what is Breast Reconstruction?
Reconstruction surgery for the breasts is done to restore one or both of the breasts to a normal appearance in shape and size following a lumpectomy or mastectomy. This advanced and delicate procedure is also performed to reconstruct a breast damaged by a birth defect or trauma. Advanced techniques and tools in reconstructive surgery have made it possible for many women to feel whole again and attain natural-looking breasts, even after they have been removed. This surgery may involve multiple procedures and various stages that may be performed along with your cancer treatment or delayed until treatment is complete.
Board-certified plastic surgeon Dr. Joseph Tamburrino is fellowship-trained in microsurgery and specializes in breast reconstruction for patients who have survived breast cancer or endured trauma. To carry out your procedure, he will create an individualized treatment plan with compassion and navigate with your cancer team to restore your feminine appearance and confidence. Prestige Institute for Plastic Surgery in Doylestown, PA is proud to help women rediscover their femininity following a mastectomy or lumpectomy.
who can get it?
Reconstruction of the breast is an extremely personalized surgery that is tailored to suit your unique situation. Each patient will be required to attend a consultation with Dr. Tamburrino to determine their surgical plan based on their needs, concerns, and appropriate techniques. If you are planning to have breast reconstruction surgery, it's vital that you have realistic expectations. While Dr. Tamburrino aims to give you an attractive, natural appearance, your reconstructed breast may not have the same feel, look, or sensation as your original breast. You should get clearance from your oncology doctor to have surgery and talk to Dr. Tamburrino regarding other medical conditions that could affect healing.
how is it done?
There are a variety of surgical techniques available for breast reconstruction. There are also multiple factors that Dr. Tamburrino takes into consideration when deciding on the technique that will produce your best results. A few of these factors include your specific cancer diagnosis, reconstruction timing, whether you will use natural tissue or implants, and if nipple reconstruction or nipple-sparing is a part of the treatment plan. To rebuild the breast, you must have enough tissue to fully cover the breast mound. Flap techniques accomplish this by using your own muscle, skin, and fat to build and cover the breast. The most common flap techniques are:
- TRAM Flap: This method takes skin, fat, and muscle from your abdomen to create the breast. The tissue used to build the new breast may be removed from the stomach or the tissue may remain attached to the donor location, keeping the original blood supply.
- DIEP Flap: The DIEP (deep inferior epigastric perforator) flap moves fat and skin from the stomach to form the breast mound, then uses microsurgery to reattach the blood vessels to the chest. Unlike other techniques, such as the TRAM flap procedure, DIEP flap doesn’t require moving your abdominal muscles. Therefore, the DIEP procedure avoids issues with impaired abdominal wall strength that TRAM flap patients must cope with. The DIEP flap technique tends to be Dr. Tamburrino's preferred approach to give patients the most gorgeous, natural-looking results.
- Latissimus Dorsi Flap: This method uses muscle, fat, and skin from your back. During this procedure, tissue is moved from the back to the mastectomy site via a surgically created path so it stays attached to the donor location, which keeps the original blood supply in place.
- PAP Flap: Another flap alternative is the PAP (profunda artery perforator). This method uses skin, fat, and muscle tissue from your inner thigh to build your breast(s).
- LTP Flap: Although the TRAM flap is one of the more common techniques used for breast reconstruction, sometimes there is not enough muscle, fat, and skin that can be taken from the abdominal area. In these situations, the LTP flap technique may be used, which takes tissue from the lateral thigh.
- Composite Flap: Also called a composite stacked flap, this technique combines flaps from various areas on your body to reconstruct the breast.
While flap procedures are usually successful and a common method for breast reconstruction surgery, you may be able to reconstruct your breast with the tissue expansion method. This involves placing a tissue expander under the breast wall and gradually filling it with saline over 4 – 6 months until the skin is properly stretched. After a flap has been created or the skin is adequately stretched through an expander, you may then decide if you want to use a natural fat transfer or breast implants to create the volume and shape of the breast. After your reconstruction mammoplasty, you can further improve the appearance of your breasts by having nipple and areola reconstruction. There are several procedures to restore the nipple-areola complex so that it looks natural.
What to Expect
Breast reconstruction surgery is done in several steps. During some phases (such as creating a flap, tissue expansion, or placing implants), general anesthesia may be used. Some patients will require an overnight stay, but this will depend on the phase of the treatment. When the final step is completed in the breast reconstruction process, you will wear a supportive bra, and you may be prescribed medication by Dr. Tamburrino to control discomfort, bleeding, and swelling. Over time, the breast will appear normal so you can feel more confident. Regular checks with breast exams and mammograms are essential and highly recommended to check for new cancer growths.
breast reconstruction faqs
Does insurance cover my surgery?
Enacted in 1998, the Women's Health and Cancer Rights Act (WHCRA) requires insurance plans that cover mastectomies to cover reconstruction surgery as well. If you have insurance, someone from Prestige Institute for Plastic Surgery can explain your policy and coverage. We can also help you submit the needed information and paperwork to your insurance carrier.
Which technique should I choose?
There is no single reconstruction technique that works for everyone. The best method for you will be based on your concerns, goals, and physique. In your consultation, Dr. Tamburrino will discuss your choices, including both flaps and implants, so you understand the advantages and drawbacks before you decide on your treatment plan. Whether you decide on implants or a flap, Dr. Tamburrino will do his best to give you the best results.
What about nipple reconstruction?
Reconstruction of the nipple and areola are usually done with cosmetic tattooing. If you're interested in this, you should talk to Dr. Tamburrino in your consultation. He will go over your options so you can decide whether you want cosmetic tattooing of your nipple-areola complex to be a part of your surgical plan.
Should I have reconstruction with my mastectomy or wait?
The timing of your breast reconstruction is dependent on many factors. Some patients choose to get their breast(s) reconstructed along with their mastectomy while other patients decide to defer reconstruction surgery. Dr. Tamburrino suggests you make an appointment for a consultation after you are diagnosed with breast cancer so you can begin considering your choices as soon as possible. If you want to have reconstruction with your mastectomy, Dr. Tamburrino can work with your oncologist to plan your care.
Reclaim Your Self-Confidence
While the breast reconstruction process can take time, it is probably one of the most worthwhile surgeries performed at Prestige Institute for Plastic Surgery. Breast reconstruction may help decrease the emotional and physical impact of a mastectomy while also allowing you to boost your self-confidence and enhance your feminine figure. If you have breast cancer, trauma to the chest, or a congenital defect that affects the appearance of your breasts, we invite you to call our Doylestown, PA office and schedule an appointment with board-certified and fellowship-trained plastic surgeon Dr. Joseph Tamburrino.