Following a mastectomy, many women choose to undergo reconstructive surgery to restore the appearance of their breasts to the way they were pre-mastectomy, or to achieve a different size or shape overall. Breast and nipple reconstruction (also known as mastectomy reconstruction) refers to a series of plastic surgery procedures used to reconstruct the nipples and breast mound. Sometimes, this involves the addition of breast implants, while other times patients choose to forego implants and use their own tissues for reconstruction. It is also important to recognize that opting for no reconstruction is also valid.
Our responsibility is to inform you of your choices and together find what is right for you. Mastectomy reconstruction is a deeply personal decision, and we understand the sensitive nature of the surgery. Dr. Anita is ready to offer compassionate and experienced care— her goal is always to ensure that all patients feel comfortable having this discussion, and confident, happy, and satisfied with their choice and the results of their procedure.
Depending on the situation, patients may opt to begin breast reconstruction surgery in Beverly Hills immediately after their mastectomy procedure— in this case, we will coordinate directly with the surgical oncologist’s office to ensure there is a smooth transition between procedures, and make sure you are a good candidate for immediate (versus delayed) reconstruction.
The reconstruction journey involves a number of steps, and after discussing what you are interested in and a good candidate for, the reconstructive steps for that type of reconstruction can be planned out. Prior to the surgery, you will fill out consent forms.
Breast reconstruction can be done using a variety of methods, ranging from implant-based reconstruction (tissue expander followed by exchange for implant; or direct-to-implant) to tissue-based reconstruction (either pedicled flap or free flap).
General anesthesia will be administered for this surgery and we recommend that you arrange to have someone drive you to and from the surgery appointment.
Please Note: These are general estimates that may or may not apply to you individually.
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The first step is reconstructing the breast(s) that had cancer. If only one breast was reconstructed, the next step is a procedure on the opposite breast to make it match. The third step is either a touch up needed to make sure both breasts match as closely as possible, or nipple reconstruction for the side without a nipple. After a nipple reconstruction, the last step is nipple tattooing to restore the color to the nipple and areola.
Implant based reconstruction is a good option for women who underwent bilateral mastectomy, already have implants, have little bulk for possible donor sites for using their own tissue, and want to minimize downtime or have the quickest recovery possible. It is important to note that this breast rebuilding is not as predictable of an option for Beverly Hills patients who have undergone radiation therapy.
The first step in implant-based reconstruction is typically having a temporary device called a tissue expander placed under the pectoralis muscle on the chest (the exception being “direct-to-implant reconstruction” if a candidate). Tissue expanders are inflatable devices that have a magnet and injection site or port. Fluid is injected through the port into the expander at a series of office visits. The amount injected per visit depends on many factors, including the condition of the skin overlying the expander, the final goal amount, and patient comfort.
Next the tissue expander is removed, and the final implant is placed. The implant chosen may be round or shaped. If the opposite breast needs to be addressed with a lift, reduction, or augmentation, it may be addressed at this surgery or a separate surgery. Since the breast has been removed in a mastectomy, there is little to camouflage the borders of the implant. In some cases, it is helpful to perform fat transfer to the breast along the upper border of the implant to provide a smoother contour.
Autologous tissue-based reconstruction means skin and tissue is used from one part of the body, and rotated into position to create a new breast. Examples of this type of reconstruction include the pedicled TRAM (transverse rectus abdominus myocutaneous) flap, and the pedicled latissimus dorsi flap. For the TRAM flap, skin, subcutaneous fat, and rectus abdominus (abs) muscle, are taken from one side of the lower abdomen and tunneled below the skin and brought out at the breast to create a new breast mound. For the latissimus flap, the tissue rotated forward comes from the back.
The advantage of this Beverly Hills surgery is that there is no implant involved, and the tissue tends to hang or drape in a way that resembles the natural breast shape. Another advantage is the flattening effect on the abdomen, if using a TRAM flap, since in order to close the donor site the abdomen is closed in a manner similar to a tummy tuck. The latissimus flap involves taking tissue from the back, and the incision is created in a way that the final scar can lay in the bra line.
In order to be a candidate for this surgery, there needs to be enough tissue at either the abdomen or back to create a breast, and this tissue cannot be previously operated on. This flap typically gives a smaller volume, and if the goal volume for reconstruction is greater than a B cup, you may need an implant in addition to this flap.
Free tissue transfer is different from the above options because it involves complete separation of skin and tissue from one area, including its blood vessels, and reattaching these vessels to blood vessels in the chest under an operating microscope.
This procedure takes significantly longer than the other techniques, and involves close postoperative monitoring and care, typically requiring at least one night stay in the intensive care unit. The total hospital stay tends to be around five to six days. While both the operating room time and recovery time are the longest for this type of Beverly Hills reconstruction, it does create natural appearing breasts and can transfer a significant volume of tissue.
The most common donor site for tissue is the lower abdomen, and different variations include the free TRAM flap, muscle-sparing TRAM flap, DIEP (deep inferior epigastric perforator) flap, and SIEA (superficial inferior epigastric artery) flap.
During your consultation, Dr. Anita will take time to learn more about your motivations and goals, understand your concerns, and discuss the treatment in detail. She will go through your medical history and perform a physical exam in order to determine the best plan to reach your goals, and make sure you are a good candidate for surgery.
For any immediate breast reconstruction procedures, our office will coordinate the reconstruction with the surgical oncologist's office. The day of surgery, Dr. Anita will meet with you in the preoperative area, review the planned procedure, and mark out areas on the skin. This is also a time you can go over any additional questions you may have prior to surgery.
After surgery, you will be provided with postoperative care instructions, and instructions for follow-up. Dr. Patel will see you for the first postoperative visit 1-2 days after surgery, with an additional visit the week after for drain removal if placed appropriate. Additional postoperative visits are typically spaced every other week for tissue expansion (in the case of implant-based reconstruction).
Reconstructive breast surgery typically refers to plastic surgery to reconstruct a breast mound and nipple after mastectomy for breast cancer.
Breast reconstruction can be done using a variety of methods, ranging from implant-based reconstruction (tissue expander followed by exchange for implant; or direct-to-implant) to tissue based reconstruction (either pedicled flap or free flap).
A breast expander is a silicone shell that is inserted with a small amount of fluid inside, and gradually inflated with more fluid, allowing the skin to stretch and grow to accommodate the growing size. It allows the body to gradually generate more skin, in an area where the skin is tight, such as after mastectomy where both skin and breast tissue are removed.
Breast reconstruction risks vary based on which type of reconstruction is performed, and also which step in reconstruction (earlier procedures tend to be greater in scope than later procedures). In addition, the risk also depends on one’s overall health status.
Yes, one can get breast implants after mastectomy. Depending on what you are a candidate for, this may involve an initial step of tissue expansion, followed by exchange for an implant, or if you are a candidate- you may be able to go straight to implant.
Mastectomy is the removal of the breast and nipple areola complex, and typically one can go back to work 10-14 days later.
Breast reconstruction is typically covered by insurance, though there may be out-of-pocket costs. Those costs depend on a number of factors, and requires additional information to answer. To provide you with accurate pricing information, we invite you to book a complimentary Pre-Consult Phone Call with our Patient Care Coordinator by calling 310-205-0212. During that phone call, important information will be discussed and ballpark pricing will be provided.
Insurance is mandated to cover mastectomy reconstruction, and also for symmetry procedures for the opposite breast if needed.
Breast reconstruction in Beverly Hills refers to rebuilding breasts following cancer surgery, such as a mastectomy, or trauma. Even patients who undergo a limited mastectomy such as a segmental resection, or a lumpectomy, may be candidates for breast reconstruction.