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Breast Reconstruction Fort Worth & Southlake

Breast Reconstruction Information and FAQs as provided by board certified plastic surgeon, Dr. Jonathan Heistein

When a woman receives the diagnosis of breast cancer, the news can be devastating. The flood of information from friends, family and the internet can be overwhelming. The first and most important thing is to find a great oncologist and a great breast surgeon. If you have a team that you are comfortable with already, that is great! If not, Dr. Heistein can help you find the perfect team for YOU. The next important thing to realize is that plastic surgery has become quite good at rebuilding breasts. Dr. Heistein is a specialist in breast reconstruction, and he will help restore your appearance after your breast surgery and any chemotherapy or radiation that you might need.

How do I know if I am a good candidate for breast reconstruction?

A good candidate for breast reconstruction should not have additional medical conditions or illnesses which may interfere with healing after breast reconstruction surgery. In addition, you should have a positive outlook and realistic goals for the outcome of the surgery.

Will I have breasts that don’t match?

This is a common concern. Matching procedures may also be performed to better match the remaining breast. This may include breast reductions, lifts, or augmentations. When performed for mastectomy patients, federal legislation mandates insurance coverage for these procedures. Although various techniques are available for breast reconstruction and to create symmetry on the unaffected breast, your breasts will never be perfectly symmetrical.

If you would like more detailed information about breast reconstruction surgery, please read below.

What happens during breast reconstruction surgery?

Step 1 – Choose lumpectomy or mastectomy.

The choice between lumpectomy and mastectomy is a choice that is made with the help of your breast cancer surgeon (either a breast cancer specialist or a general surgeon). A lumpectomy, also called partial mastectomy or breast conservation surgery, is an option for breast cancer treatment for many women. This is sometimes combined with reconstructive surgery to reshape the breast at the time of the initial surgery either as a breast lift or breast reduction as well as matching procedures on the unaffected breast. Radiation therapy is then often used after surgery to complete the cancer treatment.

If a woman chooses mastectomy, then reconstruction should be offered. A plastic surgery consultation will provide information regarding the various reconstructive techniques and which may be best for you.

Step 2 – Choose either immediate or delayed reconstruction.

Although many women elect to start reconstruction at the time of the mastectomy (immediate reconstruction), others prefer to wait until after completing all of their treatments. This is delayed reconstruction. This is sometimes recommended if radiation therapy is to be used after surgery or if a patient is unsure if reconstruction is right for her. A discussion with a plastic surgeon will help guide this decision.

Step 3 – Choose either reconstruction with a breast implant or a flap technique.

The choice of reconstructive technique depends of many factors including body type, breast size, age, tobacco use, and activity level. The process can be very different from surgeon to surgeon as there are many ways to perform these procedures. The type of reconstruction and the process will be reviewed at the time of your consultation with Dr. Heistein.

Tissue expansion

Tissue expansion stretches the skin and creates a pocket beneath the muscle to provide coverage for a breast implant. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it may be a more lengthy reconstruction process. A tissue expander (temporary spacer) is placed at the time of the mastectomy, and can involve the use of an allograft (cadaver skin) to help make the pocket for the implant. The tissue expander is then filled through an internal valve to expand the skin slowly over the ensuing months. This is done in the office. A second surgical procedure will be needed to replace the expander.

Transverse Rectus Abdominus Myocutaneous Flap (TRAM)

The TRAM flap repositions a woman’s own fat and skin to create the breast mound. Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant, or a woman may desire an autologous reconstruction without the use of an implant. If there is sufficient tissue on the abdomen, the woman is generally in good health, and the abdomen is relatively free of scars from prior surgery, then the TRAM flap may be an option.

The TRAM flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up to the chest wall (pedicled TRAM flap), or be completely detached then reattached by sewing the blood vessels under a microscope (free TRAM flap).

Latissimus Dorsi Flap (LD)

A latissimus dorsi flap uses muscle, fat and skin from the back, tunneled to the mastectomy site under the arm. Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.

Step 4 – Nipple/Areolar Reconstruction

Not all women who undergo breast reconstruction will elect to do nipple/areolar reconstruction. For those who do, there are several options available. For those women who then want the nipple reconstructed, a series of specially designed flaps on the chest will create the nipple. This is generally a simple procedure, but is only undertaken once a woman is happy with her reconstructed breast. Then, a tattoo done in the office can create the areola. Some surgeons will use a skin graft (traditionally taken from the groin or abdomen), but a tattoo allows for a better color match if there is an areola to match on the other side and does not require an additional surgical incision.

Excerpted from the ASPS/ASAPS Patient Education Brochures ©ASPS/ASAPS 2008

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