BREAST RECONSTRUCTION

Optimize the natural feel, shape and symmetry of your reconstructed breast.

A sub-specialty in my training as a plastic surgeon and that of my practice is breast reconstruction. Because I am experienced in the complex field of microsurgery, I am able to perform intricate reconstructive surgeries that optimize the natural feel, shape and symmetry of the reconstructed breast as well as minimize the donor site deformity. There are several options available for reconstructing a breast, such as the autologous method, which uses your own natural tissue.

There are several options in breast reconstruction. Selection will be based on medical and oncological criteria as well as the patient’s personal and aesthetic needs. IBreast reconstruction is one of the most rewarding procedures I perform as a plastic surgeon. Restoring a breast that has been removed due to cancer or another deformity brings about an amazing transformation for the patient, not just physically but also emotionally, it positively effects their relationships with loved ones.

Breast cancer reconstruction is an integral component of the multidisciplinary team of doctors and other health care specialists in the care of the patient with breast cancer. These specialists include the Medical Oncologist, Surgical Oncologist, Surgical Pathologist, Radiation Oncologist, Radiologist, Internist, Nutritionist, Physical and Occupational Therapist, Social Worker and Counselor among others. The plastic surgical care of the patient is often discussed during multidisciplinary rounds at Cedars Sinai Medical Center where the whole treating team is present and the optimum plastic surgical option is presented as well as secondary options in light of the oncologic parameters and long term health and safety for each patient.

Autologous Reconstruction (Muscle-sparing Free TRAM Flap):
This method uses your own fatty tissue and skin from the lower abdomen without the need for an implant and with an added benefit of a full tummy tuck. When a patient qualifies to have the muscle-sparing free TRAM flap the lower abdominal fat and skin is used and transferred to the chest area and shaped into a new breast.

Unlike most TRAM flap reconstructions; this operation does not remove the whole length of the muscle but only a small portion where the blood supply to the overlying fatty tissue and skin is present. This area of the lower abdominal fat and skin is then transferred with the use of microsurgery to the chest area and shaped into a breast. This optimizes the circulation to the newly reconstructed breast, while minimizing the amount of muscle removed from the abdomen which minimizes the chances of a future abdominal wall muscle weakness or bulging. The free TRAM technique is specially used in younger, physically active patients and those who need bilateral breast reconstruction.

Due to this better blood supply the flap that is transferred to the chest can be shaped and contoured to best match the opposite breast. The newly reconstructed breast often has a more youthful or a more up lifted appearance such that many women request a reshape or lift of the opposite breast. Any type of symmetrizing procedure to the opposite breast including insertion of implants in a patient with a history of breast cancer is considered a reconstructive procedure and not cosmetic with respect to federal and Medicare reimbursement guidelines.

Latissimus Dorsi Muscle Flap and Implant Combination Reconstruction:
In this procedure, the breast is reconstructed using tissue from the back along with an implant. An example of this would be the latissimus dorsi muscle flap procedure. There are several variations to the skin paddle shape and the location of the final incision on one’s back depending on personal needs and lifestyle.

Implant Reconstruction:
A two stage procedure is used to reconstruct breast with implants. First a tissue expander is inserted underneath the muscles of the chest after the mastectomy. In the ensuing weeks and months, this device is slowly expanded as your body learns to accommodate the expander as the chest tissues stretch and begin to relax in preparation for the second stage of the procedure. After a waiting period of six to twelve weeks, the patient is brought back to the operating room for the second stage when the expander is removed and replaced with an implant. The final implant can be saline or silicone gel as per the patient’s preference.

Reconstruction of Nipple and Areolar Complex:
A second stage for the autologous tissue breast reconstruction techniques described above and as a third stage in the expander / implant reconstruction is the creation of nipple and areolar complex. This is done as an outpatient procedure with minimal discomfort.

Tattooing of the Nipple and Areola:
The final stage in breast cancer reconstruction is the tattooing of the nipple and areolar complex. The right tattoo color is chosen to match the opposite breast or in the case of bilateral reconstruction the color is usually chosen by the patient to mimic her original nipple color.