Breast Reconstruction Archives - Breast Reconstruction Associates

When Should You See A Breast Reconstruction Surgeon?

Written by info@wildmonkeybrand.com on June 14, 2024. Posted in Breast Reconstruction.

The timing of breast reconstruction is often determined by the stage of cancer and the oncologic treatment recommendations. However, in general, we refer to the timing as immediate or delayed.

Immediate breast reconstruction

Refers to reconstruction occurring at the same time as the mastectomy. There is a two-fold benefit of immediate reconstruction. The first, it provides a breast mound and avoids a flat chest wall. The second, the skin envelope can be utilized via a skin-sparing mastectomy, thus allowing for a potentially better aesthetic outcome.

Delayed breast reconstruction

Refers to reconstruction that is performed at another time following the mastectomy. A mastectomy without reconstruction is frequently performed when a woman has advanced cancer, requires radiation therapy, or has multiple medical comorbidities.

In general, it is best to see a breast reconstruction surgeon soon after your diagnosis. Many factors contribute to the timing of reconstruction, and involving the plastic surgeon early in this decision making will help to provide the best outcome. This is true regardless of your type of cancer or expected treatments.

Lastly, if you have already had a mastectomy and have completed the recommended adjuvant treatments, you are still a candidate for reconstruction. We are happy to assist you with your reconstructive needs at any point along your journey. If you would like to get in touch with a plastic surgeon regarding the best timing for your reconstructive breast surgery, please contact us in Fort Worth, Austin, Oklahoma City, or Bozeman.

How Do You Make a Nipple?

Written by info@wildmonkeybrand.com on April 17, 2024. Posted in Breast Reconstruction.

Nipple reconstruction is usually a part of the final stage of breast reconstruction. A nipple reconstruction can be done as an office procedure, but sometimes is incorporated with revision of the reconstruction in the operating room. In our practice we perform the nipple reconstruction, and then tattooing of the areola as a separate procedure.

In simple terms, the nipple is made from elevating skin and folding it in a way that leaves a ‘nub’ of skin that looks like a nipple. In medical terms we refer to the skin elevation as “elevating a flap”, and the flaps described for nipple reconstruction are numerous. We may use a different flap design based on the needed size, width, or projection – either to match the other side (for one–sided reconstruction) or based on the patient’s goals (for two–sided reconstruction). Importantly, though the final product may strongly resemble an actual nipple, the reconstructed nipple does not have sensation or ability to change with temperature changes, and lacks erogenous sensation.

You can also watch the following 9 min video to see the specific steps involved in a nipple reconstruction done in the office.

Oncoplastics Breast Surgery | Breast Reconstruction Associates

Oncoplastic Breast Surgery: What Is It? Am I a Candidate?

Written by info@wildmonkeybrand.com on March 16, 2024. Posted in Breast Reconstruction, Womens Health.

Oncoplastic breast surgery is a surgical approach that integrates breast cancer surgery with plastic surgery techniques. Historically, breast conservation therapy, or the combination of a lumpectomy and radiation therapy, was performed to preserve a portion of the breast and still offer patients equivalent survival rates as a mastectomy. However, a traditional lumpectomy often leads to deformity of the breast; this is why combining lumpectomy with a plastic surgery technique has potential benefit for patients. The goal of oncoplastic breast surgery is to improve aesthetic outcomes without compromising the resection and treatment of breast cancer.

In general, ideal candidates for breast conservation are those who have a small tumor relative to total breast size. Oncoplastic breast surgery can be integrated with any lumpectomy procedure, but patients with large breasts or breasts with a fair degree of ptosis (or “droop”) are the optimal candidates. In these cases, the tumor can be safely removed using standard breast reduction or breast lift techniques while also improving the overall appearance of the breast. A balancing breast lift or reduction of the other breast is typically performed simultaneously for symmetry purposes.

Oncoplastic breast surgery can also be a good strategy for women who are wanting mastectomies and reconstruction but also would require post-mastectomy radiation (usually for an advanced cancer or cancer in the lymph nodes). In order to prevent radiating a total breast reconstruction, oncoplastic surgery is followed by radiation. Completion mastectomies and total breast reconstruction can then be performed at a later time after the patient has recovered from radiation therapy.

The Advantages of Having a Mastectomy

Written by info@wildmonkeybrand.com on February 18, 2024. Posted in Breast Reconstruction.

Breast cancer is one of the most common types of cancer among American women — nearly one in eight women develop it in the course of their lifetime. Treatment of breast cancer involves a multidisciplinary approach and therapies are selected based on biology, size, and location of the tumor. In most cases, surgical intervention is recommended, and patients are faced with the decision to undergo lumpectomy followed by radiation (known as breast conservation therapy) or mastectomy.

A mastectomy is the complete surgical removal of breast tissue. This surgical approach is appropriate for patients with breast cancer that does not meet the criteria for breast conservation therapy, patients who prefer mastectomy over BCT, or for prevention of breast cancer in high risk patients.

