Breast Reconstruction Archives - Page 2 of 3 - Breast Reconstruction Associates

Preparing for DIEP Flap Breast Reconstruction

Written by Breast Reconstruction Associates 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 Breast Reconstruction Associates 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 Breast Reconstruction Associates 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 Breast Reconstruction Associates 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 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.

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.