Breast Reconstruction

OVERVIEW OF RECONSTRUCTION: Q&A

What is breast reconstruction? - Breast reconstruction includes surgical procedures that are performed to restore the breast’s natural appearance, shape, and size following a mastectomy (surgical removal the breast). Breast reconstruction can also be done for correction of changes due to partial removal of the breast (lumpectomy).

Why choose breast reconstruction? - The decision to undergo breast reconstruction varies individually. Many women choose to have breast reconstruction after a mastectomy to restore breast shape, to attain symmetry in bras and clothing, and to enhance self-esteem and self-image following breast cancer. Woman who have had breast reconstruction months to years after the mastectomy often say that the reconstruction of the breast removes the daily reminder of having had breast cancer.

When is breast reconstruction done? - Breast reconstruction may be done immediately following a mastectomy or may be delayed. Advantages of immediate breast reconstruction include: fewer number of operations, possibly increased cosmetic results, and less risk of emotional difficulty.
Delayed breast reconstruction may be completed anytime following a mastectomy and is the appropriate option for most women requiring radiation therapy as well as for women unsure about reconstruction at the time of the mastectomy.
There are many personal and health related factors that will also contribute to the time the reconstruction is done which will be discussed in further detail with Dr. Mast during your consultation.

How many operations will be needed to obtain desired results? - The number of operations needed for breast reconstruction varies for each individual and may range on average from one to three procedures which are spread over the course of several months. Typically the first operation forms the breast. This is the biggest operation and usually has an overnight stay in the hospital of 1 to 4 days depending on the type of reconstruction done. Another operation is generally needed for refinement of the breast shape as well as nipple reconstruction. This is a relatively minor operation and is done as same day, outpatient surgery. A third procedure is done for nipple tattooing. This is an office procedure similar to a cosmetic tattoo.

Is it an option to have surgery on the unaffected breast? - There are a variety of surgical procedures available for the unaffected breast to obtain symmetry that may be completed during the reconstruction process. These procedures include: breast augmentation, breast lift, and breast reduction. Dr. Mast will discuss the procedure that is the best option for you during your consultation.

What does insurance cover? - All medical insurance policies, including Medicare, must cover reconstruction of the breast after mastectomy and procedure done to the other breast for symmetry. This is a federal law! Therefore, insurance covers all procedures related to the breast reconstruction process.

TIPS TO PREPARE FOR BREAST RECONSTRUCTION:

It is appropriate to begin to explore reconstruction options as soon as you are diagnosed with breast cancer and it is equally important to determine why reconstruction is an important option for you and what your goal of reconstruction might be. When diagnosed with breast cancer, it is every woman’s right to know about reconstruction. A consult with a plastic surgeon prior to any treatment is certainly appropriate.

Ask us about our breast cancer reconstruction support network, we will put you into contact with a patient who has been in your shoes and has undergone breast reconstruction by Dr. Mast.

YOUR CONSULTATION WITH DR. MAST:

We recommend that you arrange for a family member or friend to accompany you to your consultation visit to provide support.

During your consultation, Dr. Mast will spend time discussing reconstruction as well as procedure options that he recommends for you based on: your personal desires and needs, physical examination and your health history.

Dr. Mast will spend time reviewing photographs with you of patients who have undergone a similar procedure as the one proposed for you. He will also discuss your recovery time and what to expect following the surgery.

You will also be given an opportunity to discuss your insurance coverage and scheduling options with our patient care coordinator following your consultation.

RECONSTRUCTION PROCEDURES PERFORMED BY DR. MAST:

There are several types of reconstruction procedures. Breast tissue expanders allow the skin and underlying tissue to gradually stretch in size to allow for an implant to be placed as a secondary procedure. Silicone or saline implants may be used for breast reconstruction. Tissue flaps (a portion of your own skin and muscle) are often used for breast reconstruction to actually replace tissue that was removed with the mastectomy. Tissue flaps are sometimes used with breast tissue expanders or implants.; Dr. Mast will review each of these types of implants with you in detail during your consultation.

