Breast Reconstruction (Cancer)

Breast cancer is a common disease that afflicts one out of every eight women of all ages and ethnicities.  If you notice a lump or have an abnormal mammogram, you need to follow up with your physician immediately.  As reconstructive plastic surgeons, Dr. Hankins and Dr. Sohn become involved when you have been diagnosed with breast cancer and are going to have a mastectomy, a total removal of the breast tissue.

Breast reconstruction is performed to restore the breast contour lost after the cancer is removed.  With the most cutting-edge techniques in breast reconstruction, we have the ability to recreate breasts that are very close in shape, size and appearance to natural breasts.   The reconstruction can be done immediately, at the time of mastectomy, or it can be delayed.  Reconstruction can be performed with an implant and tissue expander or even with your body’s own tissue.

Some women choose to have breast reconstruction, while others choose not to.  This choice is a personal one; as plastic surgeons, we can help you identify what decision is best for you.  We have assisted many patients in determining whether undergoing breast reconstruction is the correct choice for them.

When you are first diagnosed, there are many decisions that need to be made.  Some of these include:

• Lumpectomy or Mastectomy? Your general surgeon and medical oncologist will help you with this decision.   Some factors to consider include how aggressive is your cancer, the status of the lymph nodes, BRCA status, and the size of the breast prior to surgery.
• If mastectomy is chosen, do you want to proceed with breast reconstruction?

Types of Breast Reconstruction

There are two basic types of reconstruction. Tissue expander followed by implant, or autologous reconstruction using your natural tissue.

Tissue Expander/Implant Reconstruction

When a mastectomy is performed, the nipple, areola, and some breast skin is removed.  This tightens and reduces the breast envelope.  To re-stretch the thin skin and breast pocket to accept an implant, an temporary expander is placed underneath the pectoral.  The expander is inflated periodically in the office, via a simple and painless procedure.  This expansion technique will gradually stretch out the skin to accommodate an implant.  The expander is then removed and an implant is placed at a second surgery.  You will eventually need to determine size and whether you desire saline or silicone implants.  However, your primary decision after diagnosis is simply: do you want to proceed with an expander/implant reconstruction?

Autologous Reconstruction

The two most common procedures done for autologous reconstruction are the TRAM flap and the latissimus flap + implant/expander.  A TRAM flap utilizes your tummy fat and skin to reconstruct the breast, with the additional benefit of providing an abdominoplasty.  The surgery and recovery time are longer than the expander/implant reconstruction, typically between 3-4 weeks. In an appropriate patient, it allows us to recreate a soft, natural breast from your own tissue.  However, you do have to have enough soft tissue to be a candidate for this surgery.

The latissimus flap + expander/implant is similar to the expander/implant reconstruction described above, but also utilizes the latissimus muscle, a thin broad muscle from your back.  This muscle is released, and the muscle, skin, and some fat is brought in front of the chest to help provide some additional soft tissue coverage over the implant.  This may be performed in cases where radiation therapy is a factor, or if patients are particularly thin, or if you are not a candidate for a TRAM reconstruction.

Symmetry Procedure

Procedures may be done to the contralateral (the other side) breast to help them look similar.  This may involve a breast lift (mastopexy), breast enlargement, breast reduction or a combination of these different breast enhancement procedures during the surgery.  This symmetry procedure is covered by insurance.

Nipple and Areola Reconstruction

Months after your initial reconstruction, a nipple is reconstructed by using a bit of the skin on your breast.  The areola is then reconstructed using either a skin graft or a tattoo.

Breast Cancer Information and Support Groups

There are a number of different web sites, community groups, and support forums.  We encourage you to educate yourself as much as possible, so you can make accurate, informed decisions about your health.  This is a difficult time, as many women try to be strong for their family, husbands, children, and colleagues.  We strongly urge you to find a doctor whom you like; breast cancer is about far more than the surgery.

We are the primary reconstructive surgeons at Sunrise Hospital and Medical Center, and have a vast amount of experience with all types of simple and complex breast and oncologic reconstruction.  We invite you to contact our office to schedule your complimentary appointment, at (702) 948-7595.