Breast Reconstruction


 

Breast Reconstruction

Breast cancer is the leading cancer among women of all races in the United States. It is estimated that 1 in every 7 women in the United States will be affected by breast cancer. Many women affected by breast cancer may require a partial or complete mastectomy, which is the removal of breast tissue. Breast reconstruction utilizes several plastic surgery techniques that aim to restore a breast to normal shape, appearance, and size following partial or complete mastectomy.


A note about symmetry

If only one breast is affected, it may be reconstructed on its own. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry in relation to the size and position of both breasts.


A note about cost

In 1998 a federal law was passed regarding breast reconstruction. In this law it was stated that health insurance issuers are required to cover reconstruction of the breast in which the mastectomy has been performed. Insurance must also cover surgery and reconstruction of the other breast to produce a symmetrical appearance.


Reconstruction techniques 

  • Use of Implant: A one or a two-step approach that depends or nipple sparing vs non-nipple sparing mastectomy.
    • Nipple sparing mastectomy: Immediate reconstruction with the implant
    • Non nipple sparing mastectomy: Placement of tissue expander at the time of mastectomy with exchange to implant at a later date
  • Use of Your Own Tissue:
    • Pedicled TRAM or Latissimus flap: Rotate tissue to replace the breast
    • Free Flap: Bring the tissue from another location and attach to nearby blood vessel with a micro-vascular procedure under a microscope


Breast reconstruction using fat grafting

Fat grafting for breast reconstruction has grown in popularity in Europe and now in the United States. Dr. Sofer is one of the first doctors in the area that is performing fat grafting for breast reconstruction using the power assisted liposuction and grafting system.

How does fat grafting for breast augmentation work?

This revolutionary system is changing the way we think of breast reconstruction. Fat is removed from an area (most commonly the abdomen) and is injected into the area of the removed breast. A series of treatments are required to achieve the desired effect. Power assisted liposuction (PAL) and the micro-air fat grafting system are used to obtain a patient’s own fat, which can be used as a natural, long-lasting filler to shape or form a breast and add volume.

Why use power assisted liposuction and fat grafting system?

PAL uses the same principle of the tumescent technique. However, it causes less trauma to the fat and the adjacent structures and hence is considered a more gentle approach to liposuction and a more reliable method of obtaining fat for grafting. This procedure utilizes the micro-air system, which simultaneously dislodges fat cells with a spray of water while removing the uninjured cells with low-pressure suction. The fat is collected for injection as a long-lasting filler.  PAL patients have less swelling, bruising and a faster recovery time of 2-4 days. The fat that is harvested with PAL is collected into a special filtered collection canister for a more viable fat transfer. Fat harvested with PAL is approximately 70% viable (living) as compared to 50% or less when using other methods, although experiences vary.

Fat transfer using PAL can also be used in combination with breast reconstruction using implants. Fat is injected around the implant to soften the look of the implant and give a more natural appearance.

 

Reconstruction with tissue expanders tissue expansion

This method of breast reconstruction involves the use of a tissue expander and a breast implant.

The tissue expander is made from elastic silicone rubber and is a balloon-like mechanism. In order to insert the expander during a mastectomy procedure, the surgeon extracts both skin and breast tissue. This allows the chest tissue to become flat and tight. Then, Dr. Sofer places the tissue expander below the chest tissue to make room for the breast-shaped space that the breast implant will occupy.

The tissue expander is then placed, unfilled, below the chest tissue. Next, sterile saline fluid will slowly be added via needle directly to the expander’s filling port. This will cause the tissue expander to fill and the surrounding tissue to stretch gently. Finally, the breast implant will be placed in the newly-created area.


Placing the breast implant 

Dr. Sofer will remove the tissue expander and the breast implant is placed in the pocket that it has created. In reconstruction following a mastectomy, a breast implant is most often placed sub-muscularly.

All of the above techniques have their risks and benefits that need to be discussed in detail with Dr. Sofer at the time of your consultation.

Although breast reconstruction can rebuild your breast, the results can be highly variable as follows:

  • A reconstructed breast will not have the same sensation and feel as the breast it replaces.
  • Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
  • Certain surgical techniques will leave incision lines at the donor site, which is commonly located in less-exposed areas of the body such as the back, abdomen or buttocks.
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