Steve Fallek (Plastic Surgeon & Medical Director, Face Focus Medical Spa, New York City) gives expert video advice on: How is a breast reconstruction procedure performed?; Is breast reconstruction painful?; Will I have to take time off from work after getting breast reconstruction surgery? and more...
What is "breast reconstruction"?
Breast reconstruction takes place when a patient has a breast cancer. In general, either a general surgeon or a breast surgeon usually removes the breast in what is called a “mastectomy”. A plastic surgeon gets involve either to reconstruct the breast at the time of the mastectomy or at a later time, by what is called a “delayed reconstruction”.
How is a breast reconstruction procedure performed?
I believe that it is important that you have a conversation both with your general breast surgeon and your plastic surgeon before undergoing breast cancer surgery. Only by a healthy discussion with them can you determine what's the aproppriate treatment for you, and whether or not you are an aproppriate candidate for breast reconstruction, whether that is immediate reconstruction or delayed re-construction. Breast surgery may either be performed in an immediate reconstruction, performed at the same time as a masectomy, or as a delayed reconstruction, a few months or years after surgery. In terms of the type of breast reconstruction, your doctor will determine exactly what type of reconstruction that you need. He may choose to put an expander or breast implant in, again at that time or a later date. Alternatively, he may choose what we call autoligist reconstruction, where your own body tissue is used to help re-construct the breast. Again, that can be done either at the same time or as a delayed reconstruction.
What is a "Transverse Rectus Abdominus Muscle flap" or "TRAM Flap"?
Transverse Rectus Abdominus Muscle Flap, or TRAM Flap as we tend to call it, is a method of reconstructing the breast after a mastectomy. What it entails is taking abdominal tissue, the skin and fat from the abdominal area and on its pedicle, or blood supply, and bringing that tissue up to reconstruct the breast. What's great about a TRAM Flap is that it takes your own native tissue to help reconstruct the breast.
Is breast reconstruction painful?
Breast reconstruction can be painful. For the most part it is performed in an immediate reconstruction done at the same time as a mastectomy. You're talking about two significant surgeries done at the same time. There are a variety of treatments and pain options that we can use to limit the pain that's associated with breast reconstruction. It also depends on your type of reconstruction. If you're going to have an expander and an implant placed at the same time it'll be less painful than if you're going to have some of the more complex procedures, such as a tram flap or a liticimous flap where tissue is taken from another part of your body. In fact, you're talking about another incision site and muscle which can add to the pain levels of breast reconstruction.
What incisions or scarring should I expect with a breast reconstruction procedure?
If your plastic surgeon is choosing to put in a tissue expander and then an implant, most likely he'll go through the old mastectomy or breast removal scar. There will be no added incisions in that case. If your doctor or plastic surgeon chooses to do a otologist procedure, such as a TRAM flap or a latissimus flap, then the incision sites will be where those muscles or tissues are being removed. For example, the TRAM flap is an incision site that mimics an abdominoplasty or tummy tuck incision.
What should I expect after breast reconstruction surgery?
What you should expect after breast reconstruction surgery depends on the type of procedure you're having done. If your doctor is doing an immediate reconstruction with a tissue expander, then the follow up and the initial treatment will be rather minimal. It will mostly be local wound care and wearing a bra. The doctor will need to expand the implant or expander within his office over the course of a few months. If you're having one of the other breast reconstruction procedures, such as a tram or a latissimus flap, where tissue is being brought from another part of your body, there will be more post-op care that will be involved and you'll need to discuss that with your plastic surgeon.
Will I have to take time off from work after getting breast reconstruction surgery?
You will definitely need to take time off work after breast reconstruction surgery. This is a significant surgery, and if you're having immediate breast reconstruction after mastectomy, you need to consider a few weeks off from work and from big activities. And your breast surgeon or general surgeon will also determine whether or not you are a candidate for chemotherapy or radiation. So it's important that you have this consultation with your plastic surgeon and your breast surgeon prior to any reconstructive treatment.
What are the costs associated with breast reconstruction?
Because breast reconstruction is involved with breast cancer treatment, your medical insurance should cover the cost of reconstructive surgery, whether it's immediate or a delayed treatment. This is considered a medical condition and should be covered by insurance.
Can I get other plastic surgery procedures at the same time as receiving breast reconstruction?
It's generally not a good idea to have a cosmetic procedure done at the same time as a breast reconstruction procedure. On the other hand, you may undergo contralateral or other breast surgery when you're having breast reconstructive surgery. For example, you may want to match the one breast to the other one to make them look symmetric or the same.