Author: Breast Reconstruction Associates

How to Choose Your Plastic Surgeon

Written by Breast Reconstruction Associates on August 16, 2023. Posted in Breast Implants, Breast Reconstruction, DIEP Flap Reconstruction.

What are the top things to consider when looking for a breast reconstruction surgeon?

1. Credentials.

Your surgeon should be board-certified by the American Society of Plastic Surgeons or the American Board of Medical Specialties.

According to The American Society of Plastic Surgeons (ASPS), it is important to choose a surgeon that has completed the certification requirements of their country. Members of the ASPS meet very strict standards (1):

Board certification by the American Board of Plastic Surgery® (ABPS)
Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
Pass comprehensive oral and written exams
Graduate from an accredited medical school
Complete continuing medical education, including patient safety, each year
Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

2. Works with your breast surgeon.

Your breast surgeon should have a good working relationship with your plastic surgeon. The two surgeons should communicate frequently and together formulate the best treatment plan for each specific patient. Therefore, it is important that your plastic surgeon is someone your breast surgeon feels comfortable working with. Typically, after a new breast cancer diagnosis, your breast surgeon will help narrow your decision by referring you to one or multiple plastic surgeons that may fit your reconstructive needs.

3. Discuss all of your options.

There are two main types of breast reconstruction, implant-based or autologous based. In the consultation with your plastic surgeon, both types of reconstruction should be discussed so you can fully understand your options. Some patients are better candidates for one type over the other, and your plastic surgeon will be able to provide data supporting why. Keep in mind that not all plastic surgeons specialize in or offer every type of reconstruction procedure there is and therefore you may want or need to consult multiple plastic surgeons.

4. Ease of communication.

Making an informed decision is important. You should feel comfortable asking your surgical team questions until you fully understand the procedure you are planning to undergo. By doing this, you are opening up the communication lines and establishing a good relationship with your doctor.

If you are looking for the best breast reconstruction surgeon for you, consider Breast Reconstruction Associates. They are a team of Fort Worth, Dallas, Oklahoma City, and Austin breast reconstruction surgeons who not only have premier skills and credentials but also have high regard for quality patient care.

Sources:

(1) “How Do I Choose a Plastic Surgeon for Breast Reconstruction?” American Society of Plastic Surgeons, www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction/surgeon.

Smoking and Breast Reconstruction Surgery

Written by Breast Reconstruction Associates on July 17, 2023. Posted in Breast Reconstruction, Womens Health.

It’s estimated that there are currently over 30 million active cigarette smokers in the United States. The general health impact of cigarette smoking has been well established, and issues include elevated risk of stroke, cardiovascular disease, lung cancer and COPD. The mass distribution of this information, as well as new smoking-cessation strategies for smokers, has decreased overall cigarette consumption over the last decade.

It’s important to know that there are multiple issues with cigarette smoking. There are cancer-causing agents introduced to our lung, and there is also nicotine absorbed into our blood. Nicotine has a direct impact on the health of our blood vessels. As reconstructive surgeons, it’s the nicotine absorbed into the blood that concerns us, as this causes issues with healing after surgery.

The recent trend in smoking behavior is in the form of e-cigarettes or “vaping”. These e-cigarettes come in multiple forms, some with nicotine and some without. There is new research emerging that suggests e-cigarettes come with their own spectrum of lung issues.

Its also important to know that nicotine consumption, in any form, whether it be cigarettes, e-cigarettes, gums, patches, or lozenges, still increase the risk of complications with surgery. For this reason, your plastic surgeon will need to know if you are using any nicotine products. At your consultation, your plastic surgeon can discuss with you in detail the nicotine-related risks of breast reconstruction, in a way that is tailored specifically to your case. You will be asked to discontinue use of all nicotine products for at least 4-6 weeks prior to your surgery date. It is possible your surgeon will choose to test your blood or urine for the presence of nicotine.

At Breast Reconstruction Associates, your breast reconstructive specialists in Dallas, Fort Worth, Austin and Oklahoma City, we are here to help you make the best possible decision for your general health and wellbeing, as well as to prepare you for the best possible surgical outcome.

The Advantages of DIEP Flap Breast Reconstruction

Written by Breast Reconstruction Associates on June 15, 2023. Posted in Breast Reconstruction.

When thinking about the advantages of a DIEP flap, the conversation is shaped by comparing it to an implant-based reconstruction or other autologous reconstructive donor sites.

Natural Look and Feel

One of the main advantages of DIEP Flap surgery is the ability to closely mimic the natural look and feel of a native breast. When using implants, the shape and feel of the reconstructed breast can be difficult to recreate. This is because the shape and feel are determined by the implant itself. In contrast, the shape of the breast with a DIEP flap is influenced more by the skin envelope of the breast skin preserved witht the mastectomy. Because fat from the abdomen is soft and pliable, similar to breast tissue, many patients find their results to be more comfortable and natural.

