Breast Reconstruction

Immediate vs. Delayed Reconstruction
A breast may be reconstructed immediately, such as at the same operative visit as the mastectomy, or in a delayed fashion, which means that it can still be done at some later time.

The two main categories of reconstruction involve either using breast implants, or using the patient’s own tissue from another area of her body, such as the lower abdomen.

Tissue Expanders and Implants
The most common method of utilizing implant-based reconstruction is to first place a tissue expander, which is a type of temporary balloon, following a mastectomy. The expander is then inflated in the Plastic Surgeon’s office on a weekly basis so that the skin which was removed during the mastectomy can stretch to accommodate an implant. After the skin has stretched adequately, the patient returns to the operating room and the tissue expander is removed and a permanent implant, either saline or silicone, is placed.

Using the Patient’s Own Tissues (Autologous Reconstruction)
If the patient’s own tissues are used to create a breast, the tissues can either be tunneled under the pre-existing skin, such as in a TRAM (transverse rectus abdominis myocutaneous) flap from the lower abdomen, or it can be completely disconnected from its original location on the body and then placed to recreate a breast by performing microvascular surgery, which entails carefully suturing together the blood vessels using a microscope, such as in a DIEP (deep inferior epigastric artery perforator) flap. In each of these two scenarios in which abdominal skin and fat is used, the abdomen enjoys the added benefit of a tummy tuck appearance following the breast reconstructive surgery.

Nipple-Areola Reconstruction
Following creation of a new breast, a new nipple and areola can also be created to achieve a three-dimensional quality. Typically, the nipple is created from your own skin overlying the new breast mound, while the circular areola which surrounds the nipple is fashioned from skin taken from a well-concealed location, such as your abdomen, your inner thigh, or even the opposite breast.

Nipple-Areola Tattooing
While creating a nipple and areola from pigment alone can be performed, Dr. Pathy believes that the full three-dimensional effect of a natural nipple and areola can best be achieved by first reconstructing the structures before tattooing them. Following reconstruction of the nipple and areola as described above, it may be necessary to perform tattooing with micropigmentation to result in an overall completed breast. In this short, office-based procedure, a variety of shades of ink are mixed to achieve the appropriate pigment match.

Fat Transfer
To achieve further refinement in symmetry and contour, fat transfer may be performed to your reconstructed breast. Fat transfer, also known as fat grafting or fat injection, has seen a steadily rising popularity.  It essentially involves improving defects or deformities in contour with one’s own, natural tissue. During this process, fat is extracted from an area of the patient’s body, such as the abdomen, in a process similar to liposuction. However, unlike liposuction, which targets pockets of fat for removal, fat grafting additionally focuses upon replacing the fat to specific areas to enhance volume. The fat which has been extracted is gently processed through one of a number of different methods to yield purified fat, separating it from the extraneous fluids. This purified fat is subsequently injected into an area, such as the breast, to achieve an immediate improvement in contouring.

Additional Symmetry Procedures
Not only can the breast mound be recreated, but the opposite breast can also be altered with a breast lift, breast reduction, or breast augmentation to better match the newly reconstructed breast. These procedures can be performed at the same time as your nipple-areola reconstruction to expedite the completion of your reconstruction.

Oncoplastic Surgery
In some instances, breast conservation therapy can be performed in which only the cancerous portion of the breast is removed. These patients require radiation therapy as well to better reduce the risk of further breast tumor. In certain patients, the removal of a large amount of breast tissue would cause a significant deformity. Oncoplastic surgery involves repositioning the breast tissue in such a way as to reduce the deformity and provide a more natural appearing breast after the diseased segment is removed.

Insurance Coverage
The Women’s Health and Cancer Rights Act passed in 1998 mandates insurance coverage for breast reconstruction in the United States, which includes the surgical intervention of the affected breast as well as the opposite breast for purposes of symmetry.

Consultation
Your consultation with Dr. Pathy regarding breast reconstruction will entail an in-depth view into your options as well as what you may expect post-operatively.  He understands that your decision to go forward with a procedure should not be taken lightly, and thus encourages any questions that you may have.