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3 Things You Can Expect After Breast Reconstruction Surgery

Written by Breast Reconstruction Associates on . 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 Breast Reconstruction Associates on . 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? | DIEP Flap Texas

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

Written by Breast Reconstruction Associates on . 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 Breast Reconstruction

DIEP Flap vs. Implant Breast Reconstruction

Written by Breast Reconstruction Associates on . 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:

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

10 Things to Consider before Undergoing Breast Reconstruction Surgery

Written by Breast Reconstruction Associates on . 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.

  1. 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.
  2. 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
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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 | Breast Reconstruction Associates - Dallas Forth Worth, Austin and Oklahoma City, OK

Get Your Breast Reconstruction Questions Answered

Written by Breast Reconstruction Associates on . 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.

How Common is Breast Cancer? | Breast Reconstruction Associates

How Common is Breast Cancer?

Written by Breast Reconstruction Associates on . Posted in Breast Cancer, Breast Implants, Breast Reconstruction.

Breast cancer is the most common malignancy affecting American women with one in eight women diagnosed during their lifetime (12.5% risk). There are several risk factors that can affect a woman’s risk, some of which are modifiable while others are out of our control.

Modifiable Risk Factors:

  • Body Mass Index (BMI) – Weight can significantly increase a woman’s risk for developing breast cancer as adipose aka fat tissue stores estrogen. Being overweight or obese increases estrogen exposure as well as cancer risk. It is important to maintain a healthy BMI to not only lower your breast cancer risk, but also decrease the risk of cancer recurrence if you are a breast cancer survivor. Your diet plays into this as well so it is important to eat a balanced, nutritious diet and avoid processed foods.
  • Alcohol consumption – This is an exponential risk factor in that the more alcohol you consume, the higher the risk of developing breast cancer. You should limit your intake to less than 3 to 4 drinks per week.
  • Tobacco use – As with most malignancies, nicotine use increases breast cancer risk. It also inhibits wound healing, so it is important to quit all nicotine products before undergoing surgical management.
  • Physical Activity – A sedentary lifestyle can increase your risk for breast cancer as well. Ideally, you should increase your exercise routine to 300 minutes per week, but risk reduction is observed at 150 minutes per week.
  • Hormone Replacement Therapy – Combination HRT (estrogen/ progesterone) increases breast cancer risk. Most women must stop these medications once diagnosed. It is especially important to perform routine self-breast exams and screening mammograms while taking HRT.

Non-modifiable Risk Factors:

  • Age – Breast cancer is an aging woman’s disease with a majority of cases diagnosed after the age of 50.
  • Gender – Women are overwhelmingly more affected by breast cancer than men, but men constitute 2% of all breast cancer diagnoses each year so it is important for men to practice breast awareness as well.
  • Genetics & Family History– Certain genetic mutations can increase a woman or man’s risk of developing breast cancer. Most people are aware of the BRCA1 and BRCA2 genes, but there are several other genes that increase this risk as well (CHEK2, PALB2, ATM to name a few). Even if genetic testing is negative for these mutations, patients are still considered to be at a higher risk than the general population if they have a family history of breast cancer.
  • Lifetime Estrogen Exposure – Starting menstruation before the age of 12, menopause at a later age, and delaying childbearing after the age of 30 or not having any children all lead to increased estrogen exposure and ultimately breast cancer risk.
  • Atypical breast cells – Not every breast biopsy is malignant; many are benign like fibroadenomas or cysts. There are some biopsies considered high risk lesions like atypical ductal and lobular hyperplasia and lobular carcinoma in situ.

While breast cancer rates have been increasing over the years, the good news is that more and more women are surviving this diagnosis. This is largely due to increased patient awareness and early detection as well as improved and increasing treatment options. If you have been diagnosed with breast cancer or a genetic mutation and are considering breast reconstruction surgery, reach out to us at our Fort Worth, Austin or Oklahoma City offices. At Breast Reconstruction Associates, we are committed to our patients’ overall health and reconstructive goals.