Common Questions Regarding Breast Reconstruction

Breast Reconstruction After Cancer


Patients recently diagnosed with breast cancer face many choices with regard to both their cancer treatment and reconstruction. During your consultation with Dr. Economides, you will have time to ask any questions that may come to mind to fully understand your reconstructive options. The goal of breast reconstruction is to restore the shape, appearance, symmetry, and size of the breast following mastectomy, lumpectomy, or congenital deformities. This can be achieved with a variety of reconstructive techniques, however the two main categories of breast reconstruction are: implant-based using a breast implant to reconstruct the breast mound and autologous (flap) reconstruction using a patient’s own tissues.


What Breast Reconstruction Technique is Best For Me?


Both implant-based and autologous techniques have their advantages and disadvantages, and depending on your cancer treatment and goals, one technique may be preferred over another. For example, implant-based reconstruction requires a shorter recovery time versus autologous reconstruction, but may not be suitable in all patients undergoing post-mastectomy radiation.


During your consultation with Dr. Economides, your medical history and cancer treatment plan will be reviewed taking into consideration the need for adjuvant therapies such as post-mastectomy radiation or post-lumpectomy radiation. In addition, potential flap donor sites will be examined to determine suitability for autologous reconstruction.


I’ve Heard of Breast Implants But What is Autologous Breast Reconstruction?


Autologous breast reconstruction refers to reconstruction using a patient’s own natural tissue rather than a breast implant. There are many different autologous breast reconstruction techniques depending on an individual patient’s desires and donor site availability. Dr. Economides specializes in DIEP flap reconstruction, where excess skin and fat from the lower abdomen are transferred to the chest to recreate the breast. He also offers the following flaps: SIEA Flap, Latissimus Dorsi Flap, TRAM Flap, TUG/VUG/DUG Flap, and PAP Flap. All of these techniques use a patient’s own skin and fat to reconstruct the breast leaving a lasting and permanent reconstruction that does not need further surgery once complete.


Timeline of Breast Reconstruction


Breast reconstruction may be performed at any time following a mastectomy or lumpectomy and may even be performed at the same time as the initial mastectomy or lumpectomy, thus minimizing the number of surgeries required. With advances in tissue perfusion imaging technology, it is also sometimes possible to perform “direct-to-implant” reconstruction in select patients, allowing for a single surgery for both mastectomy and definitive reconstruction.


Opposite Breast Surgery


With the passage of the 1998 Women’s Health and Cancer Rights Act (WHCRA), insurance companies are required to cover reconstruction of the affected breast, but also surgery to reconstruct or improve symmetry of the non-affected breast. In women who undergo unilateral (one side) breast reconstruction, combining a procedure on the opposite breast can improve the symmetry of both. These procedures may include complete reconstruction with the same or different technique as the affected breast, a breast lift or breast reduction to match the size and position of the other breast, implant augmentation to match the size of the other breast, or fat grafting/fat transfer to match the size and shape of the other breast.


Reconstruction Following Lumpectomy


Breast reconstruction does not necessarily have to require complete removal of the breast (mastectomy). In some patients pursuing breast conservation therapy (BCT) also known as lumpectomy, an oncoplastic reconstruction may be beneficial. Following lumpectomy, patients may notice a contour irregularity or divot where the cancerous tissue was removed. Dr. Economides has pioneered techniques in oncoplastic reconstruction which reshape the breast tissue to provide for a more harmonious appearance. Oncoplastic reconstruction may be performed at the time of the initial lumpectomy or in a separate operative setting.


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