the type of reconstruction will vary depending on the tumor location or size of the breast. Options include performing a breast reduction or breast lift on both breasts to conceal the lumpectomy site. Other options include performing a local tissue flap to fill the missing tissue. Dr. Carpin will review your tumor type, tumor location and work with your breast surgeon to develop the best treatment plan for you.
Most patients go home the same or next day after surgery and return to work in one to two weeks. Heavy exercise is permitted at four to six weeks.
Risks of surgery include infection, bleeding, pain, bruising, or asymmetry. Additional risks will be discussed during your consultation.
Breast reconstruction after lumpectomy is covered under most insurance plans. Our office will help you understand your insurance coverage.