Acceptable donor site scar pattern

There are many donor sites of the body that can be utilized to reconstruct a breast. Of the available options, DIEP flap breast reconstruction utilizes the skin and fat of the lower abdomen. While other donor sites may leave areas of irregular contour or visible scars, using the abdomen as a donor site results in favorable body contour and scars that are usually able to be concealed by regular clothing and bathing suits.

Long Lasting Reconstruction

With implant-based reconstruction, it may be recommended that implants be replaced every 10-15 years. Because DIEP flap breast reconstruction uses patients’ own tissue to recreate their breasts, there is no need for routine maintenance screenings or surgery. DIEP flap breast reconstruction may include a second stage revision surgery, but should otherwise be a lifelong reconstruction, eliminating the need for further surgeries in the future.

Preserves Core Muscle Function

DIEP Flap breast reconstruction is a muscle-sparing procedure. This means that no muscle will be removed with the transfer of the abdominal skin and fat. This results in a full restoration of core muscle function after patients have recovered and a lower risk of developing an incisional hernia. This contrasts with other breast reconstruction procedures such as the Latissimus flap or the TRAM flap.

How Do They Reconstruct a Breast after a Mastectomy?

Written by Breast Reconstruction Associates on May 16, 2023. Posted in Breast Reconstruction.

If you and your Breast Surgeon make the decision to have a total mastectomy, you will be referred to a Plastics and Reconstructive Surgeon to learn about the reconstructive process. Reconstruction can be done at the same time of the mastectomy, as an immediate reconstruction, or delayed after oncologic treatment is complete. Breast reconstructive surgery involves two primary methods: implant-based or autologous reconstruction.

Types of Breast Reconstruction Procedures

Implant-Based Reconstruction

Implant reconstruction uses an implant to rebuild the breast mound. The implants are primarily made of either saline or silicone gel and come in a variety of sizes.

The reconstruction can be done in one surgery, known as direct-to-implant reconstruction; however, the majority of cases are done in stages. At the time of the first surgery, a tissue expander is placed. The expander is filled to the desired size in the office and then later exchanged for the final implant at another surgery.

Implants can be a good option for some patients, but they do require “maintenance,” as they are not lifetime devices. This usually requires a future surgery to replace the implant (approximately every 10 to 15 years).

Autologous Reconstruction

Autologous or flap surgery means using one’s own skin and fat tissue to reconstruct the breast mound. This tissue is removed from the donor site and transplanted to the breast. Several donor sites are available for tissue transfer, including the abdomen (DIEP flap), thighs (PAP flap), or buttocks (SGAP or IGAP flap).

Historically, patients underwent a TRAM flap, which involved harvesting the abdominal muscles in addition to the skin and fat. As surgical techniques have evolved, we have transitioned to muscle sparing techniques like the DIEP flap, which avoids the abdominal morbidity common to the prior TRAM flap procedure.

The abdominal fat has a consistency similar to that of the breast tissue, allowing for a more natural appearing and feeling breast reconstruction, and it does not require any long-term maintenance procedures.

Breast reconstruction can significantly improve a woman’s morale and self-esteem throughout their survivorship journey. Some women view breast reconstruction surgery as a symbolic step to close the cancer chapter and feel whole again.

Radiation and Tissue Expander; What Should I Know?

Written by Breast Reconstruction Associates on April 14, 2023. Posted in Mastectomy Radiation, Radiation Therapy.

The indications for radiation therapy after mastectomy may include larger tumor size, nodal metastasis, or involved or close surgical margins. In some scenarios, the need for radiation is known prior to the mastectomy, and in other cases, it’s not determined until after the mastectomy, when the final pathologic stage is determined.

Occasionally, a tissue expander, which is a temporary implant, may be used as a placeholder at the time of the mastectomy to allow for further cancer treatment, i.e. chemotherapy and/or radiation therapy. The tissue expander helps preserve more skin on the chest wall and creates a temporary breast mound during cancer treatments so that you feel and look normal in clothing.

After all the treatments are concluded, the tissue expander is then exchanged for either an implant or tissue-based reconstruction. Patients who elect to have a permanent implant placed are at higher risks for both short-term and long-term complications. Short term complications include infection and extrusion of the implant while long term risks include an accelerated progression to capsular contracture. Tissue-based reconstruction offers a safer alternative for patients requiring radiation therapy after a mastectomy as the overall complications do not differ from non-radiated patients.

