Breast Reconstruction

If you ask Dr. Mancoll why he became a plastic surgeon, he will tell you a story about one of his first experiences in the operating room… “When I was a medical student, I saw a plastic surgeon move the fat from a woman’s lower abdomen to her empty chest to create a breast. I was hooked. It was at that moment I knew that this is what I would be doing the rest of my career. If I could make that kind of impact on a woman’s life, then that’s what I wanted to do. This patient was at one of her darkest moments, faced with breast cancer and a hugely deforming operation…and suddenly the surgeon was able to rebuild for her what cancer had so cruelly taken away. Talk about a life changing moment.” Now, over 2,000 breast cancer patients later, Dr. Mancoll continues his commitment to helping survivors of breast cancer recover and feel whole again.

Reconstructive Options

Breast reconstruction really is a process. Dr. Mancoll takes great pride in personally helping to guide eachone of his patients through not only their breast reconstruction but also their treatment of breast cancer in general.

Dr. Mancoll performs all of the surgical options available for reconstructing a breast, from the latest form-fitted silicone gel implants to muscle-sparing DIEP flaps and S-GAP Flaps. During a consultation with him, he will explain all of these options. What may seem overwhelming to begin with will become clear by the end of your visit.

Breast reconstruction is typically performed after a mastectomy (removal of one or both breasts) has been carried out. However, women who have had lumpectomies may also be candidates for reconstruction if the asymmetries created between their breasts are significant enough to create problems. Breast reconstruction usually consists of a series of surgeries that restores the breast(s) to its original appearance. Dr. Mancoll understands that breast reconstruction is part of a comprehensive plan to treat breast cancer and is done in a cooperative manner with your other treating physicians.

Procedure

Woman considering breast reconstruction will have two main types of surgeries to consider. The first would incorporate a medical device called a breast implant. The second general category of reconstructive surgeries would utilize tissue from the woman’s body to create a breast. Typically, this would include the abdomen, back, or buttock area.

Which technique would be best for the patient is what will be determined after an extensive consultation. A lot of factors are considered when deciding which technique would be best. These include the severity of the breast cancer, the patient’s age, other medical conditions, previous surgery, and ultimately the patient’s desired expectations for reconstruction.

Implants

For most women undergoing implant reconstruction, a temporary device called a tissue expander will be placed at the completion of the mastectomy. This procedure takes about 45 minutes. Most patients will go home the next day after surgery. In some cases, a permanent silicone gel implant could be placed at the time of mastectomy, called direct to implant reconstruction. Which implant will be best for the patient will depend on the size and shape of the breast being created, the size and shape of the breast to match, and the patient’s general body shape.

Autogenous Reconstruction (using the patient’s own body tissue)

For women who don’t wish to have a breast implant and want a more natural breast, reconstructive tissue can be utilized from multiple areas of the body.

Reconstruction Using the Back

Tissue transferred from the back to create a breast is based on the latissimus dorsi muscle. It enables extra tissue to be utilized in creating a breast and shortening the time from mastectomy to final result. In thin women in particular, this may offer extra padding to hide the ripples sometimes seen with implant reconstruction.

Reconstruction Using the Abdomen

For most women, there is an excess amount of skin and fat below the belly button. This is the same tissue that is removed during a tummy tuck. If this tissue is removed during reconstruction and it is maintained with its blood supply, it can be utilized to create a breast. Typically, this is referred to as a TRAM flap. Although most plastic surgeons will sacrifice muscle to facilitate transferring the tissue from the stomach to the breast, Dr. Mancoll utilizes a technique called a DIEP flap. It enables him to move the tissue from the lower abdomen to the breast and at the same time not sacrifice any muscle. This technique leads to quicker recovery time, shorter hospitalization, and a sooner return to normal activities. Typically, a single-sided breast reconstruction utilizing this technique takes about 6 hours of surgery, 3 days of hospitalization, and 6 weeks until unrestricted return to activities.

Reconstruction Using the Buttocks

For those women who desire a natural reconstruction but don’t have enough extra skin and fat on the abdomen, there is another choice. A superior gluteal artery perforator flap, also called and S-gap flap, can be used. This flap involves taking tissue from the lowerback/upper buttock area. Just like the TRAM flap, scars can be easily hidden beneath the bathing suit line. Of the different techniques to create a breast, this surgery usually takes the longest time to complete. Hospitalization is usually 3 days, with unrestricted return of activities in 6 weeks.

Breast reconstruction is typically done under general anesthesia and, whenever possible, at the same time as the mastectomy. Recovery time can vary. Most patients will spend at least 1 night in the hospital or up to 3 days. 4 to 6 weeks of general recovery should be expected, regardless of which technique one is having done.

After the initial breast surgery, there most likely will be some secondary procedures, either as part of the plan or as a result of the patient desiring additional symmetry and form. The timing of the surgeries will vary based on what other adjuvant therapies (chemotherapy and radiation) the patient may need.

Cost

In 1998, a breast advocacy act was passed, requiring all insurance companies, including Medicare and Medicaid, to pay for breast reconstruction and any surgery necessary to the other breast to create symmetry. As with all reconstructive surgeries, our office will assist with the insurance authorization process.

To schedule a consultation with Dr. John S. Mancoll, board-certified plastic surgeon, contact Mancoll Cosmetic & Plastic Surgery at (757) 305-9185 or fill out our online contact form. Decisions concerning breast reconstruction can be overwhelming for patients at a very difficult time. Dr. Mancoll is committed to helping his cancer patients understand all of their options and get the best results possible.