Historically, mastectomies included the removal of the overlying breast skin. Strategies to preserve the breast skin have now been developed that have significantly improved the cosmetic outcome of immediate breast reconstruction following a mastectomy. Patients who have a mastectomy followed by breast reconstruction can now have equivalent or superior cosmetic outcomes compared to breast conservation therapy.

There are other advantages of having a mastectomy over breast conservation. By choosing a mastectomy, patients have the potential to avoid the need for radiation therapy. This allows women to forgo the skin changes and other effects caused by radiation. Patients also no longer require regular mammograms following a mastectomy. And lastly, while research has demonstrated equivalent survival outcomes between mastectomy and breast conservation therapy, the risk of local recurrence is lower in patients who undergo mastectomy.

The decision to choose a mastectomy over other surgical treatment approaches is difficult and includes many variables. To determine the best plan for you, talk to your breast surgeon in Fort Worth.

Breast Reconstruction Associates – North Austin Area

Breast Reconstruction Associates – Austin TX

Preparing for DIEP Flap Breast Reconstruction

Written by info@wildmonkeybrand.com on December 15, 2023. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

Patients who have opted for mastectomy with DIEP flap reconstruction often ask what they can do to best prepare for the recovery process. The amount of time between deciding on the right surgery for you and the surgery date varies from patient to patient. Some patients have only a few weeks between their diagnosis and surgery; others have months to years depending on other treatments or life circumstances. In either situation, the following recommendations apply.

1. Maintain a healthy diet

Eating a balanced diet of protein, healthy fats, fruits and vegetables will help you get the proper macronutritents, vitamins and minerals needed for healing and recovery after surgery. Try to minimize your intake of sugar, foods with added sugar, or highly processed foods. These foods can be pro-inflammatory and are unlikely to be nutrient-rich sources of food. Most patients do not need any type of supplements prior to surgery

2. Optimize cardiovascular status

Exercise in the form of aerobic activities (i.e. walking, jogging, biking, etc.) strengthens your cardiopulmonary system to better tolerate surgery and anesthesia, helps control blood pressure, and contributes to a faster post-operative recovery. Some patients have high blood pressure, coronary artery disease or other cardiac issues. It’s important to optimize the management of these issues with your cardiologist prior to surgery. If you have a history of heart problems or are not currently physically active, check with your doctor before beginning exercise routines.

3. Minimize risk factors of surgical complications

Many patient factors that contribute to surgical complications, such as poor wound healing and infection, are modifiable. If you are an active smoker, the best thing you can do for your recovery would be to completely eliminate nicotine use. If you are overweight or have diabetes, it’s also extremely beneficial to lose weight and/or control your blood sugar as much as possible prior to surgery. Talk to your doctor about strategies to reduce risk factors of surgical complications before surgery.

4. Mental preparation

Undergoing breast reconstruction surgery can be stressful mentally and emotionally, especially if you are also processing a new breast cancer or gene mutation diagnosis. Having emotional and spiritual support systems in place in the form of family and friends is also important. You may also find it helpful to have some personal coping mechanisms in place prior to surgery such as journaling, meditation, support groups or prayer. Lastly, it’s important for you to have a positive relationship with your surgeon. Open communication about the surgery, recovery and expectations will help you feel comfortable and confident with your decision to undergo breast reconstruction surgery.

Nipple Reconstruction and 3D Nipple Tattoos

Written by info@wildmonkeybrand.com on November 16, 2023. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

Breast reconstruction surgery is designed to restore the volume and shape of the breast after mastectomy. Some women may be candidates for nipple-sparing mastectomy but in many cases, this part of the breast must be removed. To complete the reconstruction and restore the aesthetic unit of the nipple and areola, women have the option to choose from 3D nipple and areola tattoos vs nipple reconstruction followed by tattooing of the areola pigment.

3D nipple and areola tattoos are done by a professional tattoo artist that specializes in this trade. ‘Before’ photos are reviewed, and careful consideration is given to the color selection, size and placement of the nipple and areola. The pigment is then applied in the form of a tattoo with additional shading techniques to create the appearance of a 3D nipple. This means that in the mirror, the visual aesthetic unit of a nipple is present, but to the touch, the breast is smooth and flat.

Nipple reconstruction followed by NAC tattoos involves a minor procedure of nipple reconstruction that can be done at the time of breast reconstruction, in combination with a second stage revision, or alone as an office procedure. The procedure involves cutting and suturing a small amount of skin into the shape of a nipple with proper placement and symmetry on the breast mound. After this reconstructed nipple has healed, tattoo pigment can be applied to restore the color and shape of the areola. This results in restoration of the visual aesthetic unit of the nipple and areola, as well as the physical projection of a nipple. It is important to note that a nipple reconstruction does not have sensation and will always remain erect.