Latissimus Dorsi Flap: The latissimus dorsi muscle is the muscle that runs from the back of the armpit and across the back. Utilizing this muscle for breast reconstruction following a mastectomy is Dr. Mast’s preferred reconstructive technique. This type of reconstruction can be used for immediate or delayed breast reconstruction and has excellent outcomes, even following radiation therapy. This procedure is considered less complicated than several other flap procedures because the muscle and skin remain attached to their natural blood supply. The latissimus dorsi flap is often used with a breast implant which provides size or projection that is individualized for each patient.
This procedure takes about 2 in the operating room and most patients go home from the hospital within 48 hours. Patients should expect 3 to 4 weeks of recovery time to return to normal activities.

Transverse Rectus Abdominis Muscle Flap (TRAM Flap): The TRAM flap is a type of flap that uses a portion of the abdominal tissue to create the breast mound. Dr. Mast prefers to leave the muscle attached to its original blood supply and rotate the muscle to the chest. This type of flap provides a generous amount of tissue in properly selected patient. Therefore, it does not require an implant. However, this procedure is not recommended for patients with a history of previous abdominal surgery or for patients with little excess abdominal tissue. Also, patients who are very overweight or who have other complicating medical problems may not be well suited for the TRAM operation.
This procedure typically takes between 3 to 4 hours in the operating room and most patients go home from the hospital in 3 to 4. Patients should expect 4 weeks of recovery time to return to normal activities.

Nipple and Areola Reconstruction: Nipple and areola reconstruction is completed during the final stage of reconstruction and is typically preformed 3 to 4 months after the breast mound is created and the breast has healed. The nipple is shaped from the tissue that is present at the reconstructed breast. No skin grafting is needed. Dr. Mast is able to reconstruct the nipple and areola to a natural size, shape, and projection.
This procedure is done in an outpatient setting and requires very minimal recovery time. Following this procedure, nipple tattooing may be done to provide a natural color to the nipple and areola and is completed in the office after the reconstructed nipple and areola has healed.

Deep Inferior Epigastric Artery Perforator Flap (DIEP Flap): This is a form of breast reconstruction in which the skin and fat from the lower tummy is completely removed and then reconnected to the chest. Using microsurgery, blood vessels that feed the skin and fat are sewn to blood vessels in the chest so that the tissue may live. This is a very elegant operation and can create wonderful breast reconstructions without the use of implants.
Although Dr. Mast is an accomplished microsurgeon, he does not do this operation. If the blood vessels clot off or the connection is no good for another reason, the transferred skin and fat may die. If this occurs, the entire reconstruction may be wasted and it would be necessary to eventually start all over. Dr. Mast has treated two patients whom this happened to. Their microsurgery had been done by two different surgeons. Each patient came to him terribly disfigured with skin grafts on their chest. Each patient took several years to get over the trauma of the failed microsurgery flap prior to coming for more surgery. Each patient had highly successful reconstruction by Dr. Mast using latissimus dorsi flap and implants. Dr. Mast feels that the 2 to 5% chance that the microsurgery operation will fail does not make it worth the risk, especially when he can provide excellent reconstruction using less risky methods. Furthermore, the DIEP flap operation generally takes much longer that the other methods. Longer time under anesthesia has increased risks of nausea and vomiting after surgery, leg clots, lung clots, and possible breathing complications. For all these reasons, Dr. Mast does not perform DIEP flap or other microsurgery breast reconstruction.

THE ACCENT BREAST RECONSTRUCTION SUPPORT NETWORK:

The Accent Breast Reconstruction Support Network was created to provide a network to help women who have been diagnosed with breast cancer or who have undergone mastectomy and are considering reconstruction. Our goal is to provide you with emotional support and an understanding of the reconstruction process from a patients’ perspective that has completed breast reconstruction by Dr. Mast.

If you or someone you know are considering breast reconstruction, we would be happy to coordinate the opportunity for you to speak with a woman that has completed reconstruction.

Please call our office today or email us at accentsupportnetwork@gmail.com for more information.

If you have completed breast reconstruction by Dr. Mast and have a desire to help others that are considering reconstruction and are interested in joining our support network, please email us at accentsupportnetwork@gmail.com.

PATIENT QUOTES/LETTERS/WORDS OF ENCOURAGEMENT:

"Every time I go to the doctor, the staff wants to see my breasts, because they look so natural, no one can believe that I had double mastectomies." - SW, US Virgin Islands