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Breast Reconstruction at Duggal Plastic Surgery

Breast reconstruction is the surgical restoration of a breast following mastectomy. Regardless of why the breast was removed, to treat cancer or to prevent cancer in a high-risk patient, it can be an emotionally overwhelming time. There are many decisions to make, and both your surgical oncologist and Dr. Duggal can discuss with you the risks and benefits of breast reconstruction and the best timing for reconstruction. The decision to pursue reconstruction is a very personal one, and can be very physically and emotionally rewarding.

Breast reconstruction is a very personal process, and there are many different options for restoring a breast (or breasts). The surgical plan will depend on your breast size and shape, the stage of your cancer and any additional treatments recommended (such as radiation), and your goals for your new breast size. During your consultation with Dr. Duggal, all the options can be discussed and any questions answered. The final plan will be something decided on by you, your surgical oncologist, and Dr. Duggal.

Immediate breast reconstruction refers to starting the reconstructive process during the same surgical procedure as the mastectomy. Under general anesthesia, your breast surgeon will first perform the mastectomy and then Dr. Duggal will perform the reconstruction.

Delayed breast reconstruction refers to waiting until your mastectomy has healed and you have completed any additional treatment you need before beginning breast reconstruction. Delayed reconstruction also refers to women who were not initially sure they wanted breast reconstruction and come to see a plastic surgeon after they have recovered from their mastectomy and treatment.

While there are many different types of breast reconstruction, they generally fall under two main categories:

  • breast reconstruction with an implant
  • breast reconstruction with your own tissue

Reconstructing your breast with a breast implant is somewhat similar to having a breast augmentation. There are different types of implants to choose from, including anatomically shaped implants which can provide a more natural shape to your reconstructed breast. 

Most often, the first step to reconstruction with an implant is placement of a tissue expander, or temporary implant, which can be gradually filled with saline to stretch out your skin. This tissue expander would be changed to a permanent implant at a second surgery once you have reached the size breast you would like.

Depending on the size and shape of your natural breasts and the location of your cancer, Dr. Duggal may be able to place a permanent implant at the time of your mastectomy (called “direct to implant reconstruction”).

When using an implant to reconstruct your breast, you will likely also need a tissue substitute to help to add an additional layer of tissue between your skin and the implant.

There are several options for reconstructing a breast with your own tissue, or autologous breast reconstruction. This means using skin, muscle, and fat from your back or tummy to shape into a breast. The tissue used to create a breast is referred to as a “flap”.

Sometimes a flap is done in addition to an implant to bring in softer, healthier skin for your new breast, especially if you required radiation therapy and your skin is scarred.

Using tissue from your back is called a Latissimus dorsi flap, and can be done with or without an implant underneath it. There would be an additional scar along the bra-line on your back with this procedure.

Using tissue from your abdomen is called a TRAM flap, and can use the fat from your lower abdomen to recreate a breast. There would be an additional scar very similar to a tummy tuck scar on your lower abdomen with this procedure.

The BRAVA is a suction device that is worn multiple hours a day for several weeks to stretch the tissue on the chest wall. This allows for larger amounts of your own fat to be grafted to recreate a breast. The fat is harvested through liposuction of the abdomen, legs, or other areas of your body. Using the BRAVA device is very time consuming for the patient and requires effort but it does allow breast reconstruction using your own tissue without additional scarring or the need for major surgical procedures.

Breast reconstruction has a low risk of infection, bleeding, wound healing complications, and anesthesia risks. Other risks are specific to the different methods of reconstruction. Flap surgery has the risk of partial or total loss of the flap, and use of an implant has the risk of firmness (capsular contracture) around the implant. This risk is higher if you have undergone radiation therapy to the breast.

Some patients may choose not to pursue reconstruction and simply continue their lives after their mastectomy incisions have healed. One alternative to breast reconstruction for women who are worried about how they will look in clothes is to wear a breast prosthesis.

If one breast is removed by mastectomy and reconstructed, it is often necessary to change the size or shape of the other breast to match. This could be a breast reduction, a breast lift, or a breast augmentation.

Depending on the site, size, and stage of the tumor, some women may be candidates for a nipple sparing mastectomy where the nipple and areola can be saved. If the nipple needs to be removed during the mastectomy, it can be recreated at a later surgery from your own breast skin. A secondary tattoo is then done to color the areola.

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With our Vectra 3D Breast Sculptor, patients are able to get an immediate and accurate view of what they may look like after breast surgery. The results we can get after surgery are more beautiful and natural than ever.

-Claire Duggal, MD

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