Breast reconstruction is an integral part of a comprehensive breast cancer treatment plan, and by federal law, insurance plans that cover mastectomies must cover reconstruction procedures as well.
The majority of patients have two options for breast reconstruction: A breast made using a saline or silicone implant, or a breast made from the patient’s own tissue. Dr. Mancoll has years of experience performing both types of surgeries, and he will make a recommendation based on his assessment of your individual situation.
In rare cases, the permanent implant is put in place at the time of the mastectomy. But for most women, a tissue expander is placed between the skin and muscle, with an integrated port that allows Dr. Mancoll to slowly stretch the skin by injecting a saline solution over a period of weeks (or even months). During a second surgery, the expander is removed and a final implant is put in place. It is important to know that a history of radiation therapy may make tissue expansion an unwise choice, due to the possibility of unacceptable scarring.
For women who wish to avoid implants, breasts can be reconstructed using the patient’s own tissue from the back, abdomen and buttocks. In some cases, Dr. Mancoll can move tissue without moving muscles or detaching blood vessels, a technique that leads to faster recovery. Breast reconstruction using the patient’s own tissue is a more complicated procedure, but the result is typically a more natural feeling, looking and moving breast.
Free-Flap:
DIEP flap microsurgical breast reconstruction differs from other methods of reconstruction in that the tissue used to make the breast is completely removed (or “free”) from its original blood supply and then reconnected to a new supply at the breast area. For example, blood vessels from the DIEP flap tissue can be joined with blood vessels within the armpit region or near the sternum. Because of this, the DIEP technique is sometimes called a “free flap” reconstruction.
During microsurgical breast reconstruction, an incision similar to that which begins an abdominoplasty procedure is made along the bikini line. From this incision, the necessary skin, fat, and blood vessels are taken and placed into the breast area at the point of mastectomy, where the surgeon forms them into the desired shape. Finally, the abdominal skin and underlying fat are tightened and the incision is closed. The entire procedure takes approximately six to eight hours. Recovery from breast reconstruction surgery takes some time, but DIEP flap breast reconstruction has proven to be a less painful process for patients than most other reconstructive methods.
TRAM (pedicle) Flap:
Pedicle flap breast reconstruction is very popular and generally quicker to perform than microsurgical breast reconstruction. In this technique, one side of the abdominal muscle is folded upon itself and passed through a “tunnel” under the skin that connects to the breast site. This allows most of the blood vessels to remain intact and provide blood to the newly created breast.
This technique does not require training in microsurgery, and is therefore more widely performed. However, the pedicle flap breast reconstruction method does have drawbacks, including the risk of significantly decreased abdominal strength, fat necrosis (the death of fat tissue in the breast due to inadequate blood supply), and abdominal hernias.
Free TRAM Flap:
During free flap microsurgical breast reconstruction, the surgeon removes the entire section of abdominal tissue and reattaches it at the site of the new breast. The extracted tissue includes an artery and vein, which are preserved and reattached to blood vessels in the chest area. This method insures that a healthy blood supply reaches the transplanted tissue, making it easier to shape the new breast. A surgeon must have experience in microvascular surgery and microsurgical techniques to perform the free flap breast reconstruction procedure.
Because this technique uses a relatively small amount of abdominal muscle tissue, the patient’s abdominal strength is not affected as much as it is with the pedicle flap technique. Another advantage of free flap microsurgical breast reconstruction is decreased pain after surgery.
DIEP Flap:
DIEP flap breast reconstruction is one of the most advanced techniques for recreating the breast after mastectomy. DIEP, an acronym for Deep Inferior Epigastric Perforator, has a number of advantages over other breast reconstruction techniques, including the capacity to form a softer, more natural breast. The DIEP free flap technique utilizes the patient’s abdominal region as the donor tissue site. However, DIEP flap breast reconstruction uses only skin and fat, sparing the muscles. DIEP flap breast reconstruction after mastectomy is more complicated to perform than reconstruction with pedicle flaps, but it does provide the potential for more rapid recovery of abdominal strength. Deep Inferior Epigastric Perforation (DIEP) refers to the name of the tissue that is used to create the new breast; it is the tissue found beneath the rectus abdominus (the so-called “six-pack” muscles of the abdomen). Rather than taking part of this muscle, the surgeon transfers only sections of its blood vessels which have branched out to the underlying abdominal fat. Ultimately, the abdominal muscle tissue is preserved and the patient ends up with a tummy tuck of sorts due to the removal of extra fat and skin from the abdominal area.
Excessively large, sagging breasts can be uncomfortable, unhealthy and distracting from a woman’s appearance. Large breasts can also restrict certain activities. Dr. John Mancoll performs breast reduction surgery for patients in the Beverly Hills region to reduce overdeveloped breasts and alleviate back pain, shoulder strap furrows, hand numbness and breathing difficulty.
