Posted on October 17, 2019
By: Dr. Asaf Yalif
October is Breast Cancer Awareness month. And yesterday, October 16th was Breast Cancer Reconstruction Awareness day also known as BRA day. In an effort to keep our Atlanta and Alpharetta patients aware of their options we’ve created this blog to help as a springboard for discussion for anyone who finds themselves with the diagnosis of breast cancer and is starting to do their research on how to restore the breast after either lumpectomy or mastectomy.
All of the reconstructive options are predicated first and foremost on your choice for surgical cancer care. This can be through a lumpectomy, partial or complete mastectomy. We recommend having a thorough discussion with both your surgical oncologist as well as your medical oncologist on your options for tumor removal and whether or not chemotherapy before surgery may be an option to help shrink the mass.
Whatever your choice for “goal 1” aka tumor removal, we have many options to achieve “goal 2” aka restoration of the breasts. It is also important to know that reconstruction is a process that may require multiple procedures and tweaks to get to your ultimate aesthetic. This is because reconstructing different parts of the breast (breast mound vs. nipple and areola) are accomplished in different ways and not all at the same time. In addition if asymmetry remains between the 2 sides then you may consider revising.
We will divide the reconstructive options into post-lumpectomy and post-mastectomy for the sake of ease of discussion –
All reconstructive options are usually available either immediately (at the same time as the cancer surgery) or delayed (days/weeks/months afterwards).
The choice for reconstruction is yours and yours alone. We want to make sure you are aware of your options so that the best decision for you can be made and sometimes that decision is to opt for no reconstruction after tumor removal.
After a lumpectomy the breast may have a defect from the lumpectomy. We have the ability to recontour the breast mound and fill in the defect with breast tissue from the same breast. This is called an oncoplastic reconstruction and in effect can create a smaller, more youthful breast mound. At the same time we can also do a breast lift or reduction to the other breast to make sure that it matches the cancer treated side. Alternatively we can also place a small implant to help improve the symmetry.
At the same time as mastectomy we can place a tissue expander, which is a device we slowly add volume to over time. In this way we can build a breast mound the size of which you determine over time. Once you have reached a volume you like we wait several weeks and then do a second surgery where we remove the expander and place a breast implant – either saline or silicone. This confines the reconstruction to the same area as the mastectomy which usually means a less severe recovery. The expander/implant may be placed in front of or behind the chest muscle (pectoralis major muscle).
There are a series of local muscles that we can use to help create a breast mound. These can be used in conjunction with an implant or expander, or in certain cases without an implant/expander. The more common muscles used include the latissimus dorsi – a muscle from you back that is tunneled under the skin and brought forward into the chest or a traditional TRAM flap where we harvest skin, fat, and muscle from the abdomen and rotate it up and into the mastectomy defect. Because surgery now involves the mastectomy site and then another site that we take muscle from, the recovery is usually a bit more involved.
A bit more technically challenging reconstructive option that may spares all or part of the muscle is a free or perforator flap. A “free” flap involves isolating the blood vessel to an area of tissue, like the TRAM and cutting it and then sewing it into the blood vessels that supply the breast and chest. In this way we do not have to take the whole abdominal muscle. Even more technically advanced is the perforator flap where we dissect the blood vessels with microscopes so we take almost no amount of muscle with the flap. These may be done with or without an implant/expander.
Recovery for these is similar to the pedicle flap but because we don’t take the muscle the recovery may be a bit easier.
The above options are generalizations and are not meant to be specific for any particular patient – that is why we have consultations to discuss your options thoroughly and make sure that we are making the best choice for you. There are many more details and specifics to go through for each type of procedure, but this broad generalization hopefully helps you start to focus on which type of reconstruction you would like to research further and discuss with your surgeon.
As a Triple Board Certified Plastic Surgeon in Atlanta I make sure to spend significant time with you to help you realize your goals in breast reconstruction and understand your choices. With my years of experience and technical expertise, I know that I am more than capable of providing you with a result that exceeds your expectations.
Renew your look with expert, personalized treatment from Dr. Y. Begin the planning process with a one-on-one plastic surgery consultation in Alpharetta or Atlanta, Georgia. We are excited to welcome you to Y Plastic Surgery!