Breast reconstruction surgery can be performed to restore one or both of the breasts to an attractive size, shape, and appearance following a lumpectomy or mastectomy. It is also used to repair the chest if it has been damaged by a birth defect or trauma. New techniques in reconstructive surgery make it easier for breast cancer patients to feel whole again and have breasts that look natural after removal or damage. This surgery generally involves several procedures and different stages that may be done at the beginning of your breast cancer treatment or delayed until the treatment is complete. New Jersey board-certified plastic surgeon Dr. Smita Ramanadham creates a personalized surgical plan with compassion as we help you and your cancer team to restore your physical appearance and confidence at our practice.
Reconstruction of the breast(s) is an extremely individualized surgery. Each patient will be required to have an in-depth consultation appointment with Dr. Ramanadham to determine their surgical plan from their concerns, needs, and available techniques. If you are considering reconstruction, it is important that you understand realistic expectations for results. While Dr. Ramanadham aims to give you an attractive, natural appearance, your reconstructed breast(s) may not have the same look, sensations, or feel as your original breast(s). You should be cleared by your oncology team to undergo reconstruction surgery and talk to Dr. Ramanadham regarding other medical conditions that may impair your recovery.
There are many surgical techniques available to reconstruct the breast. There are also multiple factors that Dr. Ramanadham looks at when deciding on the technique that will give you your best results. A few of these factors include your specific cancer diagnosis, when the reconstruction is performed, whether you will use implants or natural tissue, and if nipple reconstruction or nipple-sparing is a part of the treatment plan. To recreate the breast, you must have enough tissue to fully cover the breast mound. Flap techniques accomplish this by using your own muscle, fat, and skin to build and cover the breast. The most frequent flap techniques are:
- TRAM Flap
This technique takes muscle, skin, and fat from your abdomen to rebuild the breast. The tissue selected to build the new breast may be removed from the stomach or the tissue may stay connected to the donor location, maintaining the original blood supply.
- DIEP Flap
Similar to a TRAM flap, the DIEP flap uses skin, fat, and blood vessels from the lower abdominal area; however, it does not use the muscle. The DIEP (deep inferior epigastric perforator) flap moves skin and fat from the stomach to build the new breast, then uses microsurgery to reattach the transferred blood vessels to the chest wall.
- Latissimus Dorsi Flap
This technique uses muscle, fat, and skin from your back. During this technique, tissue is taken from the back to the breast(s) via a surgically created path so it stays attached to the donor location, which keeps the original blood supply in place.
- PAP Flap
Another flap is the profunda artery perforator (PAP). This method uses fat, skin, and muscle tissue from your inner thigh to reconstruct your breast(s).
- LTP Flap
Although the TRAM flap is one of the most common techniques used for breast reconstruction, sometimes there is not enough muscle, fat, and skin that can be taken from the abdominal area. In this case, the LTP flap technique may be performed, which uses tissue from the outer thigh.
- Composite Flap
Also called a composite stacked flap, this technique takes flaps from various sections of your body for breast reconstruction.
Although flap procedures are a common and highly successful method for breast reconstruction surgery, you may want to reconstruct your breast(s) with the tissue expansion method. This technique places a tissue expander below the breast wall and then gradually fills it with a saline solution over 4 – 6 months to stretch the skin naturally. After you choose the flap method or tissue expansion, you may then decide whether you would prefer to use breast implants or a fat transfer to create the shape and volume of the breast(s). After your reconstruction mammoplasty, you can further improve the look by having areola and nipple reconstruction. There are several options to restore the nipple and areola so that it appears natural.
Surgical breast reconstruction is done in several steps. In some phases (like the flap creation, tissue expansion, or implant placement), general anesthesia may be used. Some patients may need to stay overnight, but this is based on the actual treatment phase. When the last stage is completed for your breast reconstruction, you should wear a medical support bra and you may be prescribed medication by Dr. Ramanadham to help control bleeding, swelling, and discomfort. In time, the reconstructed breast(s) should appear more normal so you can feel more comfortable. Regular checks with breast exams and mammograms are essential and highly recommended for your ongoing health.
- How much does breast reconstruction surgery cost?
Breast reconstruction surgery can be complicated so to achieve your best results, you should focus on finding a plastic surgeon who has years of training, like Dr. Ramanadham, over the cheapest price. During your initial consultation, Dr. Ramanadham will take time to understand your concerns and cosmetic goals before developing your unique treatment plan. Then, she will go over costs, options for payment, and where to find low-interest medical financing.
- Does insurance cover my surgery?
The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires health insurance policies that cover breast cancer surgery (mastectomy) to cover reconstruction surgery as well. If you have health insurance, a team member at our practice will help explain your policy and benefits. We can also assist you in obtaining any needed information to your insurance carrier.
- Which technique should I choose?
With so many options, there is no single reconstruction technique that works for every patient. The recommended method for you will be based on your concerns, wants, and physique. In your initial consultation, Dr. Ramanadham will explain your choices, including both flaps and implants, so you can understand the advantages and drawbacks of each before deciding which is best for you. Whether you choose a flap or implants, Dr. Ramanadham will do her best to make your results look natural.
- What about nipple reconstruction?
Nipple and areola reconstruction are typically done using 3D cosmetic tattooing. If you are interested in this, you should talk to Dr. Ramanadham in your initial consultation. She will explain your options to help you decide whether you would like nipple and areola reconstruction to be included in your surgical plan.
- Should I have reconstruction with my mastectomy or wait?
The timing of your breast reconstruction is a personal decision. Some patients decide to have their breast(s) reconstructed along with their mastectomy while others decide to defer reconstruction surgery. Dr. Ramanadham suggests you make an appointment for a consultation following a diagnosis of breast cancer so you can start thinking about your choices, including when you want to have breast reconstruction surgery. If you want to get reconstruction with your breast cancer treatment, Dr. Ramanadham will collaborate with your oncology team to plan your care.
Although the process of breast reconstruction can take time, it is probably one of the top beneficial surgeries for our New Jersey patients at our facility. It may help improve the physical and emotional impact of breast cancer treatment while also allowing you to reclaim your figure and self-confidence. If you have breast cancer, have had an injury to the chest, or have a congenital defect that affects the appearance of your breasts, we encourage you to contact our New Jersey office and schedule an appointment with Dr. Smita Ramanadham.