Dr. Paul Critelli, board-certified plastic surgeon at UT Health East Texas Cosmetic Surgery Center works with patients throughout East Texas and the DFW area who have had a mastectomy, or removal of their breasts. This may be part of breast cancer treatment, or due to other medical reasons. These patients may opt to have breast reconstruction to restore a normal appearance. There are a number of reconstruction techniques to consider, so it is important to find a surgeon who is adept at them all so that you get the right procedure for you. Dr. Critelli will meet with you early in your treatment planning to discuss your reconstructive options. He will then work with you to develop a customized plan to meet your needs and goals. Surgery may be done at the same time as the mastectomy, or it may be done later as a separate sessions, known as delayed reconstruction. In coordination with the UT Health East Texas HOPE Cancer Center, Dr. Critelli works with some of the best cancer surgeons in the region to optimize your cancer treatment and reconstruction, producing unparalleled results.
Things to Consider
The surgical planning for a breast reconstruction typically begins at the same time as the planning for the mastectomy. There are several elements that Dr. Critelli will discuss with you that determine reconstructive options, timing, and overall cosmetic appearance of the reconstructed breasts.
- Orientation of scars on the breasts. Dr. Critelli makes every effort to minimize visible scars on the breasts. While a scar is required to remove the breast its placement can have a dramatic effect on the final appearance of the breast. Some patients are candidates for a “no scar “mastectomy where the scar is hidden in the breast fold and is often imperceptible. If this is not an option, reconstruction can be done through a small vertical incision.
- Nipple preservation. This can often be used with similar oncologic results in patients with small tumors, away from the nipple. The nipple is a unique structure that makes the breast look like a breast and is difficult to recreate this once lost. Dr. Critelli has several techniques to preserve the nipple safely.
- Breast Shape. For some women who have a very favorable breast shape to begin with this can often be preserved, so that the reconstruction looks very similar to the breast prior to mastectomy. For others, particularly after children, breast feeding, and/or significant weight loss, sagging of the breasts needs to be addressed as well. Dr. Critelli has several techniques to lift the breasts at the time of breast removal. This significantly improves the end cosmetic result.
- Radiation Therapy. This will be extensively discussed in your consultation, because radiation adds an increased layer of complexity to the reconstruction.
- Symmetry procedure. The final step in reconstruction is to match the other native breast to the reconstructed breasts size and shape.
In general, there are four phases to breast reconstruction.
- Recreate breast volume and shape.
- Improve shape, contour and exchange temporary implants for permanent implants. It also often involves use of liposuction to harvest fat that is then be grafted to the new breasts.
- Nipple and areolar reconstruction.
- Symmetry procedures including, breast lift, augmentation or reduction to the other, native breast.
In general the first stage is the longest surgery with the most recovery time and the subsequent stages are minor, outpatient procedures. The stages can sometimes be combines to shorten the reconstructive course. The general goal is to help the patient regain a normal appearance of the breasts as part of the final phase of breast cancer treatment.
About the surgery
Surgical techniques vary and today, patients are getting more options that can match their personal preferences. It is important to find a highly specialized plastic surgeon to perform breast reconstruction and one who will work with the cancer surgeon to achieve a natural result.
Reconstruction with Implants
Breast implants are the most common method of breast reconstruction. When implants are being considered, the reconstruction process is usually performed in a multi-stage treatment session. A tissue expander is placed in between the chest muscle and the skin during the mastectomy. This expander will be gradually filled with a saline solution to expand the skin until you reach your desired size and shape. It is then exchanged for a permanent implant. These are the same implants used in cosmetic breast augmentation and can either be saline or silicone. Sometimes, the saline-filled expander is retained instead of an implant.
Flap procedures harvest skin, fat and muscle tissue from donor sites and transfer it to the breast. The surgeon may choose between one of the following common techniques:
- TRAM flap involves grafting skin and muscle tissues on the lower part of the abdomen.
- DIEP and SIEA flap graft tissue from the lower part of the abdomen, but harvests only the skin and fat tissues instead of muscles.
- Latissimus Dorsi flap uses skin and muscle tissues from the upper back.
- DUG flap harvests skin, fat and muscle tissues from the inner thighs near the buttocks area.
When a breast is surgically removed, the nipple and areola may need to be sacrificed. To recreate this unique structure, skin and tissues are formed to in a three dimensional, projecting, nipple while the areola is achieved by skin grafts or tattooing. This is done after the breast reconstruction has fully healed.
Breast reconstruction uses general anesthesia, and the patient is often required to stay in a hospital if done simultaneously with the mastectomy. Patients who have flap surgeries sometimes stay up to 5 days for monitoring. There will be discomfort and pain within the first week, and the patient may feel disoriented with the newly formed chest. Temporary drain tubes and bandages are placed to assist in healing. It can be unnerving to go through a major body change; however, patients find it gratifying and relieving that they are able to once again look and feel normal as they start their new journey towards becoming a cancer survivor.
While most cosmetic procedures are not covered by insurance, breast reconstruction as part of cancer treatment is usually covered. The Women’s Health and Cancer Rights Act of 1997 allows the recovering cancer patient to undergo the surgery and apply insurance coverage towards the total cost. It is difficult to place an actual dollar amount towards this surgery as many factors are involved. Schedule an appointment for a customized consultation to determine the cost of your procedure.
With breast reconstruction, a plastic surgeon will work alongside the cancer surgeon and be primarily involved and responsible as it pertains to restoring the appearance. It is a highly specialized surgery so it is critical to choose a plastic surgeon that has years of successful experiences in this type of surgery.
If a patient knows she will want to restore her breasts with a reconstruction procedure, it is recommended that this process begins at the time as the mastectomy. During the breast removal portion, the tissue expanders can be put into place, which eliminates a new surgery. This ultimately decreases the risk for complications and improves the overall cosmetic result.
Because the breast is completely removed and a new one is formed, there will be a loss of sensation. Over time, there is a possibility that this sensation can be slowly regained. This is different for every patient. While some patients regain their sensitivity, there is no guarantee that this will be the case for everyone.
In the U.S., one in eight women are diagnosed with breast cancer. Annual mammograms for women over 40 are important for early detection. To learn more about scheduling a mammogram or to learn more about the UT Health East Texas HOPE Breast Center, click here.