Breast Reconstruction Salt Lake City & Moab, UT
Reconstruction of the breast can be a very emotionally and physically rewarding procedure. Not all women desire reconstruction, and it is not a requirement. But many women, perhaps most, find it to be very beneficial in returning to a more normal life after breast cancer.
Before and After
See more samples of before & after photos.
Breast reconstruction, and any procedures necessary to the opposite side, such as a breast lift or breast reduction, is covered by health insurance. This was mandated by Congress in 1998.
Reconstruction may be done immediately – at the same surgery as the mastectomy. It may also be done much later; whenever the patient desires. Nipple reconstruction is done about 3-4 weeks later as an office procedure. If post-mastectomy radiation is known to be necessary, reconstruction is often best deferred until after radiation therapy is complete, in order to achieve the best results. Post-operative chemotherapy requirements may also affect the timing of reconstruction. Reconstruction after mastectomy, in any case, does not affect the chances of breast cancer recurrence. Feel free to discuss any breast cancer care concerns with Dr. Chick or your oncologist if you have any questions or concerns.
Breast Reconstruction Types
- Implant reconstruction (click here for more info)
- Flap reconstruction (click here for more info)
- A combination of the two (click here for more info)
Implant Reconstruction Method
Breast implants, often using a tissue expander (a temporary breast-implant device), are the simplest way to do breast reconstruction. Implants do a nice job of creating a mound, and in clothes are very satisfactory. Out of clothes, however, they do have limitations to the naturalness of appearance. Recovery generally is the same as if only a mastectomy is done, which is 2 – 3 weeks.
Breast implants may be either silicone or saline filled. Both do a nice job, but the silicone implants are probably somewhat better in terms of softness and shape.
Implants do have some disadvantages, however:
- They all break eventually, and have an average lifetime of 15 years. Replacing them is easy, but it does require surgery.
- There is a risk of capsule contracture. This is a thickening of the breast tissue around the implant, which can make the breast very hard and deformed in appearance. With breast reconstruction, the risk of this is nearly 20%, or one chance in five. If radiation is done, the risk rises dramatically to nearly 100%. I generally do not like to use breast implants in a radiated area, and prefer another method.
Most of the time, implant reconstruction requires multiple stages and begins with the placement of a tissue expander. The tissue expander is a temporary breast-implant device similar to a ballon. It is placed under the muscle and skin after the mastectomy and helps shape and enlarge the implant pocket. At the time of surgery it is empty and then gradually filled up over several weeks until the skin is stretched out and large enough to contain the real implant. Then, during a second outpatient surgery, the expander is removed and the real implant is placed. If work is going to be done on the opposite breast (reduction, lift, or enlargement), it is done during this second procedure.
Flap Reconstruction Method
Breast reconstruction can also be done by shifting body mass from other areas of the body. A common approach is to use fat and skin from the abdomen. This is called the “TRAM flap”, or “tummy tuck reconstruction.” Variations of this procedure are the DIEP flap and the “Free” TRAM flap.
These are more significant procedures than implant reconstruction. The TRAM flap takes about three hours, and requires about three nights in the hospital. However, in the right patient, this procedure is an excellent choice, as it does not use implants, will not suffer hardess from capsule contracture, tolerates radiation fairly well, and is cosmetically superior.
Essentially, what is done is an abdominoplasty, or “tummy tuck.” But instead of discarding the excess skin and fat, it is kept alive by leaving it attached to blood vessels. The fat, skin, and blood vessels are moved onto the chest and tailored into the breast.
The blood vessels from the abdomen are removed from within one of the two rectus muscles (the “six pack” muscles), requiring the muscle to be sacrificed. This may result in some weakness of the abdominal wall, causing a bulge. In rare occasions, a hernia results, which requires repair. Because of this, the best candidates for the TRAM flap procedure are not obese, are in reasonably good physical condition, and are non-smokers. Smoking causes spasming of the blood vessels, and may result in the death of the tummy tuck tissue after surgery.
I like performing TRAM flaps, and have done a large number; more than 500 over the last fifteen years. But keep in mind, although it has great benefits, it also has a higher chance of complications and a longer recovery time (about six weeks).
Free TRAM flaps and the DIEP flaps are variations on this procedure involving microsurgery. These procedures require significantly more operative time (6-10 hours), but do spare the rectus muscles, leading to less abdominal wall weakness afterwards. There are advantages and disadvantages to these, and I would be happy to discuss these with you at the time of consultation.
