Breast Reconstruction

What are the top reasons women choose to undergo breast reconstruction following a mastectomy?

Women choose breast reconstruction surgery for a variety of reasons, but some of the most common factors include:

• • Sadness, insecurity or even embarrassment about losing one or both breasts;
  • Dissatisfaction with the way clothes look and feel following a mastectomy;
  • Dissatisfaction with the way the body looks without clothes following a mastectomy; and
  • Reconstruction offers the chance to feel as “normal” as possible following a bout with breast cancer and breast cancer treatment.

*Results May Vary

Click here to see select before and after photos of Breast Reconstruction cases.

What are my breast reconstruction treatment options?

A variety of procedures are available for women considering breast reconstruction surgery. They are as follows:

• • Breast Implants– Depending on a woman’s preference, breast implants come in the form of silicone gel or saline (salt water) implants. Some women may be candidates for one-stage implant reconstruction. Or others, the insertion of the implant (s) is typically done in two steps, with the first being the insertion of a temporary tissue expander at the time of the mastectomy. The temporary expander is then given time to stretch and prepare the skin/breast tissue for the implant’s proper placement. Once this step is complete, the Dr. Weinstein will then do a second procedure to put the final saline or silicone implant in place.
  • TRAM Flap Surgery– This procedure uses a woman’s own muscle and tissue from the lower abdominal area to reconstruct a new breast without using implants. During the actual TRAM flap surgery, skin, fat and muscle from the lower abdomen will be tunneled under the skin to the chest area, in which the surgeon will then build a tissue only breast. This procedure is admittedly more complicated then breast implants, but it’s a wonderful choice for women that wish to retain a more natural look and feel to their breasts. Furthermore, the removal of fat, skin and muscle from the lower abdominal area often results in an aesthetically pleasing “tummy tuck” for an added bonus.
  • Latissmius Flap Surgery– As in the case of the TRAM flap procedures listed above, the Latissmimus Flap procedure also uses a woman’s own skin, fat and tissue to naturally reconstruct the breast without implants. However, in the Latissmius procedure, the surgeon will use the latissimus  (or the long muscle that runs beneath the armpit and diagonally across the back) instead of tissue from the abdominal wall. This once popular technique is used much less with the use of tissue expander reconstruction techniques.

See What Our Patients Are Saying…

“I have been coming to Dr. Weinstein for many years. He performed breast augmentation and then breast reconstruction on me when I was diagnosed with breast cancer. He is a wonderful doctor who is caring, friendly, compassionate and genuinely concerned about my progress and well being.” – BP

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What are the benefits and risks of breast implants vs. autologous tissue reconstruction?

As with any procedure, there are a variety of pros and cons that accompany each of the techniques listed above. Some of the most common benefits and risks that accompany breast implants and flap procedures are as follows:

Breast Reconstruction, Morristown: Is the breast reconstruction covered by insurance?

Yes. Insurance companies are required by Federal law to cover all of the above-mentioned procedures for breast reconstruction following a mastectomy.

Also, insurance companies should cover reconstructive options for women who have also undergone partial mastectomy/lumpectomy.

Do I have to undergo breast reconstructive surgery at the same time as my mastectomy?

Breast reconstructive surgery does not have to be done at the same time as a woman’s mastectomy. Similarly, some women report feeling “overwhelmed” by the mastectomy and need additional time before making such a decision; whereas others are seeking to immediately begin their reconstructive journey and wish to awake from her mastectomy with an immediately reconstructed breast.

Dr. Weinstein will make recommendations as to the timing of reconstruction based on your cancer diagnosis. Ultimately, timing of reconstruction is a personal decision and choice.

Are there any benefits to having the reconstructive surgery done at the same time as my mastectomy?

Yes, there are a variety of benefits in having the procedures done all at once. First, the surgeon can use the same incision from the mastectomy to avoid creating an additional scar during the reconstruction process. Also, having breast reconstructive surgery at the same time as a mastectomy is a great option for women suffering emotional trauma at the thought of waking up in the recovery room without a breast.

Click here to see select before and after photos of Breast Reconstruction cases.

I’d like to speak with someone further about the options available to me for breast reconstruction. How do I get started?

Our team at Weinstein Plastic Surgery Center is happy to answer any additional questions or concerns you may have regarding breast reconstruction following a mastectomy. We realize the personal nature of such a decision and wish to empower you with the information necessary to make the best choice for you and your body.

