Breast Reconstruction

What Is Breast Reconstruction?

Breast reconstruction is a surgical procedure for women who’ve survived breast cancer but lost part or all of one or both breasts. The surgery can be a positive change after a breast cancer treatment that included a mastectomy or lumpectomy. Performed by a top plastic surgeon, breast reconstruction restores the look and shape of your missing breast(s).

Breast cancer is a deadly disease that afflicts one in every eight American women. The most recommended breast cancer treatment is a mastectomy, which removes all the tissue from your breast. The procedure prevents the cancer’s spread, but the results of the surgery — the loss of your breast — can be devastating. Reconstructive breast surgery after cancer helps you heal, physically and emotionally, from the trauma of cancer.

Breast reconstruction after cancer is an intensely personal journey, at times complex and overwhelming. Visit Rowe Plastic Surgery for a caring, supportive environment. By allowing you to be a partner in the decision-making process, the staff guides you in your path to wholeness, whether you’re newly diagnosed with cancer or you had surgery many years ago, whether you’re considering preventative surgery or needing surgery to address an urgent problem. Because of decades of strong advocacy, health insurance covers all of these procedures.

Who Can Benefit from Breast Reconstruction?

Breast reconstruction surgery helps women who’ve been through cancer treatments or lost a breast for another reason. The surgery makes it possible for you to fit into your clothes, regain your shape, stop using a prosthesis in your bra and generally get a boost of self-confidence. Some factors that make you a suitable candidate for a breast reconstruction procedure include:

• You’ve had a mastectomy or lumpectomy and you don’t need further treatments.
• You’ve coped well with the cancer treatments.
• The effects of your mastectomy have negatively affected your sense of self.
• You lost your breast to a wound or accident.
• You have congenital breast deformities, although tuberous breasts can be corrected without a complete reconstruction.
• You want to have a normal, active sex life with two breasts.
• You have realistic expectations about the breast reconstruction procedure and results.
• You’re in good overall health.
• You’re currently cancer-free.
• You don’t smoke.

When you come in for a consultation, your breast surgeon carries out a thorough examination to qualify you as a candidate for breast reconstruction. The goal is to determine how the procedure may interfere with future medical treatments. The doctor also needs to establish that your body can cope with surgery at this stage. Sometimes, it’s best to wait before having this procedure.

What Is Immediate Breast Reconstruction vs. Delayed Reconstruction?

The timing of your breast reconstruction surgery depends on several factors. An immediate breast reconstruction after mastectomy for cancer happens immediately (during the same surgery) after the removal of your breast. With a delayed breast reconstruction, you can wait months or years after your breast cancer surgery for the reconstruction procedure. Issues regarding the immediate breast reconstruction vs. delayed reconstruction debate include:

• Surgical expertise. Immediate breast reconstruction surgery involves a breast cancer surgeon and a plastic surgeon. The delayed reconstruction only requires a plastic surgeon.
• Risks. Immediate breast reconstruction has a higher risk of complications because it involves two procedures: the mastectomy and the reconstruction.
• Delayed breast reconstruction with implants. A plastic surgeon can do part of an immediate breast reconstruction after mastectomy by using tissue expanders or breast implants. The other stages of reconstruction continue later, during a second surgery if a tissue expander is needed.
• Effectiveness. Both surgeries are very effective at reconstructing your breast. Each surgeries has its own positives and negatives that your surgeon will discuss with you in detail. There are other advantages to delaying your reconstruction, too.

Before deciding to get immediate or delayed surgery, you need to be evaluated by your plastic surgeon. Your doctor discusses the ramifications of each reconstruction method with you during your consultation.

What Determines Which Breast Reconstruction Option I Get?

A top NYC plastic surgeon has several breast cancer reconstruction options to choose from. The technique your doctor uses depends on both your diagnosis and prognosis. The two most common breast reconstruction techniques are:

1. Tissue-based or flap reconstruction
2. Implant-based reconstruction

The compassionate surgeon at Rowe Plastic Surgery selects the most appropriate option after a careful assessment of your body and your situation. Some of the factors that determine the best breast reconstruction surgery for you include:

• The type of mastectomy you had, which affects amount of breast tissue still available
• Whether you opt for immediate breast reconstruction or delayed breast reconstruction
• Your unique body type, height and weight
• Your goals and expectations
• Your overall age, health and lifestyle
• The possibility of additional breast cancer treatments
• Previous surgeries that can affect availability of fat tissue
• Medical conditions, such as diabetes
• A history of smoking, even if you don’t currently smoke

During your initial consultation, your NYC breast surgeon discusses the two techniques and your expectations. The doctor explains how your breast tissue, overall health and other factors affect which breast reconstruction technique to recommend.

Why Would I Choose Tissue-Based Reconstruction?

