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For a number of women, mastectomies are a necessary reality in their fight against breast cancer. This can affect their self-esteem, confidence, and sexuality.
Research studies show that breast reconstruction surgeries provide these women with quality of life improvements, along with psychological benefits. All of these life enhancements are a well-deserved gift to women who have suffered the trauma of breast cancer and mastectomy. Dr. Silvia Rotemberg makes the surgical process safe for her patients and ensures that each procedure is done at the optimal time for the healthiest outcome. Patients walk away with a new outlook on life and an understanding that they are not alone in their recovery and healing process.
What is Breast Reconstruction?
Breast reconstruction involves the use of varied surgical techniques to rebuild and restructure the breast or breasts to their natural size, shape and aesthetic. Surgeons use natural and/or prosthetic materials to construct a normal looking breast for their patients. Often times, the nipple or areola has to be completely rebuilt after a mastectomy.
- 1 What is Breast Reconstruction?
- 2 Immediate Breast Reconstruction Surgery
- 3 Delayed Breast Reconstruction Surgery
- 4 Candidates
- 5 Techniques
- 5.1 Tissue Expander Breast Implants
- 5.2 A-Cellular Dermis Technique
- 5.3 Flap Reconstruction
- 5.4 Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Breast Reconstruction
- 5.5 Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction
- 5.6 Superficial Inferior Epigastric Artery (SIEA) Flap Breast Reconstruction
- 5.7 Superior & Inferior Gluteal Artery Perforator (S-GAP and I-GAP) Flap Breast Reconstruction
- 5.8 The Latissimus Dorsi Muscle Flap
- 6 Nipple Reconstruction
- 7 Recovery
- 8 Consult with Dr Rotemberg
The surgery itself is a complex one and usually involves multiple procedures. Sometimes, surgeries are spread out over weeks, months or even years. Despite the fact that the operations often involve the use of breast implants, candidates for reconstruction are at a higher risk for developing scar tissue than an average breast augmentation patient.
In 1998 the Women’s Health and Cancer Rights Act was created. This mandated insurance coverage for breast and nipple reconstruction surgeries on patients who had suffered single or double mastectomies. In 2001, this piece of legislation was further implemented, with insurance companies who refused to cover such operations being penalized. Similar laws have been passed on an international level through national health programs.
Immediate Breast Reconstruction Surgery
For many patients, reconstruction surgery can be done immediately after a mastectomy. This must be determined by the patient’s surgeon, oncologist, and is dependent on whether or not the patient requires ongoing cancer treatment.
Delayed Breast Reconstruction Surgery
Some patients require further treatment for breast cancer such as radiation or chemotherapy. In addition, their immune systems may be compromised to where reconstruction surgery may not be possible immediately after mastectomy. Patients would then consult with their oncologist and their plastic surgeon to decipher a safe and reasonable time to perform breast reconstruction surgery.
Candidates for breast reconstruction are mostly women who have undergone the removal of one or both of their breasts due to breast cancer.
Tissue Expander Breast Implants
During this procedure, a tissue expander is inserted into an envelop in the breast skin and chest muscle. This tissue expander is similar to a saline implant but has a valve where the surgeon can add saline to increase the size.
For the next four to six months, the surgeon will expand the implant and stretch the skin and tissue until it can house the final implant. The size of implant that can be used is dependent on the size of the space created in the tissue. After the tissue is expanded to the appropriate size, the expander will be removed and replaced by a saline breast implant.
Certain patients may not need to expand the tissues of the chest and breast area, allowing them to have implants directly put in at the time of their mastectomy.
A-Cellular Dermis Technique
This surgery uses the entire skin envelope at the time of mastectomy. It is generally combined with implant surgery. The method creates a hammock from natural material called a-cellular dermal matrix, which is often donated human skin.
This surgery shortens the amount of time needed for tissue expansion and the patient can reach their aesthetic goal much sooner.
Not all women qualify for this surgery, as the size of the envelope left after mastectomy is an integral factor. A discussion with the doctor is necessary to decipher the best course of action for surgery.
This technique uses the patient’s skin, fatty tissues and muscles to create the most natural looking breast/breasts. These methods are more complex and invasive and they also require longer hospital stays during the recovery period. They also cause more significant scarring for the patient. The most commonly performed flap procedures take tissue from the back, abdomen or even the buttocks. Some of these procedures can cause permanent muscle weakening and must be carefully discussed with a surgeon.
Transverse Rectus Abdominis Myocutaneous (TRAM) Flap Breast Reconstruction
The TRAM flap procedure utilizes skin, fat and muscle tissue from the patient’s lower abdomen. A TRAM flap creates a natural looking breast and does not usually require an implant to achieve fullness if there is enough fatty tissue in the abdominal area. If a patient doesn’t have the required amount of fatty tissue, they may not be candidates for this technique.
