Breast reconstruction for breast cancer is a surgical procedure aimed at restoring the shape, size, and symmetry of the breasts following mastectomy or lumpectomy. This procedure involves the use of silicone or saline implants, autologous tissue reconstruction, liposuction / fat transfer, or injections of fat matrix to recreate a natural-looking breast mound.
A significant consideration during the planning process is the timing of reconstructive procedures. Both immediate reconstruction and delayed reconstruction are options for many patients. Your care team consisting of the breast surgeon, plastic surgeon, oncologist, and radiation oncologist will coordinate to present options that are tailored to you. Ultimately, the medical team wants to do what is safe, ontologically sound, and best supports the final functional and aesthetic outcome.
Immediate reconstruction refers to a procedure performed during the same surgical session as the cancer resection. The advantage of using a more natural skin envelope for reconstructive options is considerable. The skin envelope created during skin/nipple-sparing mastectomy can leave the patient with a more natural-appearing breast postoperatively.
Delayed reconstruction is when a patient has a planned mastectomy, then returns to the operating room a second time to perform the reconstructive portion of the procedure.
A tissue expander serves as a versatile solution for some individuals undergoing breast reconstruction. During this procedure, a temporary saline breast implant is inserted at the time of mastectomy. This serves several purposes: it helps maintain the integrity of the natural tissue, preventing it from scarring down, and in some cases, allows for the gradual expansion of the skin to accommodate a permanent implant in the future.
At times, the saline expander may be fully inflated during the initial surgery – e.g., if you have a nipple sparing mastectomy. Alternatively, if breast skin is removed during the mastectomy, the expander is gradually filled with saline during follow-up visits with Dr. Desrosiers at our office. This gradual filling process enables the skin to slowly stretch, ensuring it can accommodate a permanent implant of appropriate size and shape at a later stage, ultimately leading to a more anatomically proportionate result.
We sometimes opt for a temporary tissue expander following mastectomy rather than permanent implants for several reasons, particularly considering the potential impact of radiation therapy.
Radiation therapy can elevate the risk of various complications during breast implant reconstruction, such as capsular contracture (tightening of scar tissue around the implant), changes in skin thickness, implant extrusion, and asymmetry in breast size or shape.
A tissue expander serves as a safeguard, preserving the natural breast pocket. However, because a tissue expander is not intended as a permanent solution, it provides us with the flexibility to address any issues that may arise during final breast reconstruction. In many cases, this approach allows us to help ensure the best possible outcome, prioritizing both your safety and aesthetic goals.
Fat grafting presents a beneficial option for enhancing the appearance of irritated breast tissue. Essentially, it works to soften the skin texture of the breast, resulting in a more natural and smoother appearance. Liposuction and fat grafting may need to be performed in several stages.
For patients who prefer to avoid additional surgical procedures (and concomitant general anesthesia), alternative options such as Leneva and Renuva are available. These products offer off-the-shelf adipose matrix solutions that can be injected directly into the breast tissue. Over the span of approximately three months, these FDA-cleared products facilitate the body’s natural fat regeneration process. Essentially, these innovative products deliver healing stem cells directly to the targeted area, promoting tissue regeneration and enhancing the overall appearance of the breast.
To help ensure the best scar outcome, Dr. Desrosiers employs a meticulous approach. First, understanding each patient’s unique response to sutures is important. During the consultation, Dr. Desrosiers and his staff will seek to understand your medical history, including any prior procedures and experiences with stitch abscesses or rejection, to tailor the surgical approach accordingly. Second, Dr. Desrosiers may utilize slowly dissolving or permanent sutures beneath the skin to prevent scar widening until wound remodeling has transformed weak Type 3 collagen into more robust Type 1 collagen. Third, Dr. Desrosiers almost always requires the use of post-operative surgical bras, not only to alleviate swelling but also to provide support to the tissues, minimizing tension on the scar line. Lastly, our practice offers advanced treatments such as activated collagen gel, advanced silicone scar gel, and laser scar therapy, the combination of which have shown remarkable efficacy in promoting seamless scar formation for many patients.
If you need a priority appointment for breast reconstruction, please let the office know the details of your need. We will do our best to work you in the same week.
To learn more about breast reconstruction or to schedule a consultation with Dr. Desrosiers, please contact us at 305-403-2922 or concierge@ArthurMD.com.
Dr. Desrosiers understands that each patient is unique and requires individualized care. With his expertise and dedication to achieving exceptional results, Dr. Desrosiers is committed to guiding you through your breast reconstruction journey with confidence and support.
Providing Cosmetic, Reconstructive, & Craniofacial Plastic Surgery in Miami and West Palm Beach.