About Breast Reconstruction
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's 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. Dr. Ryan Couvillion, a plastic surgeon in Houston, TX, regularly creates personalized surgical plans to help patients and their recovery team restore physical appearance and patient confidence at Luminary Plastic Surgery.
Reconstruction of the breast(s) is an extremely individualized surgery. Each patient will be required to have an in-depth consultative appointment with Dr. Couvillion to determine their surgical plan from their concerns, needs, and available techniques. If you are considering reconstruction, it's important that you understand realistic expectations for results. While Dr. Couvillion aims to give you an attractive, natural appearance, your reconstructed breast(s) will not have the same look, sensations, or feel like your original breast(s). You should be cleared by your oncology team to undergo reconstructive surgery and talk to Dr. Couvillion regarding other medical conditions that may impair your recovery.
Tissue based reconstruction
There are many surgical techniques available to reconstruct the breast. There are also multiple factors that Dr. Couvillion 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 moved 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. To achieve an appropriate breast volume, this flap is often combined with a breast implant.
Implant Based 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 instead. This technique places a tissue expander below the breast skin and then gradually fills it with a saline solution over a period of weeks to months to stretch the skin. After tissue expansion, tissue expanders are removed and replaced by breast implants to create the shape and volume of the breast(s).
What to Expect
Surgical breast reconstruction is done in several steps. In some phases (like the flap creation, tissue expansion, or implant placement), general anesthesia is used. Some patients may need to stay overnight, but this is based on the actual treatment phase. In the postoperative period you should wear a medical support bra and you will be prescribed medication by Dr. Couvillion to help control discomfort. In time, the reconstructed breast(s) should appear more natural so you can feel more comfortable.
Frequently Asked Questions
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 Luminary Plastic Surgery will help explain your policy and benefits. We can also assist you with getting 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, general health, and physique. In your initial consultation, Dr. Couvillion will explain your choices, which may include 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. Couvillion will do his best to make your results look natural.
What about nipple reconstruction?
Nipple and areola reconstruction are typically done using 3D cosmetic tattooing. If you're interested in this, you should talk to Dr. Couvillion in your initial consultation. He will explain your options to help you decide whether you'd 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 get their breast(s) reconstructed along with their mastectomy while others decide to defer reconstruction surgery. Dr. Couvillion 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. Couvillion will collaborate with your oncology team to plan your care.
Reclaim Your Self-Confidence
Although the process of breast reconstruction can take time, it's probably one of the most beneficial surgeries for our Houston, TX patients at Luminary Plastic Surgery. 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 Houston, TX office and make an appointment with Dr. Ryan Couvillion.