This form of reconstruction uses your body’s own tissue to recreate your breast in a procedure called autologous reconstruction. There are no artificial materials or implants in your body after surgery. A top plastic and reconstructive surgeon takes tissue from different sites, depending on what works best for you and your body. This autologous tissue most often comes from your abdomen, which is similar to your breast tissue. There are several flap surgery techniques for breast reconstruction, including:

• Deep inferior epigastric perforator (DIEP) flap breast reconstruction. In DIEP flap surgery, your surgeon takes the extra tissue from your tummy that would be thrown away in a tummy tuck and use it to construct a new breast or breasts. You can undergo this procedure at the same time as your mastectomy or years after your initial reconstruction, especially if you’ve undergone radiation and would prefer a softer, more natural-looking breast.
• Transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. This is a flap surgery where your doctor uses all or some of your rectus abdominis muscle, skin, blood vessels and fat tissues from your abdomen to rebuild your breast. This is a potential alternative to a DIEP flap in a situation where your blood vessel anatomy limits the ability to perform a DIEP flap.
• Superficial inferior epigastric artery (SIEA) flap breast reconstruction. A less-invasive flap surgery, the SIEA procedure involves only using your abdominal tissue supplied by superficial blood vessels to reconstruct breast. This alternate procedure is an option depending on your specific blood vessel anatomy – your surgeon can determine if this is an option before surgery.
• Pedicled flap breast reconstruction. In this procedure, your surgeon uses the muscle and fat from your belly, preserving its blood supply. This is a less common procedure but may be necessary depending on your specific needs.
• PAP flap reconstruction. The profunda artery perforator (PAP) reconstruction method uses tissue from your thigh, but without the muscle, and connects it to the profunda artery.
• The latissimus dorsi muscle flap reconstruction. In this is a breast reconstruction procedure, the surgeon moves muscle, tissue and skin from your upper back to the front of your chest to rebuild your breast. It uses its original blood vessels which remain attached. This may be combined with an implant depending on your specific needs.

Flap breast reconstruction is more extensive than implant based reconstruction because it involved two surgical sites: your breast(s) and the site where the tissue is harvested from. Your breast doctor chooses the best variation of flap surgery to fit your needs and your body.

An alternative or adjunct to flap surgery is a fat grafting breast reconstruction. Fat grafting uses your own fat, removed with liposuction from another area, to create a more natural appearance for your upper breast. This is not a procedure that can be used to reconstruct the entire breast but can potentially increase the volume of either an implant-based or flap-based reconstruction, especially in the upper breast.

Why Would I Choose Implant-Based Reconstruction Surgery?

Another option for breast cancer reconstruction is the use of implants, instead of your own autologous tissue. This surgery is typically done in two stages. The first stage occurs at the time of your mastectomy, when the surgeon inserts a tissue expander, a temporary implant that creates a pocket either below or above your chest muscle for the breast implant. The second stage involves exchanging the tissue expander for a more permanent implant. This typically is a short, outpatient procedure that can be combined with a symmetrizing breast lift  or a reduction on the opposite side.

Breast reconstruction with implants replicates your breast mound, restoring your figure. While this is a much simpler surgery, keep in mind that breast implants have a 10-15 year lifespan and will need to be exchanged at that time.

Breast implant types, each enclosed in a safe silicone shell:

1. Saline-based breast implants, which contain sterile salt water.
2. Silicone-based breast implants, which contain silicone gel.

Along with advice from your surgeon, you choose the size of the implant to suit your desires, and if necessary, you can have the opposite breast augmented at the same time to maintain symmetry. Your doctor advises you, based on your unique health situation, to plan for the best outcome.

What Is Oncoplastic Surgery?

If your breast cancer treatment involved partial mastectomy or a lumpectomy, you didn’t have an extensive surgical procedure, compared to a total mastectomy. In these instances, oncoplastic surgery helps you recover or even augment your breast shape. Your initial breast surgery procedure may not have affected your breasts’ shape that significantly, but you can still benefit from a breast reconstruction. The techniques used in oncoplastic surgery include a:

• Breast lift. This procedure elevates the shape of your breasts after the removal of a section that contained cancerous tissue.
• Breast reduction surgery. This procedure creates symmetry between your breasts after a partial mastectomy or lumpectomy.
• Transfer of tissue flaps. Grafting skin, fat or muscle tissue from another part of your body can restore the shape of your breasts.

Oncoplastic surgery improves your breast shape and boosts your self-image after your cancer treatment. If you’re worried about the effects of a lumpectomy or partial mastectomy, talk to a surgeon about reconstructing your breast after this breast conservation surgery. The surgeons at Rowe Plastic Surgery in New York City and New Jersey review your case and recommend the most appropriate surgical procedure for you, so you can continue your life with little impact.

Is Nipple Reconstruction a Part of Breast Reconstruction?

When you lose a breast to cancer, you obviously lose the nipple as well, meaning the functionality and sensation are both gone forever. This takes time to get used to. Once you’ve completed the reconstruction stage, your doctor can perform a variety of procedures to create a nipple on your new breast. This can involve a small procedure to create the button of the nipple, potentially combined with tattooing to create a color that’s as natural as possible.

