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

The Advantages of DIEP Flap Breast Reconstruction

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

How Long Does Mastectomy and Immediate Breast Reconstruction Surgery Take?

Written by info@wildmonkeybrand.com 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.

Who’s a Good Candidate for Implant vs. Own Tissue Breast Reconstruction?

Written by info@wildmonkeybrand.com on April 13, 2022. Posted in Breast Reconstruction.

There are two main approaches when it comes to breast reconstruction after mastectomies—namely implant based reconstruction and autologous tissue based reconstruction. There are many differences in each approach and some patients are better suited for one approach vs another.

Implant based reconstruction is a good option for many patients who are considering mastectomies, but optimal results are often achieved in patients who are non-obese, have smaller breast size with little sag, and are considering reconstructing both breasts.

Studies have also shown that there are specific groups of patients who may have better results with tissue based breast reconstruction. Patients who are obese (BMI > 30), who have many health comorbidities such as diabetes and hypertension, or who have had or will need radiation therapy all do well with tissue reconstruction. These same groups however are at increased risk for complications or failure with implant reconstruction. Autologous tissue based reconstruction offers a safer alternative for these patients.

The tissue based reconstruction approach to breast reconstruction can be considered by all patients interested in pursuing mastectomy including most patients with normal and lower BMIs. In a 2019 study from the Journal of ASPS, it was found that the obese population reported greater satisfaction after tissue based reconstruction than with implant based reconstruction [sup](1)[/sup]. This finding is consistent with the conclusion of the 2017 study from the Journal of Clinical Oncology that found all patients, regardless of past medical history or body habitus, reported greater satisfaction with tissue based reconstruction over implants [sup](2)[/sup]. While it is a good option for higher risk patients, autologous tissue based reconstruction can provide safe, successful and satisfying results for many women.

As a patient considering breast reconstruction, it’s important to discuss all available options with your surgeon to determine the best fit for you. At Breast Reconstruction Associates, our goal is to help you be a fully informed participant in your care and to feel comfortable moving forward with your reconstruction plan. Please reach out to us for your Fort Worth breast reconstruction needs. We also have locations in Oklahoma City, OK and Austin, TX.

DIEP Flap vs. Implant Breast Reconstruction

Written by info@wildmonkeybrand.com on March 15, 2022. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

Breast cancer patients now have a lot of options when it comes to reconstructive surgery. The Deep Inferior Epigastric Perforator flap, also known as DIEP flap, replaces the soft tissue and skin removed during mastectomy with abdominal tissues[sup](1)[/sup]. This is an advanced method of breast reconstruction; unlike the TRAM flap procedure, the DIEP flap preserves all the muscles of the abdomen.

The procedure is available at Breast Reconstruction Associates, your DIEP flap providers in Dallas Fort Worth, Texas. Our goal is simple: we offer a state-of-the-art breast reconstruction option to women through a team approach of individualized and compassionate care.

The benefits of the DIEP flap vs. implant breast reconstruction are as follows:

1. The patient’s skin and fat are utilized to replace the breast volume that is removed during the mastectomy. This avoids the need to use an implant to recreate the breast volume.

2. Implant reconstruction patients may experience implant ruptures or capsular contracture, also known as breast hardening, that may need one or more maintenance surgeries years after their initial reconstruction. With DIEP flap reconstruction, the reconstructed breast tends to get softer and even more natural-feeling over time. After completing the DIEP flap reconstructive process, there is no anticipated maintenance necessary for the longevity of the reconstruction.

3. One advance in DIEP flap reconstruction is sensory nerve reconstruction of the flap. The hope with this additional step in a DIEP flap reconstruction is to provide sensation to the transplanted tissue. At this time, we are not doing this routinely in all cases, but rather it is offered in select patient scenarios. Your surgeon can discuss this option, review the pros and cons, and determine if sensory nerve reconstruction should be included as part of your reconstruction.

4. Post-operative pain is a common concern for patients considering DIEP flap reconstruction. It is often falsely assumed that implant reconstruction is less painful since it has a shorter operative time compared to the DIEP flap and does not involve surgery to the abdomen. At Breast Reconstruction Associates, we utilize a post-operative pain protocol that effectively manages most patient’s pain without requiring the use of narcotic pain medication.

In our practice’s experience, patient’s recovery and healing after DIEP flap reconstruction are actually significantly easier than what most people anticipate. Many of our patients choose to go home after a two-night stay in the hospital.

Truly, the DIEP flap is an excellent breast reconstruction option for women which results in a natural-looking and feeling breast after mastectomy, especially in women who prefer to avoid the use of implants. If you want more information about today’s “gold standard” in breast reconstruction, feel free to contact us at Breast Reconstruction Associates, your DIEP flap experts in Dallas Fort Worth, Texas.

Sources:

https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/diep

10 Things to Consider before Undergoing Breast Reconstruction Surgery

Written by info@wildmonkeybrand.com on February 17, 2022. Posted in Breast Reconstruction.

There is an overwhelming amount of information on the internet about breast cancer related topics. When you are newly diagnosis with breast cancer, trying to digest this high volume of information can feel like trying to drink from a fire hydrant. The checklist below provides a good starting point for things to consider when deciding your treatment plan.

