Breast Reconstruction (after mastectomy)
San Diego Breast Reconstruction
Types of Breast Reconstruction
There are two broad categories of breast reconstruction procedures: 1. Implant based restoration of volume, and 2. Natural tissue flap restoration. Natural tissue restoration requires transfer of skin and fat from an area of your body where there is extra skin and fat to the mastectomy site, where skin and fat have been removed. In some cases, both implants and tissue flaps are combined to achieve the best result.
Implant Based Breast Restoration
Dr. Laverson, and most plastic surgeons, perform implant reconstruction when a satisfactory result can be achieved by this method, because although serial surgical procedures may be involved, they are of less magnitude (usually outpatient day surgery) than tissue flap restoration, and there is no necessity for surgery elsewhere on your body to borrow tissue for transfer to the mastectomy site. Implant based reconstruction has some important limitations however. Thin scar your body forms around a breast implant may become thickened over time causing the reconstructed breast to become firm or hard, to reposition above its proper location, and to become more globular and un-natural in shape. This phenomenon, called “capsular contracture,” also occurs in women who have implants for augmentation, but less commonly. Capsular contracture is even more common among women who have had radiation therapy after mastectomy. Women who develop contracture are unhappy with their reconstructions. In these cases, surgery to remove the capsule is indicated. At that procedure, the implant may be replaced with another implant, replaced with a tissue expander type implant to enlarge available chest skin area for a better quality restoration, or replaced with a natural tissue flap,
Natural Tissue Flap Breast Restoration (Autologous Tissue Breast Restoration)
Although transfer of skin and fat into the mastectomy defect involves a technically more complex surgical procedure, the final contours are often more natural, and the tissue usually remains softer over time. For many women, autologous restoration is a better choice than implant based procedures. These operations involve transfer of skin and fat to replace breast skin and breast volume removed at mastectomy. Sources of skin and fat for transfer are called “donor sites.” Dr. Laverson transfers skin and fat for breast reconstruction from either the lower abdomen or the back. Both of these donor sites are well established and widely used for post-mastectomy breast restoration. They often harbor enough extra skin and fat for breast restoration, and scars in these areas will be relatively hidden.
Natural tissue reconstruction has the advantage that it may be contoured to more precisely match the opposite breast. Still, sometimes a “symmetrizing” procedure on the non-mastectomy side to match both breasts is recommended. Secondary outpatient (day surgery) procedures are usually required to refine the natural tissue flap result over time and to fabricate a nipple and tattoo the areola. With either method of breast restoration, complications may develop that necessitate additional procedures and/or unanticipated choices. Generally however, problems are manageable, and reconstruction provides a satisfactory breast substitute.