Breast Reconstruction

Breast Reconstruction is the dimension of plastic surgery devoted to the repair of a breast following lumpectomy or the creation of a breast after mastectomy surgery. Included are procedures plastic surgeons perform in order to improve breast symmetry (breasts equal in shape and size) and/or to correct a congenital anomalies of the breast.

Dr. Perrotta, Dr. Luppens, and Dr. Kerestes have extensive training and experience in breast reconstruction, and receive great fulfillment in providing successful outcomes for their patients.

Dr. Perrotta, Dr. Luppens, and Dr. Kerestes are well versed also in reconstructing breasts following nipple-sparing mastectomies, a procedure many women undergo to reduce their risk of developing breast cancer.

Goals Of Breast Reconstruction

Candidates For Breast Reconstruction

Women who are scheduled for partial mastectomy (lumpectomy) or mastectomy and desire their breast reconstruction immediately following removal of the breast cancer
Women who have undergone breast conservation therapy (partial mastectomy or lumpectomy and radiation therapy) and notice the treated breast has developed a deformity and/or has contracted to become smaller than the opposite breasts.
Women who have undergone mastectomy for breast cancer
Women who have undergone mastectomy for severe, painful fibrocystic disease
Women who have undergone prophylactic mastectomy for a high risk of breast cancer, severe atypia
Women are considering nipple sparing mastectomies to lower their risk of breast cancer
Women of any age with a congenital or acquired breast deformity

What to Expect at your Consultation

Dr. Perrotta, Dr. Luppens, and Dr. Kerestes will devote as much time as necessary to discuss your individual goals and needs with you. After a focused physical examination, your surgeon will provide preliminary recommendations and explain what you can expect from surgery.

Once your surgeon determines his surgical plan, our aesthetic coordinator will produce a written quote, which lists all costs of your proposed surgery so that there are no surprises. At that time, an appointment is set for your pre-op visit.

Pre-Op Visit

Much is covered during your pre-op visit. First, one of our highly trained medical assistants will take pre-op photos. Next, your surgeon will explain the surgical technique to you and thoroughly inform you as to what you can expect, including any potential complications. Note that all procedures involve some risk, but major complications are rare. Dr. Perrotta, Dr. Luppens or Dr. Kerestes will then obtain a more complete medical history from you and perform a final pre-op physical examination, including a check of your vital functions to ensure that you are physically fit for surgery. All informed consents for surgery will be filled out at this appointment and final payments are due at this time. You will be notified 24 hours prior to your surgery with your arrival time.

The Breast Reconstruction Surgery

Dr. Perrotta, Dr. Luppens, and Dr. Kerestes are very experienced with multiple types of reconstruction, including implant-based reconstruction and approaches during which they utilize the patient’s own tissue.

During the process of implant reconstruction, the surgeon initially stretches the skin with a tissue expander. He inserts the tissue expander immediately following your mastectomy or weeks, months, or years after (depending on your preference). At least two weeks after the tissue expander has been inserted, the surgeon passes a fine needle through the skin and inflates the expander with some saline. This minor office procedure is repeated every 2-3 weeks, until the skin is adequately expanded, at which point the tissue expander should be slightly larger than the envisioned reconstructed breast. The process of tissue expansion usually takes a minimum of three months to complete.

Next, the surgeon brings the patient back to the operating room to replace the tissue expander with a permanent saline or silicone gel breast implant. In selected cases, the tissue expander can serve as the permanent implant, which spares the patient a surgery.

During TRAM flap reconstruction, a 5-7-hour procedure, the surgeon uses skin and fat from the lower belly to form a breast. This procedure leaves a long scar but also produces a flatter belly with tighter skin. Some patients feel they have undergone a simultaneous tummy tuck. Generally speaking, a TRAM flap-reconstructed breast appears and feels more natural than a breast reconstructed by either the implant or latissimus dorsi technique.

During Latissimus Dorsi Reconstruction, the surgeon elevates the latissimus dorsi muscle (on the back) with overlying skin and tunnel both to the chest. The muscle and skin is then draped over a saline or silicone gel breast implant. Since there is a thick layer of soft tissue covering the breast implant, the reconstructed breast drapes well and appears and feels more natural than a breast reconstructed with an implant alone. This approach does result in a large scar on the back, however.

The perforator flap enables the surgeon to recruit additional skin and volume for a breast without the sacrifice of a muscle or strength in any other part of the body.

There are other types of breast reconstruction available at the university setting that your surgeons will discuss with you if you are interested or if they are recommended in your case.

Following successful breast reconstruction, most patients opt for reconstruction of the nipple/areola complex as well.

Post-Op Recovery

The duration of the recovery period is dependent on the type of reconstruction. Following surgeries for implant reconstruction, most patients return back to work at home or the office within two weeks. Following latissimus dorsi or TRAM flap reconstruction, the recovery period takes at least 4-6 weeks.

Dr. Perrotta, Dr. Luppens, and Dr. Kerestes monitor all patients closely after reconstruction surgery. They also offer complimentary annual check-ups, during which the breasts are assessed for capsular contracture or any migration of the breast implants.

FAQ’s

Who is a good candidate?

Ideal candidates for breast reconstruction include women who have undergone mastectomies or lumpectomies, those with congenital or acquired breast deformities, and women at high risk for breast cancer opting for prophylactic mastectomies.

When will I see the results?

Initial results are seen immediately, but the outcome, especially after tissue expansion, may take several months as the body heals and adjusts to the new breast form.

How long do the results last?

Breast reconstruction results are intended to be permanent, although longevity can be influenced by aging, weight changes, and possible complications related to the implants or reconstructed tissues.