Research. It is common to want to rush the process along when you are given the shocking news of a breast cancer diagnosis. While this is very understandable, it is also very important for you to take enough time to understand all of your options. A discussion with your doctors will provide you with answers and reputable resources to reference.
Talk to your doctor. With the emerging popularity of social media, patients frequently get information from online support groups and other patient forums. Although having the support of others going through breast cancer is amazing and can be very helpful, it is also very important to remember that every patient’s situation is unique and you are only able to see part of the picture online. Questions specific to your care should be addressed directly with your doctor and their team for the most accurate information
Make the best decision for you. Breast reconstruction surgery is a personal decision, and several factors play into it. It can be helpful to bring your spouse, family, or support system with you to your consultation so they also understand your options and expectations. It is helpful to weigh the options with your support system, but ultimately you must make the best decision for YOU in your current situation.
Plan ahead. After any type of surgery there is an obligatory recovery period. The length of your recovery varies depending on the type of work you need to resume. Be sure to discuss the details of your expected recovery and post-op restrictions with your surgeon so you can plan accordingly with your support system and your employer.
Can I pick my breast size? The size of your breast reconstruction is dependent on your pre-operative body habitus. Part of your consultation with your reconstructive surgeon will involve discussing what your ideal breast size is (bigger, smaller, or in line with your current size). After examining you, your surgeon will be able to discuss your expected breast size and the likelihood of meeting your expectations. Your surgeon may show you photos of patients with a similar body habitus to help you get a better idea of what you will look like.
Know your timeline. Our goal at Breast Reconstruction Associates is to complete your reconstruction in as few surgeries as possible. Ask your surgeon how many surgeries they anticipate for you, and what the expected timing of each of surgery will be. Timing of reconstruction may have to be adjusted to prioritize the cancer treatment specific to your care.
What will I look like? Looking at photos of other patients who have had the surgery can go a long way in allaying your fears. At Breast Reconstruction Associates, we often look at photos together with patients to give them an accurate visual of the scars patterns they will have.
Ask questions. Nothing is off the table – make a list of all the questions you have and go over all of them with your doctor.
What about your nipples? Even with a mastectomy, some patients have the option of keeping their nipples; this is called a nipple sparing mastectomy. Depending on the location of your tumor, and the position (ptosis) of your nipples, your breast surgeon and plastic surgeon will assess and determine if you are a candidate for a nipple sparing mastectomy. If you are not able to keep your nipples, there are other great options to complete your reconstruction like nipple reconstruction or 3D nipple areola tattoos.
What is the goal of reconstruction? It is important to discuss realistic expectations with your plastic surgeon, and to understand the difference in reconstructive surgery and cosmetic surgery. The goal of reconstruction is to restore what cancer took away from you; to rebuild your breasts and be able to fit clothing evenly without the need to use a prosthesis. While it is a life-changing experience, it is often emotional during the transition. It takes time and perspective to accept and love your new reconstructed self. Don’t be embarrassed or afraid to discuss your emotions through your healing process.

In summary, take some time to learn about your options before moving forward. For more information, visit Breast Reconstruction Associates.

Get Your Breast Reconstruction Questions Answered

Written by info@wildmonkeybrand.com on January 17, 2022. Posted in Breast Reconstruction, DIEP Flap Reconstruction.

Even if you think you are prepared for breast reconstruction surgery, more often than not, you will still have questions for your surgeon. This is very understandable since patients are normally taking a lot and are feeling stressed during that period.

For most patients, the diagnosis of breast cancer comes as a surprise with many associated uncertainties. Even patients who are considering delayed or prophylactic mastectomies and reconstruction have a lot of information to take in when making their reconstruction choices. At Breast Reconstruction Associates, we have been caring for patients like you since 2014. We want you to feel comfortable and informed about what autologous breast reconstruction can offer you. Here are a few of the most common patient questions we receive to help you further process and understand your decision to undergo breast reconstruction.

Q: How much pain can I expect after surgery?

A: Most patients experience a very tolerable degree of post-operative pain. Our pain medication regimen which is aligned with the Enhanced Recovery After Surgery (ERAS) protocol has proven remarkably effective. After surgery, most patients are able to do their regular activities of daily living and sleep with mild-moderate discomfort. The majority of our patients are no longer needing regular pain medications after 2 weeks.

Q: What will my breast size be?

A: During the initial reconstruction surgery, it is possible to control the width and the height of the flap when creating a breast. The depth, or projection, of the flap is largely dependent on the depth, or projection, of the abdominal tissue. Your surgeon should be able to estimate how close to your current breast size you will be after surgery at your consultation. It is possible to make adjustments to size and shape after the initial reconstruction surgery if needed.

Q: Will I have drains after surgery?

A: You can expect a drain in each breast that is operated on and 1-2 drains in your abdomen after surgery. Typically, patients will go home with all of their drains in place. While inpatient, your nurse will educate you regarding the emptying, recording of drainage and general care of your drains before you go home. Once at home, our team is available to address any questions or concerns that may come up. Most patients have their drains removed 1-2 weeks after surgery.

Q: What kind of bra should I wear after surgery?

A: You will be given a hospital-issued post-surgical bra after surgery. This eliminates the need to purchase a bra prior to reconstruction. After surgery, you may be fitted for a compression bra in our office for proper sizing and comfort.

Q: When can I start exercising again?

A: After surgery, we ask that you limit your activities to light walking, no core muscle use, and lifting weight less than 10 pounds. Once you are 4 weeks post-op, you may start cardio activities such as using the stationary bike or the elliptical machine. After this point, let your surgeon guide you as to how and when to get back into more strenuous activities. In general, most patients are free of restrictions and may use their core muscles again 12 weeks after surgery.

If you have additional questions, make a list! We are happy to be your resource for breast reconstruction information. Contact one of our offices in Fort Worth, Austin or Oklahoma City for more information or to schedule a consultation.