Despite the result of a natural looking breast, this surgery does have some negatives. Once the surgery has been performed, it cannot be done again. Being that one of the abdominal muscles is removed, weakness in the area is experienced in addition to extensive scarring. If a patient is active, they may want to consult with their surgeon when selecting a procedure.
Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction
This form of flap reconstruction also utilizes fatty tissue from the lower abdomen to reconstruct the breast. The difference between this procedure and the TRAM flap reconstruction is that DIEP keeps the abdominal muscle in tact, preventing the loss of strength post-recovery.
Like the TRAM flap, this surgery cannot be done more than once. It is a complex surgery and requires two surgeons specializing in micro-vascular surgery to be properly executed.
The surgery also requires a stay in the ICU during recovery. Well-trained, micro-vascular surgeons who have experience with the procedure and its risks should always perform the DIEP technique.
Superficial Inferior Epigastric Artery (SIEA) Flap Breast Reconstruction
The SIEA procedure also uses skin, fatty tissue and blood vessels from the abdominal area to reconstruct the breast. It is not as commonly used as TRAM and DIEP flap procedures because it requires very large blood vessel size to be successful, which most women do not have. SIEA leaves all the muscles and the majority of the connective tissue in tact so there is no risk of weakness post surgery. This can be a good option for active women.
Superior & Inferior Gluteal Artery Perforator (S-GAP and I-GAP) Flap Breast Reconstruction
GAP procedures use skin and fatty tissue from the buttocks for breast re-creation. The S-GAP specifically uses tissue from the upper part of the buttocks. The I-GAP procedure uses skin and fatty tissue from the lower area of the buttock. No buttock muscle is used in either procedure, which allows the patient to retain full activity after surgery.
These flap surgeries are good options for patients who do not have enough fatty tissue in their abdominal area to perform TRAM or DIEP flap surgeries.
As with all flap procedures, the surgical risks are higher do to the complexity of the operations. Also, the S-GAP and I-GAP surgeries take longer than all other flap surgeries. Unlike TRAM or DIEP surgeries, however, the S-GAP and I-GAP can be performed again if unsuccessful the first time around.
The Latissimus Dorsi Muscle Flap
This surgery utilizes a large muscle in the back along with the skin and underlying fatty tissue to reconstruct the normal breast. The use of fatty tissue makes a more natural looking breast.
Due to the limited amount of available fatty tissue in this area, a breast implant is also required to achieve a natural breast volume.
The soft tissue from the latissimus dorsi flap goes over the breast implant, giving it the look of a natural breast.
Recreating the nipple and areola is the final stage of breast reconstruction. This makes the breasts look more natural and can conceal some of the scars from a mastectomy.
Not all women are candidates for nipple reconstruction and those who have undergone radiation might have higher risks. The nipple can be recreated using skin from the reconstructed breast after the flap surgery or incision from the breast implant has healed. The areola can be either tattooed onto the skin or can be reconstructed with skin from the groin area due to its similar tint and texture.
Patients who undergo implant-based reconstruction generally heal faster than patients with flap-based reconstructions. Both take three to six weeks for recovery and require additional surgeries to reconstruct the areola and nipple areas.
Recipients of these procedures must avoid sports, overhead lifting, and sexual activity during the recovery period. Light cardio exercise such as tread mill, walking or biking are approved for rehabilitation after surgery and for weight control.
The majority of patients return to normal activity levels after surgery, except for TRAM flap patients, who may experience a reduction in abdominal muscle strength even after recovery. This TRAM flap, or bilateral breast reconstruction surgery, requires a sacrifice of both rectus muscles, which is why abdominal strength is lost. Because of this, many surgeons avoid this technique and opt for procedures that do not reduce the patient’s activity in the long term.
For many women, there is an emotional adjustment that occurs after breast reconstruction surgery. Depression, anxiety and sadness are common and can it can be helpful to seek the support of a counselor or related support group.
Consult with Dr Rotemberg
Dr. Silvia Rotemberg is a leading plastic surgeon operating in the city of Miami. Her technique incorporates the latest surgical advancements, combined with a vast knowledge of the foundations of plastic surgery. Whether you find yourself a candidate for breast reconstruction or other techniques, Dr. Silvia Rotemberg will provide a comprehensive evaluation of your goals and develop a unique treatment approach. The end result will be a more confident and youthful version of you. To schedule a consult or for additional information on breast reconstruction surgery, call (305) 539-7083