Nipple reconstruction surgery is almost always part of your overall breast reconstruction after mastectomy. This type of reconstruction surgery focuses on the appearance of your nipple. Nipple reconstruction surgery can include:

• Flap nipple reconstruction. Your cosmetic surgeon uses skin flaps from your breast to create a nipple after the reconstruction of your breast.
• Nipple grafting. The surgeon takes tissue from other parts of your body to form a nipple during the breast reconstruction procedure.
• Shared nipples. If you had only one breast removed, your surgeon can use part of the nipple on the healthy breast to form a new nipple for your reconstructed breast.
• Tattooed nipple. If you don’t want extensive surgery, your surgeon can recommend medical tattooing for both the nipple and areola.

If you had nipple-sparing mastectomy with implants, you don’t need nipple reconstruction methods. When you talk to a NYC plastic surgeon, you learn everything you need to know about breast reconstruction. For instance, single and double mastectomy breast reconstruction surgery differs because of the amount of tissue that’s required. The goal is always to restore your figure for physical and emotional wellness.

What’s Involved in the Breast Reconstruction Process?

Breast reconstruction surgery varies from one patient to another. Your procedure can take from one to six hours, depending on the extent of corrective work required. Your breast reconstruction procedure follows a set of general steps, which include:

• Consultation. Consult a plastic surgeon even before your mastectomy or lumpectomy. This consultation answers all your questions about the breast reconstruction procedure. A top surgeon examines your breasts and consults with your breast cancer surgeon. During this consultation, you can decide on an immediate or delayed breast reconstruction.
• Preparation. Depending on when you have your reconstruction procedure, your plastic surgeon advises you to stop taking aspirin and other anti-inflammatory drugs before your procedure. You must stop smoking several months before the surgery to promote healing.
• Surgery. Breast reconstruction is a complex procedure done while you’re under general anesthesia. Your plastic surgeon uses the most appropriate technique, which may be the newest technique, to rebuild your breast. The combined effects of these multiple surgeries give you shapely breasts to retain or regain your figure after your mastectomy.

The best cosmetic surgeons in New York City use a multi-dimensional approach to breast reconstruction surgery. To achieve the desired results from your breast reconstruction, your surgeon carries out the procedures in stages. You may require several surgeries on separate dates, with healing time in between.

How Long Is the Recovery from Breast Reconstruction?

By then, you should know what to expect. During your recovery process:

• Expect pain, swelling and discomfort immediately after the surgery. Your doctor can prescribe short-term pain medication if you need it.
• The incisions may have drains inserted to prevent infection and fluid build-up.
• If you got breast implants at the time of your mastectomy, you may need just a day or two in the hospital. For flap surgeries, you may spend up to three or four days in the hospital.
• The swelling in your breast can take up to three weeks to subside. Don’t expect immediate results.
• You may have to wait as long as six months for the full results of your surgeries.

The doctor provides instructions on bandage care, bathing and taking care of the wound. Follow these instructions carefully for the best healing experience. Avoid any activity that strains your sutures. Avoid lifting heavy objects or strenuous activities once you leave the hospital. The staff at Rowe Plastic Surgery is available 24 hours a day during your recovery to answer any questions or concerns.

Breast Reconstruction FAQs

• Is breast reconstruction surgery painful? You undergo the procedure under general anesthesia, so you’re asleep and feeling no pain. You likely feel discomfort and soreness after the surgery, which subsides in time.
• Do my reconstructed breasts have nipples? Nipple reconstruction is always part of breast reconstruction if the patient desires this. Not everyone does!
• Will I have any feeling in my reconstructed breast? Not immediately. The reconstructed breasts can regain their sensitivity as the tissue grows, but your new nipple will not have any sensations. We can also perform a nerve reconstruction at the time of a DIEP flap reconstruction. This nerve reconstruction is not possible with an implant-based reconstruction.
• How close is a reconstructed breast in size to my natural breast? Depending on the reconstruction technique, your surgeon can create realistic breasts that closely resemble natural ones. Some patients prefer breasts larger or smaller than their original breasts. This will all be covered during the consultation with your surgeon.
• Can I have a normal sex life with a reconstructed breast? You can enjoy your sex life as before, but only after you’ve fully healed. Ask your plastic surgeon for advice before and after the procedure.
• Does insurance cover breast reconstruction? Under the Women’s Health and Cancer Rights Act (WHCRA), most breast reconstruction procedures after mastectomy are covered by your health insurance. Your plastic surgeon helps you file any paperwork required.
  

With breast reconstruction, you restore one or both breasts that you lost to breast cancer treatment. Your new breasts not only boost your self-esteem, but they reaffirm your femininity. To enjoy the life-changing benefits of breast reconstruction, contact the NYC plastic surgery team at Rowe Plastic Surgery.

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With breast reconstruction, you restore one or both breasts that you lost to breast cancer treatment. Your new breasts not only boost your self-esteem, but they reaffirm your femininity. To enjoy the life-changing benefits of breast reconstruction, contact the plastic surgery team at Rowe Plastic Surgery. They have offices in Manhattan, Long Island, New Jersey and the Hamptons.

212-628-7300