After breast mound reconstruction surgery, Dr. Weinstein usually recommends nipple and areola reconstruction to complete the process of a more natural breast appearance.

After the nipple reconstruction, a tattoo is used to create the look of an areola. The tattoo can be repeated if the areola color fades over time as tattoos usually do. The areola is often slightly darker than the desired pigment to compensate for the expected fading. Sometimes tattooing the opposite areola is recommended to achieve symmetry.

Implant breast reconstruction can be a simpler restoration process than with autologous (tissue-only) reconstruction and usually involves less operative time than autologous procedures. However, implant reconstruction can be a process that requires several weeks to months.
FDA approved implants are made of a silicone outer shell, and filled with silicone gel or saline (salt water). Usually, implant reconstruction requires two stages. The first stage is to place a temporary tissue expander implant at the tie of the mastectomy. This is a saline filled temporary implant that can be subsequently filled in the office to expand the mastectomy skin to the patient’s desired volume.

The second stage surgery involves removing the temporary tissue expander (which is often hard) and place a softer final saline or silicone gel implant and to tune the result.

There are options for single-stage implant reconstructions utilizing Alloderm®. Alloderm® is a cellular dermal matrix that is a donated human tissue from which the cells have been removed washing away all immune components. Alloderm helps create a new envelope for the implant often facilitating a more natural looking breast.

Both saline and silicone gel implants are FDA approved for widespread use. Both saline and new generation silicone gel implants are safe medical devices, but no medical devices last forever. Extensive research has shown that implants do not cause or increase the risk for illnesses.

Although very safe, implants are foreign bodies and do have risks which include: infection, rupture/deflation, and scar formation around the implant (capsular contracture). Patients with reconstructive breast implant may require revisional surgery in the future. Those women who do not wish to face the potential for revisional surgery secondary to implant related issues often choose autologous tissue only reconstruction

Breast restoration may include the need for nipple reconstruction. Nipple reconstruction uses small, local skin flaps and fat that are pulled from the breast mound. This creates a projecting nub which has a more natural breast appearance.

Nipple reconstruction is not mandatory, and some patients choose not to undergo this final stage of breast reconstruction. However, patients are encouraged to undergo nipple reconstruction because it adds so much to the appearance of the breast. Nipple reconstructions are also covered by your insurance.

Revision surgery is to be expected as part of the breast reconstruction process. It is require to fine-tune your results. Remember, breast reconstruction is a process to build an aesthetically pleasing breast from what mastectomy took away; it is not an overnight process. Breast reconstruction revisions may be needed to reduce the breast size, improve breast projection or shape, reduce excess tissue, to achieve better symmetry or revise mastectomy/lumpectomy/IV port scars.

Revisions of a breast made of autologous tissue are often thought to be one of the most artistically challenging surgeries in breast reconstruction. It is an area in which the patient’s choice of plastic surgeon is an important choice. With a revision, an experienced and proven plastic surgeon can often turn a mediocre reconstruction into an excellent restoration.

For breast restoration, women may consider the TRAM flap. TRAM stands for “transverse rectus abdominis myocutaneous,” named after a muscle located in the lower abdomen. There is generally enough skin, fat, and muscle in this area that can be used to reconstruct a new breast.

The TRAM flap takes the excess lower abdominal skin and fat. A relatively insignificant abdominal muscle is used to carry the blood vessels that feed the overlying skin and fat reside inside the muscle.
The skin/fat/muscle unit is then tunneled under the skin up to the breast to build a tissue only breast. In a pedicled TRAM procedure, the tissue’s own blood supply remains attached and the lower abdominal tissue is rotated into position on the chest. The tissue is then tunneled under the skin to the chest area, where it is brought through the mastectomy incision. There is usually no need for microvascular surgery in a pedicle TRAM procedure.

Reconstruction of the breast is an option for most women who have had a mastectomy. You may choose immediate reconstruction, in which the process is started during the same surgery as the mastectomy. Or you may delay reconstruction and start the procedures after your initial surgery and other treatments are complete. Some women say that starting reconstruction right away helps reduce the trauma of losing a breast; immediate reconstruction also erases the need for an additional hospitalization and anesthesia.

There are two methods for reconstruction: using an implant to replace the lost tissue or using tissues from elsewhere in the body to replace the lost tissue. The new breast will not function like a breast, and it will not have much sensation. But depending on the method of reconstruction, in clothes it can look almost exactly like the other breast. In the final step, a new nipple-areola complex is built and the nipple area can be tattooed to have a similar color to the other.

