Breast cancer is the most common cause of non-skin-related cancer in women. There are a wide variety of treatment options available to patients diagnosed with breast cancer, and the treatment plan involves physicians from multiple specialties, such as Primary Care Medicine, Oncology, Radiology, Radiation Oncology, Pathology, Breast Surgery, and Plastic and Reconstructive Surgery. Dr. Pathy has developed an extensive breast reconstructive practice for women diagnosed with breast cancer.
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Having a breast reconstructed after it is removed for breast cancer (mastectomy) is a personal decision. Studies reveal that psychologically, having a breast reconstructed after a mastectomy has tremendous positive benefits for the patient.
Immediate vs. Delayed Reconstruction
A breast may be reconstructed immediately, meaning at the same operative visit as the mastectomy, or in a delayed fashion, meaning at a date separate from the mastectomy procedure. While immediate reconstruction may be preferred in many instances, delayed reconstruction continues to remain a suitable option for patients in many circumstances.
The two main categories of reconstruction involve either using breast implants, or using the patient’s own tissue from another area of her body, such as the lower abdomen.
Tissue Expanders and Implants
The most common method of implant-based breast reconstruction is a two-stage method. In this type of reconstruction, a tissue expander, which is a type of temporary balloon, is placed at the first stage of reconstruction following a mastectomy. The expander is then inflated in the office on a weekly basis so that the skin which may have been removed during the mastectomy can stretch to accommodate an implant. After the skin has stretched adequately, the patient returns to the operating room for the second stage and the tissue expander is removed and a permanent implant, either saline or silicone, is placed. In some instances, an implant can be placed immediately following a mastectomy without the necessity of tissue expander in a procedure known as “direct-to-implant” breast reconstruction.
Using the Patient’s Own Tissues (Autologous Reconstruction)
If the patient’s own tissues are used to create a breast, the tissues can either be tunneled under the pre-existing skin, such as in a TRAM (transverse rectus abdominis myocutaneous) flap from the lower abdomen, or it can be completely disconnected from its original location on the body and then placed at the chest to recreate a breast by performing microvascular surgery, which entails carefully suturing together the blood vessels using a microscope, such as in a DIEP (deep inferior epigastric perforator) flap. In each of these two scenarios in which abdominal skin and fat is used, the abdomen enjoys the added benefit of a tummy tuck appearance following the breast reconstructive surgery.
A latissimus myocatuneous flap is an additional type of autologous reconstruction method which uses tissues from the patient’s back, usually in combination with an implant as well, so as to create an aesthetically appropriate breast.
DIEP Flap (Deep Inferior Epigastric Perforator Flap)
The DIEP (Deep Inferior Epigastric Perforator) flap is quickly becoming one of the most sought-after forms of breast reconstruction. Dr. Pathy is one of a select few plastic surgeons who performs this type of microvascular breast reconstruction in Connecticut. This technique uses only a patient’s abdominal skin and fat to reconstruct her breast and, because no muscle is utilized for reconstruction, recovery is more rapid than other forms of autologous reconstruction.
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Following creation of a new breast, a new nipple and areola can additionally be created to achieve a true three-dimensional quality. Typically, the nipple is created from a patient’s own skin overlying the new breast mound, while the circular areola which surrounds the nipple can be fashioned from skin taken from a well-concealed location, such as your abdomen, your inner thigh, or even the opposite breast. Following healing, pigment can be added to the reconstructed nipple and areola to achieve a more natural result.
While creating a nipple and areola from pigment alone can be performed, Dr. Pathy believes that the full three-dimensional effect of a natural nipple and areola can best be achieved by first reconstructing the structures before tattooing them. Following reconstruction of the nipple and areola as described above, it may be necessary to perform tattooing with micropigmentation to result in a fully completed breast. In a brief, office-based procedure, a variety of shades of ink are mixed to achieve an appropriate pigment match.
To achieve further refinement in symmetry and contour, fat transfer may be performed to your reconstructed breast. Fat transfer, also known as fat grafting or fat injection, has seen a steady rise in popularity. It essentially involves improving defects or deformities in contour with one’s own, natural tissue. During this process, fat is extracted from an area of the patient’s body, such as the abdomen, in a process similar to liposuction. However, unlike standard liposuction, which targets pockets of fat for removal, fat grafting additionally focuses upon replacing the removed fat to specific areas so as to enhance volume. The fat which had been extracted is gently processed through one of a number of different methods to yield purified fat, separating it from the extraneous fluids. This purified fat is subsequently injected into an area, such as the breast or face, to achieve an immediate improvement in contouring.
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Additional Symmetry Procedures
Not only can the affected breast be reconstructed, but the opposite breast can also be altered with a breast lift, breast reduction, or breast augmentation to achieve a better match to the newly reconstructed breast. These procedures can be performed at the same time as your nipple-areola reconstruction to expedite the completion of your reconstruction.
In some instances, breast conservation therapy can be performed in which only the cancerous portion of the breast is removed. Patients who opt for this treatment plan require radiation therapy as well to better reduce the risk of further breast tumor. In certain patients, the removal of a large amount of breast tissue would cause a significant deformity. Oncoplastic surgery involves repositioning the breast tissue in such a way as to reduce the deformity and provide a more natural appearing breast after the diseased segment is removed.
The Women’s Health and Cancer Rights Act passed in 1998 mandates insurance coverage for breast reconstruction in the United States, which includes the surgical intervention of the affected breast as well as the opposite breast for purposes of symmetry.
Your consultation with our team regarding breast reconstruction will entail an in-depth assessment of your options as well as what you may expect post-operatively. We understand that your decision to go forward with a procedure should not be taken lightly, and thus encourage any questions that you may have at any time.