These procedures are not mandatory but encouraged to achieve the most optimal and the most natural aesthetic result. If you have questions, please consult your breast reconstruction experts of Austin, North Texas and Oklahoma at Breast Reconstruction Associates. You may also find it helpful to review some of our before and after photos. The surgery and completion details are indicated for each photo.

Pain After Breast Reconstruction

Written by info@wildmonkeybrand.com on October 17, 2023. Posted in Breast Reconstruction, Womens Health.

Most surgical interventions come with some degree of postoperative pain or discomfort. This can be a source of fear and anxiety for many patients facing mastectomy and breast reconstruction surgery. At Breast Reconstruction Associates, we use a specific pain control protocol that has proven efficacy, and we work together with patients to achieve the optimal degree of pain control. Most of our patients have been pleasantly surprised that their pain was less than expected. Here is some insight into the way we approach pain control.

While it is not feasible to guarantee a pain score of 0/10, even with adequate pain medications, we are committed to helping you remain as comfortable as is safely possible after surgery. Our goals are to reduce your discomfort to a degree that is tolerable so regular activities of daily living can be performed, to avoid over-sedation, and to avoid adverse medication side effects.

There are many different types of pain that are experienced after mastectomy and breast reconstruction—general post-operative pain of incision sites, neuropathy (nerve-related pain) and musculoskeletal pain. In our pain control protocol, we prescribe medications that target each type of pain to yield better overall pain control.

The post-operative pain medication regimen used at Breast Reconstruction Associates is aligned with the ERAS (Enhanced Recovery After Surgery) protocol. This protocol was developed to be a perioperative strategy that promotes quicker recovery after surgery and helps patients avoid opioid-based pain medications. The medication regimen associated with this protocol is supported by evidence-based research and is used worldwide. Our practice takes a patient-centered approach to the use of this regimen and we have had great success with our patients’ post-operative recovery.

Our patients are our priority. Your post-operative comfort and care are important to us. If you are considering DIEP flap breast reconstruction and have questions about post-operative pain, reach out to our plastic surgeons at Breast Reconstruction Associates.

Common Plastic Surgery Risks | Breast Reconstruction Dallas Forth Worth, Austin & Oklahoma City, OK

Surgical Risks of Breast Surgery and Reconstruction

Written by info@wildmonkeybrand.com on September 18, 2023. Posted in Breast Cancer, Breast Reconstruction, Womens Health.

Making the decision to undergo surgery, regardless of the operation, can be overwhelming. At Breast Reconstruction Associates, we understand that discussing the surgical details in plain English as well as reviewing the potential risks involved imparts the needed information that leaves patients feeling informed and confident.

A few of the general risks associated with any surgery are bleeding, infection of the surgical site, blood clots, and adverse reactions to general anesthesia. During your consultation with your plastic surgeon, you will review these general risks as well as the risks specific to breast surgery and/or reconstruction in detail. Although most women do not experience the following complications, here is a brief preview of the risks that will be covered in your discussion:

Fluid collections

Fluid or blood (seroma or hematoma) may accumulate between the skin and underlying tissues following surgery. Drains may be left in place after surgery to prevent this accumulation. Should this problem occur after drain removal, it may require additional procedures for drainage of the fluid.

Changes in sensation

The surgery will alter the sensation to the nipple, areola and surrounding breast skin. It’s important to discuss the possible extent of these changes with your surgeon, as it will depend on what type of surgery has been recommended for you.

Potential loss of the nipple-areola complex

If you are having a procedure that spares the nipple and areola, there is a risk of decreased vascular supply to these structures which can lead to necrosis (or death). This can either be self-limiting or require intervention.

Mastectomy flap necrosis

The breast skin remaining after mastectomy can have trouble healing from a lack of blood supply. When the blood supply is low enough, breast skin can die. This is more common in larger breasted women. Tobacco use and previous radiation history can also increase the risk of mastectomy flap necrosis.

Delayed wound healing

Wounds may separate after surgery. This may require daily home wound care or further surgery to correct the defect.

Microvascular thrombosis

Autologous breast reconstruction is associated with the risk of clot formation within the artery or vein providing circulation to the flap. This most commonly occurs during surgery but can happen afterwards, usually within the first 24-48 hours after surgery. This requires a second operation to attempt salvage of the tissue. The risk of this occurring is low and will be discussed in further detail with your surgeon.

Failure of the reconstruction –

Regardless of the method selected (implants, DIEP flap, or other flap), the reconstruction can fail which leaves the patient with a flat chest wall. Alternative methods would be considered if the patient elects to proceed with secondary reconstruction. In general, in properly selected patients, failure is uncommon.

At Breast Reconstruction Associates, we are committed to helping you navigate your surgical options, weigh the risks and benefits of surgery, and make the best decision specific to your care. Reach out to our plastic surgery office in Fort Worth, Austin or Oklahoma City if you have questions. We are here as a resource for you.

How to Choose Your Plastic Surgeon

Written by info@wildmonkeybrand.com 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 info@wildmonkeybrand.com 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.