Cosmetic Plastic Breast Surgery Procedures
Breast reconstruction restores a natural, symmetrical appearance to the bosom, maintains body proportion, allows clothes to fit better, and most important of all, boosts self-confidence for women who have lost one or both breasts to mastectomy or who lack breasts due to a congenital or developmental abnormality. Reconstructive surgeons strive to create a new breast and nipple that resemble the woman’s natural breast as closely as possible in shape, size and position. The unaffected breast is also reshaped to give it a more youthful look and improved symmetry.
Plastic Breast Surgery Procedures:
Mastectomy patients are usually candidates for breast reconstruction. The reconstruction can be performed immediately after the mastectomy in many cases to get the best results. In certain cases a delaying the reconstruction may be the best option. A consultation with one of our plastic surgeons, who will review your medical history and after a detailed examination, will allow us to best advise you on the recommended treatment.
Patients who have had a more limited procedure to treat the breast cancer, a lumpectomy and radiation, may also be candidates for reconstruction. This can be done to restore symmetry and a consultation with one of our plastic surgeons will help determine if you are a good candidate for this procedure.
The reconstruction itself consists of multiple operations, the first of which involves creation of the breast mound and is performed during or after mastectomy in a hospital under general anesthesia. Later surgeries, if necessary, may be done in the hospital or an outpatient facility, with either general or local anesthesia.
There are several ways to reconstruct the breast, both with and without implants; your breast surgeon and plastic surgeon should work together with you in deciding which is the best for you.
A commonly used technique combines skin expansion with implant insertion. First, the surgeon inserts a balloon expander beneath the skin and chest muscle . A saline (salt water) solution is then injected into the expander in the office stretching the skin until the breast mound reaches the desired size. The expander is then replaced with a permanent implant. A final procedure reconstructs the nipple and areola (dark area of skin around the nipple). In very rare situations, a patient may not require tissue expansion and begin with the implant.
Another, type of implant reconstruction involves the creation of a breast using tissue from other parts of the body. If the flap is not large enough to serve as the new breast by itself, an implant can be inserted beneath it. The Tissue that is transferred consists of skin, fat and occasionally muscle from the back, abdomen or thigh and may either be surgically removed and reattached (free flap, requiring a microvascular surgeon) or remain connected to its original blood supply and “tunneled” through the body to the chest (pedicled flap). These procedures are known as DIEP flaps, muscle sparing TRAM flaps, and a TUG flap respectively. Advantages over implant insertion are a more natural look and feel for the breast and abdomen, and elimination of any risks associated with silicone implants; disadvantages are scars at the breast and donor-tissue site, and longer recovery.
Our surgeons perform all of the above mentioned procedures frequently and with good results. We are one of the few practices in South Texas that offer some of the more complicated procedures such as the DIEP flap and muscle sparing TRAM flaps. We work with all of the general surgeons and breast surgeons in the area so that we can perform the reconstructive procedures immediately after the mastectomy if desired and appropriate.
Both implant insertion and tissue flap surgery are followed by nipple and areola reconstruction and revision surgery on the reconstructed breast to optimize the appearance. The reconstructed breast will probably look and feel different from the natural breast. Further surgery may be desired to adjust the natural breast to better match the reconstructed one. Good symmetry is usually obtained although perfect symmetry, which is usually not present before surgery, is not always reached.
Most patients will be in the hospital from two to four days and will then go home. We give them medications for pain and if required nausea and antibiotics. Most will have surgical drains which need to be cared for. The drains should be emptied every eight hours and the output should be carefully measured in milliliters and recorded separately. This is because we remove the drains when the output is a certain amount. All drains are usually removed within three to four weeks after surgery.
Patients may shower two days after the surgery. Although the area can get wet, there can be no immersion of the wounds; that is no swimming or wading in pools, bath-tubs and other such activities. It is also important to not perform any strenuous activities. All normal activities can be performed, but nothing that requires strenuous use of the arms, and in the case of TRAM flaps or DIEP flaps, no strenuous use of the abdomen. This limited activity level should be strictly followed for four to six weeks after the surgery is performed.
The reconstructed breast will be numb following surgery, some sensation will return as time passes. Scars will fade over time. Periodic mammograms with a radiologist trained to examine breasts with implants are recommended.
Dr. Bindingnavele is committed to providing ongoing communication to both patients and referring physicians. Before, during and after any plastic surgery or treatment, patients and their families can expect concern and compassion, as well as education about their condition.
The information above is for informational purposes only, for patients and their families.