Introduction to Breast Reconstruction
The diagnosis of breast cancer can be an extraordinarily traumatic event for any woman. The treatment of breast cancer centers on removing the tumor with a combination of radiation, chemotherapy, and surgery. In recent years surgeons have developed newer procedures that aim to conserve as much of the original breast as possible. Many women may choose to have a lumpectomy and radiation, while many choose to undergo total mastectomy. For some women a total mastectomy may be the only option.
There are a number of reconstructive options depending on the severity, size, and location of the breast defect. For women who have undergone a lumpectomy a local flap reconstruction may be needed to repair smaller contour defects. For those who undergo mastectomy, breast reconstruction surgery can help them avoid the devastating psychological impact mastectomy can have on one’s self–image and self–confidence.
As recently as 30 years ago, the options for mastectomy reconstruction were severely limited and the cosmetic results were unsatisfying for patients. The results of those older procedures were unnatural. Innovations in plastic surgery made since that time have enabled us to offer a full range of reconstructive options for patients with contour deformities due to lumpectomy and single and double mastectomy patients total breast reconstruction. Procedures for breast reconstruction available today can be done at the same time as the lumpectomy or mastectomy, or after waiting a few months to several years.
In general, there are three broad categories of reconstruction. Each type of reconstruction has its own advantages and disadvantages. They are:
- Autologous tissue breast reconstruction,
- Prosthetic breast reconstruction
- Autologous tissue with prosthetic breast reconstruction.
Autologous Tissue Breast Reconstruction
Autologous tissue breast reconstruction involves reconstructing the breast with the patient’s own tissues. These tissues are generally taken from the abdomen, the back, or the buttock, with the abdomen (TRAM flap) being the most common.
The primary advantage of using one’s own tissue to reconstruct the breast is that this tissue will heal and grow with the patient. There is no future maintenance for an autologous tissue reconstruction as there may be with implants. Tissue reconstructions feel and look more natural and aesthetic than other reconstructive options. For women undergoing a one sided mastectomy, symmetry is general better when compared to implants based reconstructions. The main disadvantage of autologous breast reconstruction is that tissue must be transplanted from an otherwise healthy part of the body. This creates a donor site that must be closed. This can result in scarring and occasional loss of strength at the donor site. These problems, including hernias and abdominal wall weakness, may be seen with traditional abdominal TRAM flap autologous reconstructions. Furthermore, autologous tissue breast reconstructions have longer operative times and hospital stays when compared to implant-based reconstructions. Some women are not optimal candidates for autologous breast reconstruction. Factors such as body shape, previous surgeries, smoking history, and co–existing medical conditions may preclude breast reconstruction with autologous techniques, such as the TRAM flap.
Prosthetic Breast Reconstruction
The second option for breast reconstruction, called prosthetic breast reconstruction, uses implants to reconstruct the breast, similar to those used in cosmetic breast augmentation. Unlike a breast augmentation, there is little remaining tissue to cover the implant and a new pocket for the implant must be created. A tissue expander must be inserted into the mastectomy site prior to the insertion of the implant to make a pocket where the implant will ultimately lie. Prosthetic breast reconstruction techniques spare the patient the loss of donor site tissue as well as donor site scarring. The prosthetic breast reconstruction procedures also take less time to perform and hospital stay is generally shorter. However, prosthetic breast reconstructions is a multi-stage procedure performed over 6 to 12 months. A minimum of 2 stages are required. The permanent implant will likely require maintenance in the future.
Autologous and Prosthetic Breast Reconstruction
The third option for breast reconstruction is a combination of prosthetic and tissue reconstruction. This option involves the transfer of the patient’s own tissues in combination with the insertion of an implant. This option has both the advantages and disadvantages of the autologous and prosthetic breast reconstruction techniques. However, because expanders are not usually required for these techniques, it is better tolerated by many patients than standard prosthetic breast reconstruction.
In recent years, there have been dramatic technical advances in autologous breast reconstruction, which is considered by many to be the “gold standard” of breast reconstruction. Advances in microvascular surgery, including “muscle–sparing” techniques and “DIEP perforator flaps”, have made it possible to transfer the necessary tissue with minimal trauma to the donor site. This has resulted in dramatically reduced donor site problems without compromising the outcome of the breast reconstruction. Furthermore, these technological advances have made the option of autologous breast reconstruction a reality for patients who previously were not considered good candidates.
For patients undergoing mastectomy for breast cancer, health insurance must cover the cost of breast reconstruction. The Federal Woman’s Health and Cancer Right Acts of 1998 guarantees coverage for breast reconstruction. Health insurance also must cover the cost of a matching procedure for the opposite side in order to obtain proper symmetry. Navigating the insurance claim process can often be difficult and time–consuming. Dr. Zemmel’s staff at Richmond Aesthetic Surgery will be available to file claims on behalf of breast reconstruction patients and investigate the extent of coverage offered by their insurance carriers. Our Richmond, Virginia office accepts most major insurance carriers.
Dr. Neil J. Zemmel offers the latest techniques for breast reconstruction in women undergoing partial or total mastectomy. Dr. Zemmel offers expander-implant reconstructions using the “alloderm sling” technique. Dr. Zemmel also offers autologous tissue reconstructions using the pedicled TRAM techniques. Dr. Zemmel performs reconstruction for cancer and in women undergoing prophylactic mastectomy for a strong family history or genetically positive cancer.
Richmond Plastic Surgeon Neil J. Zemmel completed medical school at the University of Virginia and completed the Plastic Surgery Training program at the Virginia Commonwealth University Medical Center. Dr. Zemmel’s training extended the full breadth of cosmetic and reconstructive techniques including head and neck reconstruction, hand and upper extremity surgery, microvascular surgery, breast reconstruction, burn reconstruction, and cosmetic surgery.
Learn more about breast reconstruction insurance coverage.
Dr. Zemmel has extensive experience with both implant-based and autologous tissue breast reconstruction. Dr. Zemmel has performed countless breast reconstruction surgeries at his Richmond, Virginia practice. This experience, combined with his broad background in general reconstructive surgery, makes him qualified to offer mastectomy patients an extensive range of options.
If you are interested in breast reconstruction, contact our Richmond, Virginia practice to find out which breast reconstruction technique is right for you.