Breast reconstruction involves many surgical techniques which are designed to recreate the breast mound after cancer removal. It serves to restore the patient’s sense of self and womanhood. Research has shown that breast reconstruction has immense psychological and quality-of-life benefits for breast cancer survivors.
Dr. Zhang and his team understand that facing breast cancer surgery, and the associated potential treatment therapies such as chemotherapy and radiation, can be overwhelming. We aim to help make the breast reconstruction journey as positive as possible for our patients.
Our practice offers all types of breast reconstruction, ranging from Implant-based reconstruction, to Autologous reconstruction, to oncoplastic reduction. Dr. Zhang and his team will help his patients find the best option to create beautiful and well-proportioned reconstructed breasts.
While most breast reconstruction takes several stages, we try to minimize the number of surgeries while striving to maximize safety and increase the chances of aesthetic success.
Breast reconstruction techniques vary in terms of materials used for the reconstruction. It can be classified into two major categories: implant-based (tissue expander and implant) or the body’s own tissue ie autologous.
Autologous reconstruction is further divided based on anatomy of the tissue used, the most popular is DIEP which uses the patient’s excess abdominal skin and fat. Other options include the thigh (PAP), the buttock (GAP), and the back (Lat flap).
Breast reconstruction can also be classified based on time of the surgery. Dr. Zhang takes the approach of delayed immediate reconstruction.
This approach involves placing a tissue expander at the time of the mastectomy. In a delayed fashion (that ranges from a week to 2 months) the tissue expander is removed and replaced with an autologous flap such as DIEP. This approach allows the patient to have breast mounds immediately after surgery with added safety of letting the mastectomy skin flap heal first. It’s also very useful in a patient who has not yet decided on a definitive reconstruction option at the time of cancer surgery. Our experience with this approach showed excellent long-term cosmetic results. (Click To See Photo : Delayed and Immediate Approach Illustration) Dr. Zhang and his team will discuss the options at length so that the patient is completely comfortable with her decision.
Smokers are at increased risk of complications and should quit smoking as far in advance of surgery (4 weeks) as possible.
In short, YES. Dr. Zhang and his team work diligently with your surgical and medical oncologist to maximize your cancer treatment, while minimizing chances of complications arising from chemotherapy or radiation.
If you are planning your cancer treatment and have a high chance of needing radiation therapy, the delayed immediate approach is a great option. The tissue expander will be maximally expanded prior to radiation and later be removed at the time of autologous reconstruction (usually 6 months after the last dose of radiation).
If you have already had a mastectomy and radiation therapy with a flat contour to your chest, then autologous reconstruction is usually recommended. Placing an implant beneath stiff and contracted radiated chest skin has an increased risk of complications such as infection, thinning of the skin, implant exposure, “extrusion??? (coming through the skin), and the consequent need for implant removal.
If there is not enough abdominal tissue for reconstruction or the patient desires implant-based reconstruction, the lat muscle from the back is usually used to cover the implant. (See radiated patient reconstruction with lat flap)
For women who do not have nipple-sparing mastectomies, a new nipple can be made from local skin flaps and the areolar circle can be tattooed with the pigment chosen by the patient. Nipple reconstruction is usually done 3-6 months after the breast reconstruction to allow healing to occur and for the breast to assume its most natural form.
A balancing procedure is usually recommended for the patient’s opposite breast to match the reconstructed breast. Balancing procedures may include a breast reduction, breast lift, breast augmentation, and fat grafting to name a few. (Click to See Photo : Symmetry procedure) Surgery on the non-cancer breast is also covered by insurance and is usually done after the initial reconstructed breast assumes its final shape.
Breast reconstruction using the patient’s own tissue (ie skin, fat and muscle) is called autologous reconstruction. Autologous reconstruction varies based on the location of the donor tissue
Using synthetic or non-tissue-based implants to restore shape and appearance after a breast removal
Providing a new nipple from local skin flips and a tattooed areolar circle for women who do not have nipple-sparing mastectomies.
Si está considerando obtener cirugía reconstructiva, recomendamos que hable con su cirujano oncologo, y con el doctor Zhang, antes de su cirujia para extirpar el tumor o el seno canceroso. Esto permitirá que sus cirujanos planifiquen el tratamiento mas adecuado para usted, igual, si decide esperar y tener cirujia reconstructiva en una occasion posterior.
Si usted ya tuvo su cirujia primaria del seno canceroso, usted puede subsecuentemente obtener cirujia plastica reconstructiva del seno para mejorar la apariencia del seno, o construir un seno neuvo.
Técnicas quirúrgicas para la Reconstruction del seno son variables en materiales que se usan. Puden ser calsificados en dos categorias: un implante (expansor de tejido, e implante de salina o silicon)(Photo Implant_based recon) O el tejido propio de la mujer (reconstruccion autologa). Reconstruccion autologa es subsecuntemente categorizada basado en que tipo de tejido se usa. El mas popular se llama DIEP- cual usa el tejido del abdomen de la mujer (piel y grasa). Otra opccion es PAP – tejido del muslo/pierna, GAP- tejiido del gluteo, y Lat Flap – tejido de la espalda.
Adopted from American Cancer Society website on reconstructive breast surgery. www.cancer.org