About Breast Reconstruction
Surgical breast reconstruction is performed to restore the chest to a normal appearance in shape and size after a mastectomy or lumpectomy. It is also an option to restore a breast damaged by trauma or a birth defect. Advanced technologies in breast reconstruction surgery make it possible for you to feel complete and attain natural-looking breasts, even after they have been removed. Breast reconstruction can either be performed at the same time as your cancer treatment or delayed until a later date. Newburyport, MA plastic surgeon Dr. Michele Sasmor creates an individualized treatment plan and uses a compassionate approach as we work with you to restore your appearance and confidence at RiverSong Plastic Surgery.
Breast reconstruction is a very personalized procedure. Every patient will have a confidential, comprehensive consultation with Dr. Sasmor to create their treatment plan based on their needs, concerns, and appropriate options. If you are planning to have breast reconstruction surgery, it is vital that you have realistic expectations. While Dr. Sasmor strives to create a natural appearance, your newly reconstructed breast(s) will not have the same feel, look, or sensation as your original breast(s). You should get approval from your oncology doctor to have surgery and tell Dr. Sasmor about any other factors that could impact healing.
There are a variety of techniques available today for breast reconstruction. There are also many factors that Dr. Sasmor considers when determining the technique that will produce your best results. Some of these factors include cancer diagnosis, reconstruction timing, whether you will use natural tissue or implants, and if nipple-sparing or nipple reconstruction is a part of the process. In order to rebuild the breast, there must be enough tissue to adequately cover the breast mound. Flap procedures accomplish this by using your own skin, fat, and muscle to create, cover, and build the mound. The most common flap techniques are:
- TRAM Flap
This method uses skin, fat, and muscle from your stomach to create the breast. The tissue used to create the new breast can be detached from the abdomen or it may remain attached to the donor location, keeping the original blood supply.
- DIEP Flap
Like a TRAM Flap, a DIEP Flap removes fat, skin, and blood vessels from the lower stomach, but it doesn't take the muscle. The DIEP (deep inferior epigastric perforator) flap removes fat and skin from the belly to form the breast mound, then uses microsurgery to attach the blood vessels to the chest.
- Latissimus Dorsi Flap
This method uses muscle, skin, and fat from your back. During this procedure, tissue is moved from the back to the mastectomy site through a surgically created tunnel and remains attached to the donor location, which leaves the original blood supply intact.
- PAP Flap
Another flap alternative is the PAP (profunda artery perforator). This technique takes skin, fat, and muscle tissue from your inner thigh to create your breast(s).
- LTP Flap
While the TRAM flap tends to be one of the more common methods used during reconstruction, sometimes there is not enough muscle, skin, and fat that can be taken from the abdominal area. In these situations, the LTP flap may be used, which takes tissue from the lateral thigh area.
- Composite Flap
Also known as a composite stacked flap, this method combines flaps from different areas on your body to reconstruct the breast.
While flap procedures are usually successful and a common method used in breast reconstruction, you may be able to rebuild your breast(s) with tissue expansion. This involves placing a tissue expander under the breast skin and then slowly filling it with saline over the course of 1-3 months until the skin is properly stretched. After adequate volume has been created, different techniques to create the volume and shape of the breast(s) are utilized. These include a natural fat transfer in conjuncrtion with breast implants . After your breast reconstruction surgery, you may want to improve the appearance with nipple and areola reconstruction. There are numerous techniques to restore the nipple-areola complex so that the breasts look more normal.
What to Expect
Breast reconstruction surgery is performed in various stages. During certain phases (such as creating a flap, inserting an expander, or placing implants), general anesthesia is often used. Some patients will require an overnight stay — this is dependent on the current phase of treatment. Once the final step has been completed in the breast reconstruction process, you will wear a surgical bra for the chest and you will be given medication by Dr. Sasmor to control discomfort, and swelling. Over time, the breast(s) will look normal so you can feel more confident. Ongoing monitoring with mammograms on non recopnstructed breasts and breast exams are important and recommended for long-term health.
Frequently Asked Questions
How much does breast reconstruction surgery cost?
Breast reconstruction is a complex surgery so to get great results, you should concentrate on choosing a plastic surgeon with years of experience, like Dr. Sasmor. Generally, insurance will cover all apects of breast reconstruction. Dr. Sasmor and her staff will work with you and your insurance carrier to smooth the process. Deductibles and co-pays will apply.
Does insurance cover my surgery?
The WHCRA (Women's Health and Cancer Rights Act) of 1998 requires insurance plans that cover mastectomies to also cover breast reconstruction surgery. If you have insurance, a member of the RiverSong Plastic Surgery team will help you understand your policy and coverage. We will also help you submit needed information and paperwork to your insurance.
Which technique should I choose?
There is no single technique that is right for everyone. The best technique for you will depend on your needs, goals, and body. During your consultation, Dr. Sasmor can go over your options, including both implants and flaps, so you understand the benefits and challenges before you decide on your treatment plan. Whether you decide on implants or a flap for reconstruction, Dr. Sasmor will do her best to give you natural-looking results.
What about nipple reconstruction?
Reconstruction of the nipple-areola complex and be performed surgically or performed with cosmetic tattooing. Nipple/areola reconstruction is generally discussed once the reconstruction process is complete. Dr. Sasmor will go over your options so you can decide if you want nipple and areola reconstruction as part of your treatment plan.
Should I have reconstruction with my mastectomy or wait?
When you choose to have breast reconstruction is based on several things. Some patients choose to have their reconstruction performed at the same time as their mastectomy, while some patients prefer to wait. Dr. Sasmor recommends you schedule a consultation after your cancer diagnosis so you can begin learning about your options and decide when you may want reconstruction surgery. If you decide to have reconstruction at the same time as your mastectomy, Dr. Sasmor can work with your oncologist and general surgeonto plan your surgery.
Reclaim Your Self-Confidence
While the breast reconstruction process can be lengthy, it is considered one of the most worthwhile reconstructive surgeries for our Newburyport, MA patients at RiverSong Plastic Surgery. It can help decrease the emotional and physical impact of a mastectomy while also allowing you to boost your self-confidence and body image. If you have been diagnosed with breast cancer, have had trauma to the chest, or were born with a defect that affects the shape of your breasts, we invite you to call our Newburyport, MA office and schedule your consultation with Dr. Michele Sasmor.