Top Breast Reconstruction Surgeon
Advances in the treatment of breast cancer have enabled surgeons to remove the cancer while preserving the sensitivity of the breast. These procedures are far less invasive than the radical mastectomy, formerly the most common procedure. Despite these advances there are still a significant number of patients in whom breast conservation is not possible and mastectomy is needed. The diagnosis of breast cancer and the resulting physical deformity adds greatly to the patient’s psychological and emotional stress.
For these patients, breast reconstruction is a physically and emotionally rewarding procedure. The ability to create a new breast dramatically improves a woman’s self esteem, self image and quality of life.
A Multi-Stage Process
Breast reconstruction is rarely a single-stage operation. Most often, multiple stages are needed to complete the reconstruction. The different options for reconstruction include using breast implants, flap surgery and a combination of both.
Selection of the appropriate procedure depends upon the patient’s medical history, physical characteristics, lifestyle as well as the surgeons’ experience. Reconstruction can be performed either at the same time as the mastectomy or can be delayed for a few months.
During the first phase of implant reconstruction, a tissue expander is inserted under the chest muscle. After surgery the patient is admitted to the hospital for one or two days to manage and minimize pain. The device is then gradually filled with saline during the subsequent office visits. This gradual process stretches the muscle and helps create a pocket for the permanent implant.
Once the desired size is achieved the expander is left in place for 6 to 8 weeks. This allows the scar tissue to mature around the implant. During the second operation the tissue expander is replaced with a permanent breast implant.
Selection of a Breast Implant
Patients now have the option to choose between saline or silicone breast implant. Silicone implants are preferred by most patients because of their natural and soft texture. Few weeks after the implant exchange, nipple reconstruction is performed, followed by tattooing of the areola. Both of these procedures can be performed in the office.
New advances have been made in implant reconstruction which has tremendously reduced the time between the first and second stage. This is mainly due to a new product called AlloDerm. In properly selected patients, it is now possible to insert the implant during the first stage thus eliminating the expansion phase.
Approaches to Breast Reconstruction
There are some patients who prefer to use their own tissue for breast reconstruction. In those patients, the TRAM flap is a very good option. In this procedure skin and fat from the lower part of abdomen is used to reconstruct the breast. In order to keep these tissues alive it is necessary to sacrifice part of the abdominal muscle which supplies blood to these tissues. This procedure requires longer operation time, longer hospital stay and recovery.
Not every patient is a candidate for TRAM flap surgery. The main determining factors are the medical history and physical attributes of the patient. With newer microsurgical techniques it is now possible to move these tissues to the chest without sacrificing any part of the abdominal muscle. In some centers, by utilizing microsurgical techniques fat is harvested from the buttock region and transferred to the chest for breast reconstruction.
Another option for breast reconstruction is LD flap which stands for latissimus dorsi muscle flap. In this procedure the muscle from the back of chest is transferred to the front and an implant is inserted to complete the breast reconstruction.
What to Expect After Surgery
Despite all these advances in techniques and technology the reconstructed breast will always feel different and lack sensation. Still, this surgery profoundly effects patient self esteem and confidence and is one of the most rewarding plastic surgery procedures possible.
Find out what Doctor Ali’s patients are saying about their experience.