This reconstructive method uses a combination of an implant and a flap from the latissimus muscle (located in the back). This option works very well for a lot of situations. In very thin women, this procedure helps to provide more tissue over an implant, which helps it look and feel more natural. It is an easier recovery than a TRAM flap reconstruction. In delayed reconstruction, it negates the need for an expander, allowing us to do the reconstruction as one operation. If radiation has been done, it allows us to put non-radiated tissue over the implant with a significantly lower risk of capsule contracture (“hardening of the breast”).
The operation involves taking skin and muscle from the back to supply the skin removed during the mastectomy. It does not have enough bulk to build a breast, so an implant is placed under this flap of tissue.
This operation takes about 2 1/2 hours, and most women spend one or two nights in the hospital afterwards. There is a resulting scar on the back, but it is well hidden in the bra line.
The latissimus muscle is expendable, as there are other muscles that will take over its function. Athletes may notice some reduced strength in some situations, but the majority of women will recover full use of the arm and shoulder.
This flap procedure is a “safer” flap procedure than the TRAM flap procedure in that its blood supply is very good, and few wound healing complications are seen.
This is a good choice for a lot of women who cannot or do not have TRAM flap options.
There are several different ways to reconstruct the nipple. One option is to use a skin graft taken from another area of the body to create the nipple; during a separate procedure, tattooing techniques are used to match the graft to the color of the opposite breast’s natural nipple.
The Initial Consultation
During your initial breast reconstruction consultation, Dr. Chick will evaluate you for surgery and perform a visual examination of your breasts. He will review the treatment options and inquire about your specific goals of surgery, including the breast size and shape you desire. Together, you and Dr. Chick will determine a suitable plan of action.
Breast Reconstruction Recovery
Dr. Chick will provide you with comprehensive instructions to follow after breast reconstruction. These instructions include how to take care of drains and incisions, activities to limit or avoid and signs of potential complications.
In general, bruising, swelling and soreness in the chest and, if applicable, donor area of the body is to be expected. Medication is prescribed to help alleviate pain and discomfort.
If you undergo implant-based reconstruction, you should be able to return to your routine activities within two to three weeks. If you undergo flap-based reconstruction, you may need additional time to recuperate.
Dr. Chick will address specific recovery timeframes with you individually based on your health and personal circumstances.
Frequently Asked Questions About Breast Reconstruction
How can I decide which reconstruction method is best for me?
The reconstruction method that is right for you depends on factors such as your body shape, previous surgeries, health status and treatment goals. During a consultation with Dr. Chick, he will explain your reconstructive options and the expected outcomes of each option to help you make the decision that is best for you.
Does reconstruction change the risk of my cancer returning?
Research does not show a link between reconstructive surgery and an increased risk of cancer recurrence.
Does reconstruction make cancer detection harder?
No, reconstruction does not make it harder to detect cancer if it returns.
I may need (or have already had) radiation to my breast area. Can I still have implants placed?
Radiation increases the risk of implant-related complications such as infection, capsular contracture and fluid buildup. If you have had or plan to have radiation, Dr. Chick encourages you to explore your flap-based reconstructive options.
Will my reconstructed breast match my natural breast?
Dr. Chick’s goal is to match your reconstructed breast to your natural breast as much as possible. He may need to augment your natural breast with an implant or reduce or lift the natural breast to create symmetry between your breasts. The natural breast may be treated several months after reconstructive surgery.
What happens before breast reconstruction surgery?
Prior to breast reconstruction, you may be asked to have blood work done or undergo X-rays or other testing. You will also need to prepare your body for surgery by stopping certain medications or vitamins known to increase the risk of bleeding or adverse reactions to anesthesia.
How often will I need to return for follow-up care after breast reconstruction?
During your initial recovery, you will need to see Dr. Chick for weekly follow-up appointments. Beyond that, expect to see him approximately six weeks and six months after surgery.
Are there any risks to breast reconstruction?
Breast reconstruction risks include:
- Poor wound healing
- Adverse reaction to anesthesia
- Capsular contracture and rupture (with implants)
- Partial or complete loss of flap (with flap-based reconstruction)
- Loss of sensation of the reconstructive site and donor area (with flap-based reconstruction)
Schedule a Consultation Today
Dr. Leland Chick< and his staff understand that there are many things to consider when undergoing breast reconstruction surgery. They will work with you to help you understand all of your options and help you make a decision that is best for you. To learn more about the breast reconstruction procedures available or about Dr. Chick’s experience as a breast reconstruction surgeon, contact us today at 801-322-1188.