What is it?
Being diagnosed with breast cancer is a scary and overwhelming experience. It is important for you to know that you have options that can restore your breasts and femininity if that is something that you desire. In the majority of instances, after breast cancer is diagnosed, a patient will be referred to a breast surgeon that will remove the tumor and work with an oncologist to treat the cancer, and a referral will also be made to a plastic surgeon who works with the breast surgeon to provide breast reconstruction. Unfortunately, some patients are never referred to a plastic surgeon, and have no idea that breast reconstruction is even an option. Lift Plastic Surgery is unique, in that it can provide all of these services for you. Dr. Patel and Dr. Wegge are both fully trained in general surgery and plastic surgery, making them the best plastic surgeons for breast reconstruction. For breast reconstruction in Houston, choose us. By coming to us, your care can be simplified, as you have one team treating you from beginning to end, and providing all of your needs. It can be a comfort to know that your surgeon is invested in every part of your care, and knows your history, goals, and desires inside and out. Additionally, our plastic surgery skillset gives us the ability to plan your cancer removal in the most aesthetic way, taking into account future reconstruction that might be planned for the best possible final outcome.
However, if you already have a relationship with a breast surgeon, and/or have previously had breast cancer surgery, we are excited to work with you to accomplish your goals for your breast reconstruction. In these situations, we would ideally like to form a treatment team with your breast surgeon and oncologist to come up with a treatment plan together that it is right for you. This may mean meeting with us several times before your first breast surgery to make sure all of your questions are answered. The reconstructive options available depend on the specifics of your cancer, what type of surgery you will need to remove your cancer, and if you will need any additional treatment like chemotherapy or radiation. The full scope of this discussion will happen at your office consultation where it can be tailored to you and your unique circumstance. Expect that you will likely need several operations before reaching your desired result. After the initial surgery, scar or shape revisions are often required as well as nipple reconstruction and tattooing.
In general, breast reconstruction can be broken into three categories:
- Oncoplastic reconstruction
- Autologous tissue reconstruction
- Implant-based reconstruction.
Oncoplastic reconstruction refers to rearranging your own breast tissue after cancer removal. It is appropriate for situations where it is determined that the tumor can be safely excised without removing your whole breast. There must be enough tissue left that it can be reshaped into an acceptable appearing breast. Sometimes this means that your other breast may need a lift or reduction as well to make the two breasts match.
Autologous reconstruction refers to using your own tissue to create one or both breasts. It is appropriate when you must have one or both of your breasts completely removed (mastectomy). In order to do this, you must have a donor area on your body with enough fat and skin available to make a breast which is also connected to a good blood supply. This blood supply cannot be damaged in any way by other surgery you may have had in the past. This tissue is called a “flap”. The flap is then moved from the donor area to your chest where the arteries and veins in the flap must be connected to arteries and veins in your chest in order for it to live in its new position. This is called a “free flap”. This is done under a microscope. Most commonly the tissue that we use comes from the abdomen, which also gives the added bonus of a “tummy tuck”. We generally perform a DIEP flap (deep inferior epigastric flap) reconstruction. This means that we leave your abdominal muscles intact, and only remove the blood vessels, extra fat and skin. This decreases the risk of postoperative deformity and hernia, and maintains the strength of your abdominal wall. The flap tissue is then shaped into a breast which ultimately has a fairly natural feel. The surgery itself is very delicate and often can take all day. Sometimes we can do the surgery at the same time as your mastectomy. More often, it is done in a delayed fashion because we need to know your final pathology and whether or not you will need chemotherapy or radiation before proceeding with reconstruction. The surgery itself can be much more difficult with a greater potential for failure if you have had radiation to the chest. This is because the blood vessels in the chest have also been exposed to the radiation, making them more fragile.
After surgery, you will spend about 2-5 days in the hospital during which we are closely monitoring the blood supply to the flap and making sure there are no complications. Since we have to reconnect tiny blood vessels back together, there are many potential reasons why this connection could fail. If caught early, the problem can often be fixed, but there is always a risk that the flap could die and be lost. In these situations, you will generally have to heal and then later reconstruction with implants can be discussed. After surgery, you will also have drains in your abdomen and breast that you will go home with. You will have discomfort, mainly in your abdomen, for several weeks, and will not be able to stand up straight until your abdominal skin stretches out. You will have to limit all pressure to your chest for several weeks, and will also significantly have to limit your activity for 4-6 weeks to allow the flaps to heal. Expect that you will likely need several surgeries depending on your ultimate goal. Generally, patients will have a second surgery after several months, once swelling has decreased and the new breast shape has settled. This often involves the creation of nipples, tweaking of the breast shape, revision of the abdominal scar/contour and possibly liposuction and fat grafting. These procedures may also be accomplished in more than one surgery. Nipple reconstruction involves creating a nipple from your own tissue by creating small interlocking flaps of fat and skin almost like origami. Once recovered from this surgery, if coloration of the nipple/areola is desired, then tattooing is performed. We can perform this for you, or refer you to a tattoo artist that specializes in nipple tattooing.
Another form of autologous breast reconstruction commonly used is the latissimus dorsi flap. The latissimus dorsi is one of the large muscles of your back/side. In can be rotated along with a piece of fat and skin from your back to your chest while still keeping it attached to its blood supply. It is a very durable flap and it is a less technically challenging operation than a DIEP flap since it does not require microsurgery. As a result, hospital stay and recovery are easier. A latissimus flap can be a good option for a woman with small or medium breasts, or someone who is not a candidate for a free flap. IT usually does not have enough volume to create a larger breast. It is often used in combination with a breast implant to give a more natural looking breast with good volume, especially when a patient has undergone radiation. In general, using the latissimus muscle does not affect your overall function as the other muscles of the back take over.
Implant based reconstruction refers to the use of breast implants to recreate the breast. This is a good option if the patient is not a candidate for a free flap, or wants a quicker easier surgery and recovery. Sometimes the implants can be placed at the time of the mastectomy. More commonly, a tissue expander is placed first. A tissue expander is similar to an implant, but has a firm back that allows it to gradually stretch out the remaining breast skin to make room for a permanent implant. As mentioned above, placement of the tissue expander is often coupled with the use of a latissimus dorsi flap. Once the tissue is healed from surgery (usually about 2 weeks) the expander is gradually filled with saline until the desired shape and size of the breast is reached. This is generally a several week to month process requiring office appointments where the expander is injected with sterile saline. The expander is ready to be removed and exchanged for a permanent implant once it has been allowed to settle for a few weeks and it has been determined that no further treatment, such as radiation, is required. The implant exchange is a short day surgery procedure. As mentioned above, further small revisions, nipple reconstruction and tattooing are often necessary.
Overall, breast cancer surgery and reconstruction is a long process with many steps which require healing in between. Because of this, the whole process tends to take a year from start to finish. Whatever you decide, we will be there to help you every step of the way!