The decision to use a tissue expander is unique to each patient as it is influenced by the overall cancer treatment plan. Please contact us at Breast Reconstruction Associates so we can work with you, your breast surgeon, and your radiation oncologist to determine the best reconstruction strategy.

Breast Surgery for Older Women

Written by Breast Reconstruction Associates on March 15, 2023. Posted in Breast Cancer, Breast Reconstruction, Womens Health.

Breast cancer is the most common malignancy affecting American women with 1 in 8 women diagnosed during their lifetime. There are several risk factors involved in the development of breast cancer, some of which are modifiable (weight/BMI, hormone use, smoking and alcohol use) while others cannot be changed or controlled (age, genetics). Increasing age is considered the most significant risk factor for this diagnosis, and it may contribute to the treatment decisions as chronologically advanced women may have other co-morbidities that must be considered.

As we age, our organs experience various changes that can affect surgical healing. For example, the skin becomes thinner and has less connective tissue like collagen and elastin, all of which can lead to delayed healing. While we cannot reverse this physiologic process, we can control other components like smoking. All nicotine products cause vasoconstriction, which makes it more difficult for the arteries to deliver necessary oxygen and nutrients to all organs and tissue. Smoking and the use of nicotine products exponentially increases the risks of surgery and can sometimes disqualify a patient from reconstructive surgery. We prefer that any patient undergoing reconstructive surgery be off all nicotine products for at least 6 weeks.

General anesthesia is required during breast reconstructive surgery whether using implants or autologous aka tissue-based reconstruction. At Breast Reconstruction Associates, we use a two-surgeon team on all autologous cases to minimize the length of surgery and therefore the amount of anesthesia, which directly correlates to quicker recovery times. Age is a consideration for these surgeries as there are increased risks of post-operative delirium and post-operative cognitive dysfunction in patients aged 65 and older. These patients are at higher risk if they have an established diagnosis of any form of cognitive impairment.

At Breast Reconstruction Associates, we offer various reconstructive options for our patients and always involve the patients in this discussion and decision process. Each patient is unique due to their age, medical and family history, and tumor profile among many other considerations. We want to work with you and your breast cancer team to determine the best possible outcome, so please contact us today to set up a consultation.

Sources:
“Preparing for Surgery – Age Risks,” American Society of Anesthesiologists, https://www.asahq.org/whensecondscount/preparing-for-surgery/risks/age/.

I’ve Had (or Need) Post-Mastectomy Radiation, What Are My Reconstructive Options?

Written by Breast Reconstruction Associates on March 3, 2023. Posted in Breast Reconstruction, DIEP Flap Reconstruction, Mastectomy Radiation.

Radiation is a mainstay of treatment for breast cancer and is sometimes required after a total mastectomy. Even though the breast is gone, the chest wall including the skin and underlying pectoralis muscle as well as regional lymph nodes may benefit from radiation. The need for post-mastectomy radiation will be determined by your final surgical stage.

Radiation therapy can pose challenges for implant-based reconstruction as it leads to higher rates of implant failure requiring subsequent surgeries to remove or exchange the implant. Complications after radiation also include pain, delayed healing and infection, and accelerated progression to capsular contracture. In patients who have previously been treated with radiation or know post-mastectomy radiation is planned for a current cancer diagnosis, autologous reconstruction (meaning using tissue from one’s own body) is the preferred approach over implant-based reconstruction.

At Breast Reconstruction Associates, our preferred donor site for autologous reconstruction is the lower abdominal skin and fat (DIEP flap) as enough skin and fat can usually be harvested to reconstruct a breast without the need for an implant. However, there are other donor site options available if you’re not a candidate for the DIEP flap, e.g. previous abdominoplasty. Rarely, an augmentation implant may be combined with your own tissue to complete the reconstruction process.

If you previously underwent a mastectomy without reconstruction followed by chest wall radiation, you can proceed with autologous reconstruction even years later. Autologous reconstruction brings soft, non-radiated skin and fat to the chest wall to help create a new and more natural-appearing breast mound.

For patients with a current breast cancer diagnosis requiring radiation therapy, autologous reconstruction can be done immediately at the time of the mastectomy or in a delayed fashion once all cancer treatments have been completed. This decision is made on a case by case basis between you, your plastic surgeon and breast surgeon. If a delayed approach is considered, then the final reconstruction usually occurs 3 to 6 months after completing radiation therapy.

