Immediate Reconstruction
Immediate reconstruction
Is a procedure that is performed at the time of your mastectomy. The majority of reconstructive breast surgeries are performed at the time of the mastectomy. However, this choice depends upon several different factors:
- Your immediate situation
- Your breast shape and size
- Your lifestyle
- Your aesthetic goals
The best candidates for reconstruction are women with small or medium sized breasts.
Breast reconstruction is a two stage surgical procedure.
State of the art in immediate breast reconstruction at the time of mastectomy involves using your own (autogenous) tissue, implants, and expander devices. The first stage involves the placement of autogenous breast tissue or an expander device at the time of your mastectomy. This serves to create a breast mound from which your final breast will be created.
The second stage involves the creation of the nipple-areolar complex along with the refinement of the reconstructed breast. This stage also involves various procedures such as mastopexies, reductions or augmentation to the opposite breast to create symmetry. Finishing touches with nipple tattooing will provide a realistic appearance for the final result of your breast reconstruction.
There are multiple reconstruction options available.
Generally with mastectomies, the preferred choice that gives the best overall results is the skin-sparing mastectomy. Normally, I prefer to pair it with the immediate island TRAM flap procedure for the best results. However, if the tram flap procedure is not an option, then I often use the same skin-sparing mastectomy technique with an immediate island latissimus flap procedure. Under those conditions, I will also use an implant or a tissue expander to help re-create your breast mound. There may be however, conditions that require the use of the third reconstruction option, which uses a tissue expander only.
What makes a skin-sparing mastectomy different from other mastectomies?
With the skin-sparing mastectomy, only the nipple-areola skin along with breast tissue is removed, saving the breast’s skin as a form. This, along with the use of malleable living tissue, allows me to give you a truly natural look and feel.
Once a decision is made on a mastectomy or lumpectomy, we will discuss options together. You, your oncological surgeon and I will develop a solution, which looks best given your unique situation.
Please click on the links below to view beofre and after photos.
Tram Flap Procedure
The immediate island TRAM flap procedure is a reconstruction method using your own body tissue. The skin, tissue and rectus muscle is taken from the abdomen and tunneled into the breast area to create the breast mound.
Latissimus Flap Procedure
The tissue that is relocated is referred to as a flap. It is this tissue that is used to create the breast mound. This method gives a nice aesthetic result when combined with a skin-sparing mastectomy.
The primary advantage of the TRAM flap procedure is a natural looking and natural feeling breast created from your own tissue. Although TRAM surgery is more extensive, it prevents you from future surgeries associated with breast implant maintenance.
The immediate island latissimus flap procedure is a method of reconstruction that uses your own body tissue, together with an expander or implant. The tissue that is relocated is referred to as a flap. Skin, tissue and latissimus dorsi muscle are taken from the back and tunneled below the skin into the breast area to create the breast mound along with an implant.
This method gives a nice aesthetic result when combined with a skin-sparing mastectomy. Since the immediate island latissimus dorsi flap is smaller and thinner than the TRAM flap, the addition of an implant provides the ideal solution for the replacement of additional breast tissue that is removed at the time of your mastectomy.
Tissue Expander Procedure
The tissue expander procedure is a method using a tissue expander and an implant. It is a temporary implant with a valve that is placed under the skin and muscle and filled externally. It is gradually inflated with saline over a period of weeks or months, depending on the length of time needed to stretch the skin. Once the skin is sufficiently stretched, another surgery is performed to remove the expander and replace it with a breast implant.
I prefer to use what is called a Becker Tissue Expander/Implant, which helps to simplify the procedure. It is a device with a valve and two shells. The outer shell contains silicone to give a softer feel and the inner shell is filled with saline to allow for expansion. Once we obtained the required size, the valve is removed and the Becker becomes a permanent implant. By using this implant, the second surgery is no longer required.
The tissue expander placement procedure may require a brief hospital stay or be done on an outpatient basis. Typically you can resume daily activities after two to three weeks. The surgery to replace the tissue expander with a breast implant may require a brief hospital stay or be done on an outpatient basis.