Radiation therapy can sometimes cause damage to the skin that makes breast reconstruction challenging. Dr. Weinstein has extensive experience with reconstruction for patients who have already had radiation therapy.

As of October 1998, a federal law requires insurance companies to cover all aspects of reconstruction, including operations to match the reconstructed breast to the opposite breast.

Implant Surgery

Implants are best for women with small- to medium-size breasts and those who have not had any radiation therapy to the breast area. In the first step, a pocket is formed from the pectoralis muscle and an expander is placed in that space. Over the next several months, saline is injected through a valve into the expander sac to slowly stretch the skin and muscle in preparation for the implant. During a second, shorter operation, the expander is removed and the implant is inserted in its place.

Implants come in different shapes and sizes and are made of saline or silicone. A plastic surgeon will help determine which type of implant is best for you.

Tissue Transfer

Another method for reconstructing the breast is to use tissue transferred from somewhere else in the body. The new breast mound is built using muscle from one of three locations:

TRAM (transverse rectus abdominus myocutaneous) Flap

An oval-shaped section of fat and skin is removed from the abdomen and shaped into a breast on the chest wall.

Latissimus Dorsi Flap

Skin and muscle are moved from the upper back to the chest area and shaped into a breast.

The type of reconstruction that is most appropriate for each patient depends on the amount of skin remaining on the chest wall, the size and shape of the other breast, the amount of body fat and tissue available elsewhere, the patient’s general health, her smoking history, and her personal preferences. If you know that you will want a reconstruction, you should talk to your doctor about it early in your treatment — even before you have a surgical biopsy, if possible. Your choice might influence where incisions are made.

Once the breast mound is completed, the other breast may be altered (with an implant, a reduction, or a lift) to achieve symmetry. In the final step, a new nipple-areola complex is built, and the area can then be tattooed to have a similar color to the other side.

Prosthesis

Women who decline or cannot undergo breast reconstruction can use a silicone breast prosthesis for symmetry. Breast prostheses come in firm, medium, and soft silicone textures, as well as a variety of sizes, shapes, and skin tones to match the other breast. Prostheses can be placed in a special pocket in a bra or bathing suit. A properly fitted and weighted prosthesis provides the balance needed for correct posture. Custom-made prostheses are now also available.

To purchase a prosthesis, visit the boutique in The Dane Shop in Morristown, New Jersey or call the local office of the American Cancer Society. These stores specialize in breast prostheses and post-mastectomy bras and have experienced, sensitive, certified fitters who will help you find the perfect prosthesis for your body. The fitter will consider the type of surgery you had as well as the size, shape, and texture of your remaining breast to select the prosthesis that is best for you. Fitters also provide instructions for care of the prosthesis.

Before purchasing a breast prosthesis, make sure that you have a prescription from your doctor. Both prostheses and post-mastectomy bras are often covered by insurance.

Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.

Although breast reconstruction can rebuild your breast, the results are highly variable:

• A reconstructed breast will not have the same sensation and feel as the breast it replaces.
• Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
• Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.

A note about symmetry: If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.

Click here to see select before and after photos of Breast Reconstruction cases.

Breast Reconstruction to Help You Move Forward

Over 180,000 women in the US each year are diagnosed with breast cancer. You are not alone. Like you, many women have the option of Breast Reconstruction after their mastectomy. There is a growing acceptance and popularity for breast reconstructive surgery among mastectomy patients and in the medical community. Be sure to ask your breast surgeon or general surgeon about your Breast Reconstruction options early on in your treatment plan.

While not everyone chooses to have Breast Reconstruction, women with Breast Reconstruction have reported an increase in self-confidence, gained emotional well-being, renewed body image and an increased sense of femininity and sexuality.

While you’re considering your treatment options, empower yourself and make an informed decision about Breast Reconstruction. This is a personal choice that your breast surgeon (or general surgeon) and plastic surgeon are ready to discuss with you, and plan for, right at the onset of your treatment for breast cancer.

Fully exploring your options will help you make the best choice for your body and your life after cancer. And research has shown that the more informed you are about Breast Reconstruction upfront, the better your plan will be. This look at Breast Reconstruction provides insight for a knowledgeable decision.

While Breast Reconstruction can be performed at the time of your mastectomy or delayed months or even years, knowing your options now can reduce your fear and strengthen your decision. Once you have read this information, be sure to consult with your breast/general surgeon and a qualified board certified breast reconstructive plastic surgeon like Dr. Weinstein to determine what option is right for you.