Some treatments — like radiation therapy — will impact their options for reconstruction because of permanent side effects to the tissue, which the patients usually aren’t informed of beforehand unless they see a plastic surgeon. Not all patients will jive with all surgeons, and getting a second opinion is not a bad thing (as long as it doesn’t substantially delay your treatment). Ultimately, you should feel like your surgeon listens to you and you should trust them and feel comfortable with the decisions that you make together. What does breast cancer reconstruction entail? SP: While there are some patients who are candidates for a single “one-and-done” procedure, most patients will undergo a series of two to three surgeries over the span of a few months to a year. The timing and number of their surgeries depend on multiple factors, including their preoperative breast anatomy and final aesthetic goals, tumor size and location; whether they choose lumpectomy or mastectomy; whether they need chemotherapy or radiation; and whether they choose implant-based or autologous (tissue-based) reconstruction. The ideal situation is a patient with optimal breast anatomy who is a candidate for a nipple-sparing mastectomy with immediate reconstruction where the mastectomy is completed through an incision that hides in the crease below the breast, and I can place their permanent implant at the time of the mastectomy. They go into the OR and come out looking very similar (and sometimes even better) with no really obvious scars.
While this isn’t the situation with every patient, techniques have been developed to preserve the nipple and areola and to lift it to the correct position if needed during mastectomy; and even to re-connect the nerves to the
with an MRI or ultrasound 5-6 years after they’re placed, and then every two to three years after that (for silicone implants). Saline implants don’t require imaging because if they rupture, they deflate like a flat tire and it’s obvious. If implants are ruptured, then the recommendation is to have them exchanged; but if they’re intact (even if they’re older than 10 years) and not giving you issues, you don’t need surgery. The other type of reconstruction I perform is called autologous, or “flap,” reconstruction. In this type of surgery, skin and fat is taken from one area of the body, with the artery and vein that supply it, moved to a new area, where the vessels (averaging 1-3mm in diameter) are sewn together under a microscope to provide blood supply for the transferred tissue. Typically, for breast reconstruction,
nipple using a nerve graft to restore sensation after
we use the skin and fat from the lower abdomen that would be discarded during a tummy tuck. This is called a DIEP (deep inferior epigastric perforator) flap. In patients who don’t have enough belly tissue or have had a previous abdominoplasty, we can take tissue from other areas like the posterior thighs, the lateral lower back and the buttocks. This is obviously much more extensive surgery than implant- based reconstruction; however, the benefit is that it is your own tissue and it never needs to be removed, monitored or replaced. Recovery after breast reconstruction surgery varies on the type of surgery, but we typically [it can take up to]four to six weeks.
mastectomy. Aesthetic goals for breast cancer patients are coming closer to the goals for cosmetic breast patients, which is a high bar, but one that we’re happy to strive for. Breast reconstruction after mastectomy with a saline or silicone implant does require some ongoing upkeep because implants are not life-long devices. They have a rupture rate of about 1% per year, and an average lifespan of 10-12 years. They can obviously last much longer than that, and they don’t have a definitive “expiration date.” While there’s an old wives tale that you need to change out your implants every 10 years, the current recommendations from the FDA and the implant companies are to monitor them
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