Greensboro, NC

336-907-7980

Breast Reconstruction

Breast reconstruction is an important component in the multidisciplinary team approach to the treatment of the breast cancer patient. The goal of these procedures is restoration of body contour, promotion of a healthy body image, and the provision of the positive psychological benefits that have been demonstrated in breast reconstruction patients. While an exact restoration of the missing breast is not possible, the restoration of a pleasing degree of symmetry is a realistic goal that enables the breast cancer patient to take an additional positive step in her recovery process.

Best Candidates

Candidates for breast reconstruction should have the following characteristics:

Good general physical and mental health
Reasonable body weight
An absence of metastatic disease
A minimal chance of radiation after the reconstruction is performed
Motivation
Realistic expectations

If you are interested in breast reconstruction and would like to learn more about options available to you, please call Bowers Plastic Surgery at 336-907-7980 or Contact Us to arrange a consultation with Dr. David Bowers.

Techniques

Each technique for breast reconstruction is designed to overcome the dual deficits of missing breast mound and missing skin. This may be accomplished in one or two stages depending upon the technique selected.

One method involves the use of a breast implant. This type of reconstruction is usually performed in two stages. A device called a tissue expander is placed as a first stage. This can be done either immediately, at the time of the mastectomy, or delayed until a later time. Once healing has begun, a small amount of sterile saline is placed in the expander in the office at 3 to 4 week intervals. The overlying skin responds to the expansion process with a remarkable increase in skin cell growth that provides a considerable amount of additional skin over time. After 3 to 5 months sufficient volume of saline has been placed and adequate skin coverage obtained. At the second stage, the expander is removed, the space under the muscle is modified with internal sutures if needed, and a saline or silicone gel implant is placed. The choice of saline or silicone gel is based upon the patient’s preference.

Another method for breast reconstruction uses the patient’s own tissue. The donor site most commonly selected is the lower abdomen. This procedure transfers lower abdominal tissue to the chest through a tunnel under the upper abdominal skin or as a detached flap (free flap) that is connected to new blood supply in the chest using a microscope. When the flap is tunneled to the chest it is called a TRAM flap (Transverse Rectus Abdominis Myocutaneous flap). When the flap is transferred with reconnection of blood vessels in the chest using a microscope it is called a DIEP flap (Deep Inferior Epigastric Perforator flap).

An additional choice for reconstruction combines the use of an implant and the patient’s own tissue. This method is known as Latissimus flap with implant. A flap of tissue from the back composed of skin, fat, and muscle (Latissimus) is transferred through a tunnel to the mastectomy in the front. An implant is placed under this flap to provide satisfactory volume for the breast reconstruction. One advantage of this procedure is that for some patients it is possible to avoid the tissue expansion process and complete the reconstruction in a single stage.

The Surgery

Breast reconstruction procedures are usually performed in the hospital when planned in conjunction with the mastectomy. The occasional exception is the placement of a tissue expander, which sometimes takes place in an outpatient facility. All of these procedures require general anesthesia. Tissue transfer procedures such as the TRAM flap and the Latissimus flap involve a hospital stay of 1 to 3 days. Placement of a tissue expander generally requires a stay of 1 to 2 nights. Coordination of schedules allows the general and plastic surgeons to provide immediate breast reconstruction. In special cases, such as nipple sparing mastectomy with immediate placement of an implant, the general and plastic surgeons may work together and assist one another.

Recovery

It is normal to be sore after these types of surgery. It is also normal to notice areas of numbness at operative sites. Some bruising and swelling can be expected.

Every breast reconstruction affects a muscle in some fashion. Consequently, the recovery time is about 6 weeks no matter which type of reconstruction is chosen. It is important to avoid exercise, lifting, or any strenuous activity during this time.

Drains will be left in the mastectomy site as well as the donor site if flap reconstruction is performed. The drains evacuate fluid that seeps into the space where surgery has taken place. These drains promote healing and are left in place for 1 to 3 weeks after surgery. They are removed in the office once the amount of drainage reaches a minimal level. Most surgeons discourage showering while drains remain.

Risks

Breast reconstruction does carry risks as the case with any surgery. These risks include bleeding, infection, unsatisfactory scarring, areas of sensory loss, fluid accumulations, anesthesia complications, loss of tissue, decreased range of motion or strength, and asymmetry. Dr. Bowers will discuss these risks carefully and answer each of your questions.

Commonly Combined Procedures

Many breast reconstruction patients desire a surgery on the opposite breast as well in order to achieve optimal symmetry and balance. Procedures such as breast augmentation, breast reduction, or breast lift (mastopexy) on the opposite breast can provide an improved result overall and enhance the patient’s sense of wellbeing. These combination procedures often yield a high degree of patient satisfaction that makes them rewarding for both patient and surgeon.

Ancillary Procedures

Additional procedures that are less involved and smaller in scope can be performed later to enhance the overall result of the breast reconstruction. These include fat grafting for small contour depressions, nipple reconstruction, and nipple/areolar tattoo. Bowers Plastic Surgery is able to provide each of these services.

If you are interested in breast reconstruction or symmetry procedures for the opposite breast please call Bowers Plastic Surgery at 336-907-7980 or Contact Us to arrange a consultation with Dr. David Bowers.

Get in Touch

Phone: 336-907-7980

1002 North Church Street, Suite 203

Greensboro, NC 27401

Schedule your consultation today.