What about getting pregnant and nursing?
If you are considering having children, you should discuss this with Dr. Mancoll during your consultation. The ability to nurse after you have had the size of your breasts reduced is unpredictable. Should you decide to nurse after your surgery, you probably will experience some temporary engorgement.
What about mammograms?
The risk of developing breast cancer seems to remain unchanged following a breast reduction, as do our recommendations for cancer screenings. Self breast examination should be performed monthly. A new baseline mammogram should be performed one year after your surgery. Your doctor will make further recommendations during your consultation.
Who are the best candidates for breast reduction?
The best candidates are women with very large breasts who require physical relief. Other candidates for breast reduction include those patients with one breast significantly larger than the other. Those with indentations in their shoulders from tight bra straps and those who are self-conscious or dissatisfied with their oversized breasts are also excellent candidates.
How is the procedure performed?
Traditional breast reduction surgery is an outpatient procedure, but is sometimes performed as an inpatient procedure under general anesthesia, and takes between 2 - 4 hours. There are many variations to the procedure. The most common procedure involves an incision that circles the areola and extends downward following the curve of the crease beneath the breast. Your surgeon removes the excess glandular and fatty tissue. Then the nipple and areola are moved to their new position. The skin is then drawn together and down around the areola, providing a new shape to your breast. Unless your breasts are very large and pendulous, the nipples will likely remain attached. All incisions are closed with stitches.
Breast liposuction is a safe alternative to traditional breast reduction surgery. It may be performed with twilight sleep anesthesia combined with local anesthesia. Since the female breast is about 50% fat, a 1 - 3 cup reduction in size can be obtained using liposuction alone. Liposuction of the breast enables the surgeon to remove fatty tissue, but not glandular tissue. With this procedure, most patients experience a quicker recovery time with minimal scarring as compared to a traditional breast reduction. Depending on your breast size, breast liposuction might be an option to consider.
How will I feel after surgery?
After Dr. Mancoll performs a traditional breast reduction procedure, the recovery can be extensive. Following your surgery, it is a good idea to sleep on your back to avoid undo pressure on your breasts. Sexual activity should be avoided for 1 - 2 weeks following surgery, and you should avoid strenuous activity for several weeks. It may be possible to return to work in 1 - 2 weeks. The stitches will be removed over the next few weeks. Bruising and swelling may take up to 6 weeks to disappear, and it may take up to a year or two for the scars to flatten and fade.
In contrast, patients undergoing breast liposuction are encouraged By Dr. Mancoll to resume normal activities as soon as they feel up to it. The scar is small and hidden, out of sight under the breast fold. The results of breast reduction surgery are permanent, but breast size may change due to weight gain or pregnancy.
Your New Figure
A breast reduction can make a dramatic change in your appearance and your outlook. A breast reduction can make your breasts smaller and firmer. Many patients find a new enjoyment in sports, exercise, dancing, or even just walking.
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Saline and silicone breast implant removal surgery is an option for women who are not satisfied with the results of their breast augmentation, or when complications with breast implants arise. B reast implant removal surgery may become necessary if the original breast implant placement was performed incorrectly. Breast implants may become displaced or contracted because of improper placement or due to pressure from scar tissue. Breast implant removal may also be necessary if the implants rupture or deflate as a result of injury or a defect in the implant itself. Additionally, breast implants may need to be removed if infection occurs.
Saline Breast Implant Removal:
During saline breast implant removal, the surgeon may deflate the implant before removing it. This will allow for easier removal. Once the implant has been removed, the surgeon may remove scar tissue from the previous breast augmentation surgery. Placement of new implants or breast lift surgery will be performed as soon as the original implant is removed. The surgery itself should take 30 to 45 minutes, and the patient will remain in the hospital for a few hours after the surgery for observation.
Silicone Breast Implant Removal:
During silicone breast implant removal surgery, because a ruptured silicone implant may have gone undetected, the surgeon will manually inspect the implant for any signs of distress or rupture prior to its removal. This allows the surgeon to minimize any risks associated with the breast implant removal procedure. Removal of the implant may be more complicated then the original placement, particularly if the outer shell is textured or foam covered. Sometimes, surrounding tissue and muscle may have to be removed along with the implant.
The length of the removal procedure depends on whether there are any other procedures being performed at the same time. Breast implant replacement, breast lift, or scar revision may be performed at the time of the removal. Generally, silicone breast implant removal surgery should take less than an hour and the patient will remain for observation for a few hours after the surgery. Patients undergoing breast implant removal or revision surgery should be able to return to work within a week.
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Mancoll Cosmetic & Plastic Surgery, 1925 Glenn Mitchell Dr., Suite 206, Virginia Beach, VA 23456 | Frequently Asked Questions Media Contact Us |