What should I do before and after?

Patients should follow pre-surgical instructions closely, including medication management and fasting protocols. Post-surgery, adherence to recovery guidelines such as wound care, wearing appropriate support garments, and activity restrictions are crucial for healing.

Is there any downtime or side effects?

Downtime varies based on the type of reconstruction—two weeks for implant-based methods and up to six weeks for flap reconstructions. Swelling, bruising, and discomfort are common side effects, and long-term monitoring for complications such as capsular contracture is necessary.

What can I expect?

Consultations will discuss goals and options, from implant-based reconstructions to flap procedures using the patient’s tissues. Surgeries are performed under anesthesia with various incisions based on the technique. Post-operative care includes regular follow-ups to monitor the healing and integrity of the reconstruction.

Nipple Reconstruction

CANDIDATES FOR NIPPLE RECONSTRUCTION

Women who have an absence of nipple(s) due to surgery.

Women who have inverted nipple(s).

Women who have excessively large nipples.

What to Expect at your Consultation

Dr. Perrotta, Dr. Luppens and Dr. Kerestes will devote as much time as necessary to discuss your individual goals and needs with you. After a focused physical examination, your surgeon will provide preliminary recommendations and explain what you can expect from surgery.

Pre-Op Visit

The Nipple Reconstruction Procedure

The type of procedure performed depends on the specific goals of surgery. Usually the surgeon uses local anesthesia alone. However, IV sedation or general anesthesia is always an option. If the primary goal is for the provision of a nipple, the surgeon raises small flaps of skin and molds them into a small mound that resembles a nipple.

Options for the formation of an areola include a medical grade tattoo and a skin graft from a part of the body where skin is dark. When the problem is nipple inversion, the procedure requires releasing the bands of fibrous tissue and ducts that pull the nipple inward. In order to prevent recurrence of the inversion, the surgeon uses tiny flaps of tissue to create a platform underneath the corrected nipple. If a nipple is too large, the surgeon simply removes a wedge of tissue to reduce it.

Post-Op Recovery

Post-op discomfort is controlled with oral medications. Most patients return to work at home or outside the house the next day. Sutures are removed 4-14 days after surgery.

Nipple Sparing Mastectomy

Nipple sparing mastectomy with reconstruction consists of the removal of breast tissue but preservation of the patient’s own nipples and areola. Immediately following breast removal, a plastic surgeon reconstructs the breast by inserting a tissue expander or a permanent breast implant.

In 2013, renowned actress Angelina Jolie revealed to the world that she had undergone bilateral nipple sparing mastectomy surgery to lower her risk of developing breast cancer. She had both a strong family history of breast cancer and a mutation of her BRCA1 gene, one of the genes that suppresses the growth of tumor cells. Angelina learned that the majority of women carrying the BRCA1 mutation are expected to develop breast cancer if they live to the age of 70.

Nipple sparing mastectomy is also a solution for women with severe fibrocystic disease. These women often complain of breast lumps, pain and tenderness of the breast(s), all of which can be responsive to the patient’s menstrual cycle.

Ever since Angelina’s announcement, nipple sparing mastectomies have become quite popular. Women are ecstatic with the idea that they can significantly reduce their risk of breast cancer or rid themselves of severe fibrocystic disease and yet possess reconstructed breasts which contain their own nipples. However, there are some details which every prospective patient must be aware.

Nipple sparing mastectomies do not completely erase the risk of developing breast cancer.

The nipples might appear perfectly normal but they do not function normally:

It is more likely than not that revision surgeries will eventually be necessary.

Patients who decide to undergo nipple-sparing mastectomies conclude the benefits of the procedure far outweigh these shortcomings.

Doctor Perrotta is highly skilled at reconstructing breasts following nipple-sparing mastectomies, and receives great fulfillment serving as integral parts of the regional breast-care team.

GOALS OF NSM AND IMPLANT BREAST RECONSTRUCTION

For women with pre-malignant breast lesions: to lower the risk of breast cancer
For some women with specific types and presentations of breast cancer: to remove the breast cancer
For women with severe fibrocystic disease: to relieve the breast pain and tenderness

CANDIDATES FOR NSM AND IMPLANT BREAST RECONSTRUCTION

women with strong family history of breast cancer
women with genetic high risk of breast cancer
women with severe, symptomatic fibrocystic disease
some women with breast cancer

What to Expect at your Consultation

Pre-Op Visit

Much is covered during your pre-op visit. First, one of our highly trained medical assistants will take pre-op photos. Next, your surgeon will explain the surgical technique to you and thoroughly inform you as to what you can expect, including any potential complications. Note that all procedures involve some risk, but major complications are rare. Dr. Perrotta, Dr. Luppens and Dr. Kerestes will then obtain a more complete medical history from you and perform a final pre-op physical examination, including a check of your vital functions to ensure that you are physically fit for surgery. All informed consents for surgery will be filled out at this appointment and final payments are due at this time. You will be notified 24 hours prior to your surgery with your arrival time.

The Procedure

Nipple sparing mastectomies are performed in tandem with immediate breast reconstruction. In most cases, a breast surgeon removes the breasts and, while doing so, leaves in place all the skin, including the the nipples and areolas. Immediately thereafter, the plastic surgeon reconstructs the breasts with implants.

Post-Op Recovery

Most patients have significant pain for up to several days and then moderate discomfort for two weeks thereafter. They can return to work in two to three weeks. Months following the initial surgery, fat grafting can be effective in smoothing the contours of the breasts and/or thickening the skin lying over the implants.

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Breast Reconstruction