Breast Reconstruction Options

Many women are candidates for incision via the inframmamary fold (the bra line). I had mine done this way and one can hardly tell that I had a mastectomy. This is often available for small and medium breasted women, less so for women with large breasts. Be sure to discuss this option with your doctor to see if you are a candidate. Many do not offer this option, so be sure that you determine if you are not a candidate or if your surgeon simply does not offer the procedure.

Preferably immediately after diagnosis. I feel it is very important for patients to learn about all their breast cancer treatment options, including breast reconstruction, at the very beginning of their journey. This is the only way to ensure they are truly involved in their treatment plan. It also allows those patients interested in immediate breast reconstruction to pursue it if they are candidates. For those that may not be candidates, knowing they will have the option once all their other breast cancer treatment is completed is often a huge source of strength.

Dr C
http://www.PRMA-enhance.com

The amount of scarring depends on the technique the surgeon uses for the mastectomy. Generally, skin sparing mastectomies have less scars.

Scars are permanent but to improve their appearance we start a scar control program 3 weeks after surgery and continue it until the scars are flat, smooth and the right color.

Many of my patients come to me years after their mastectomy. Of course, I prefer to rebuild their breast during the mastectomy operation. But the result is the same.

With our BRAVA + AFT (autologous fat transfer) procedure you will not be cut open again. As compared to the traditional methods, this involves no incisions, no new scars, no foreign objects and it recreates a natural feeling breast with the benefit of liposuction.

Plus, you will keep as close to normal sensation in your breasts and nipples. The procedure is covered by insurance for breast cancer patients.

BRAVA is placed over the breast area. The bra is worn while you sleep for average of 30 days before surgery. External expansion of the breast occurs via a comfortable vacuum pressure created by BRAVA. Tissue, and blood vessels begin to expand and generate a scaffold for fat to be injected. Your fat is harvested from several areas of your body through liposuction and is strategically injected into your breasts. No cuts or incisions are made.

There are usually a number of options. Perhaps minor adjustments can be made to the implant reconstruction in the surgeon's office or as an outpatient procedure in an operating room. If more significant revisions are needed, this may require replacing the implant with a new implant, or replacing it with a flap. An experienced plastic surgeon can give you more details on what would be appropriate for you after he or she examines you.

Great question! Your options would be very similar to those you would have if you had a mastectomy. Keep in mind that if your lumpectomy was followed by radiation, the behavior of the radiated skin and tissue can complicate a reconstruction procedure utilizing implants and your best option may be to use your own tissue to restore your breast size and shape. Nonetheless, it's your plastic surgeons responsibility to tell you all of the options available to you and let you choose how to proceed. Also discuss with your surgeon any procedure that may need to be done on your unaffected breast to achieve symmetry. Here's my short list of options:

1. Tissue expanders and subsequent replacement with permanent implants. Ask about silicone vs. saline implants. How about the use of a skin and tissue replacement like fat or a dermal matrix (like Alloderm).

2. Autologeous reconstruction with latissimus flap (back). Will implants be needed as well?

3. TRAM flap (transverse rectus abdominus muscle). Uses the muscle, skin, and fat of the abdomen to rebuild the breast. Make sure you have been told of the risks involved in removing this muscle.

4. DIEP, SIEA (deep inferior epigastric perforator or superficial inferior epigastric artery). Uses the skin and fat of the abdomen to rebuild the breast but leaves the muscle of the abdomen intact.

5. GAP (gluteal artery perforator). Uses the skin and fat from the upper (inferior) or lower (superior) buttocks. Like the DIEP, no muscle is removed for this procedure.

6. TUG (transverse upper gracilis). Inner thigh donor area, utilizes skin, fat, and muscle of the upper inner thigh.

7. Intercostal perforator. Utilizes skin and fat from under the arm.

8. Maybe you're happy with the size of your post-lumpectomy breast but would like the shape addressed. Procedures such as mastopexy or reduction mammaplasty on the unaffected breast may be the procedures to investigate.

9. If it's a small defect, a simple fat transfer from another part of your body may remedy the problem.

Best Wishes,

The Center for Natural Breast Reconstruction Team