3 Things You Can Expect After Breast Reconstruction Surgery

Written by Breast Reconstruction Associates on August 14, 2022. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

Breast reconstruction surgery is a major event in a patient’s life and can be a source of fear or anxiety. At Breast Reconstruction Associates, we want you and your loved ones to feel prepared and supported throughout the entire peri-operative process. Time will be spent with you prior to surgery to review the risks of surgery, the expected hospital course and the details of your post-operative recovery. Here are some basic changes you can expect after DIEP flap breast reconstruction:

1. Swelling

Because of the overall healing response of multiple surgical sites, swelling is normal and expected of the breasts and the abdomen after surgery.
Swelling can take 4-8 weeks to completely resolve.
Compression garments such as a compression bra, shape wear or an abdominal binder can help reduce swelling.
Swelling on one side of the body more than the other (such as one breast vs. the other or one leg vs. the other) warrants a call to your surgeon right away.

2. Scar Tissue

Scars will continue to remodel and mature which changes their appearance for 1 -2 years after surgery.
Topical therapies to improve the appearance of scars can be helpful. Please discuss with your surgeon the best options for you after surgery.
Scar tissue can also cause some tightness and discomfort. This can be improved with stretching, physical therapy or massage therapy of the surgical sites. Your surgeon can discuss this with you after surgery if needed.
We do our best to position scars in locations generally covered by most clothing/swimwear.

3. Sensory Changes

Its normal to experience numbness of the breast mound and around the central part of the abdominal incision.
Sensation can return to surgical site areas, but generally only partial return of sensation is achieved. If sensation has not returned after 6-12 months, the numbness is likely permanent.
Sensory changes can make it difficult to detect if something is too hot or too cold which is why we discourage the use of ice packs or heating pads.
We prefer you wait until you are 12 weeks post op to wear an underwire bra. Until that time, you may wear a post-surgical compression bra or a well-fitted sports bra.

The differences between a Lumpectomy with Radiation Therapy and a Mastectomy with Reconstruction

Written by Breast Reconstruction Associates on July 14, 2022. Posted in Mastectomy Radiation, Radiation Therapy.

Lumpectomy vs Mastectomy – What’s the difference?

A lumpectomy, or ‘partial’ mastectomy, is the removal of only a portion of the breast – specifically the tumor and a normal rim of breast tissue immediately surrounding the tumor. This is an option for cancer treatment and is followed by breast radiation to lower rates of recurrence. The combination of ‘lumpectomy + radiation’ is frequently referred to as ‘breast conservation therapy’ or ‘BCT’.

A mastectomy is the removal of the entire breast. In many cases, this eliminates a patient’s need for radiation therapy.

Cancer considerations

The size and location of a breast tumor determine if a patient is a candidate for breast conservation therapy. When considering BCT, breast surgeons are weighing complete clearance of cancer with the maintenance of an aesthetically satisfactory breast. Though a mastectomy is always an option to treat breast cancers, most breast surgeons treat more than 50% of patients with breast conservation therapy.

When deciding between these two approaches, patients are counselled that BCT and mastectomy have equivalent outcomes with regards to survival, but that BCT is associated with a higher rate of local recurrence.

Cosmetic Considerations

In general, when deciding between these two approaches, reconstructive surgeons are focused on optimizing the aesthetics of the breast, including consideration of volume, shape, and symmetry.

If you are a candidate for either surgical option, the tumor size and breast size are the main variables we consider when determining the most optimal cosmetic approach for you.

If the tumor is small and the breast is large, then only a small percentage of the breast would need to be removed. In such a case, BCT is often a good choice. If needed, the other breast can be reduced or lifted for purposes of symmetry. It is important to note, that the final appearance of the cancer breast may be impacted by radiation therapy. In the long-term radiation can cause volume loss and skin tightening of the breast, these changes can impact symmetry over time.

For women with small or moderate sized breasts, even a small tumor could require removal of a significant amount of the total breast volume, leading to a breast deformity or significant asymmetry. In such cases, a mastectomy with reconstruction may provide a better cosmetic result. A balancing breast lift of the other breast can also be performed simultaneously for symmetry purposes. In some circumstances, radiation can be avoided after mastectomy, which eliminates the possibility of future asymmetry caused by radiation.

How Long Does Mastectomy and Immediate Breast Reconstruction Surgery Take?

Written by Breast Reconstruction Associates on June 15, 2022. Posted in Breast Reconstruction.

Historically, DIEP flap surgery has been associated with extended operative times of 12 to 14 hours compared to those of implant reconstruction. However, at Breast Reconstructive Associates, we aim to change the narrative of DIEP flap surgery by performing these surgeries with a team of two experienced microsurgeons.

Our operative times have been reduced to an average of four hours for a one-sided mastectomy with reconstruction, and six hours for a double mastectomy with reconstruction. These are numbers for a total operative time from the start of the mastectomy to the completion of DIEP flap reconstruction.

The importance of reducing operative times correlates directly to patient safety. This means that there is less anesthesia time, reduced need for blood transfusions, no required ICU stays, and faster total recovery time.