Breast Reconstruction
Overview of Breast Reconstruction
Few operations in plastic surgery require the technical expertise and the personal compassion that breast reconstruction does. Dr. Cruise has extensive experience with breast reconstruction and understands the needs and issues associated with it. No matter which plastic surgeon you consult with, it is imperative to form a bond and trust with that surgeon, as he or she will guide you through the emotional, difficult time of mastectomy due to breast cancer. Often, the patient feels like she is in a fog, and nothing seems real. But the consequences are very real. It is important to take all this into consideration when planning what is best for the patient as a whole.
Sometimes it is best to wait after mastectomy and reconstruct at a later time. In general, however, it is best to have the reconstruction performed at the same time. This allows the woman to immediately feel whole after the mastectomy. Facing breast cancer is difficult enough, so from a psychological point of view it is helpful to know and to see that things are getting back close to normal. Another significant advantage is that the woman only has to undergo one anesthesia.
Another fundamental decision the patient must make, with the help of the plastic surgeon, is whether or not she wants her breast reconstructed with an implant or with her own natural tissue. The use of her natural tissue usually means performing a TRAM flap reconstruction using abdominal muscle and fat. This has the additional benefit of having a tummy-tuck done at the same time. This is helpful to the patient’s state of mind. She feels that even though she just lost something very dear to her, she gained something in return. Not every woman is a good candidate for a TRAM flap. Poor candidates include patients with significant obesity, a history of heavy smoking, certain abdominal scars, previous abdominoplasty, significant lung or heart disease and brittle diabetes. Another choice for reconstruction with natural tissue is using fat and muscle from the back. This is known as a latissimus dorsi flap. It can be used with or without an implant.
Another option, which does not involve using the patient's own natural tissue, is to use a tissue expander. It is done by placing an implant under the pectoralis muscle, usually at the time of mastectomy, and expanding it to the desired size over the next 3 months. The expansion is done during regular office visits and is relatively painless. Once the expanders are filled to the desired size, they are usually removed and replaced with a permanent implant. This is a quick outpatient procedure. It is often an excellent choice if both breasts are removed and are being reconstructed simultaneously. Implant reconstruction does not create as normal appearing breasts as your own tissue does. If both breasts are being reconstructed, this is not as much of a problem because at least there is very good symmetry. If only one breast is being reconstructed, this is more of a problem, especially if the breasts have some sag, which most do beyond the age of 30. Here, a patient's own tissue produces a more natural result.
To summarize, the most important question a patient needs to answer, with the help of her plastic surgeon, is whether she wants to use an implant or her own natural tissue. If she decides to have an implant, she can always have reconstruction with her own tissue later on if she wants to.
It should be mentioned that breast reconstruction, no matter which type is decided upon, does not affect the recurrence of the breast cancer, nor does it interfere with radiation or chemotherapy, if it is necessary.
Dr. Cruise has extensive experience in breast reconstruction using both implants and native tissue. He works closely with the general surgeon who removes the breast, to make sure that the reconstructed breast is the best possible. Although Dr. Cruise prefers what is called a skin-sparing mastectomy, it is not always possible. It depends on the location of the tumor and the location of the breast biopsy incision. This type of mastectomy allows a reconstruction with a much less conspicuous scar. Even if this type of mastectomy is not possible, Dr. Cruise has developed techniques that provide a result that is state-of-the-art.