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16865 Boones Ferry Rd
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Lake Oswego, OR 97035

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Breast Reconstruction

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Breast reconstruction includes several different options to recreate the breast. The reconstructed breasts will differ from your natural breasts. Depending on which procedure you and your surgeon decide upon, your reconstruction may be started when you undergo your mastectomy, or at a later date. Although your newly reconstructed breasts may not look entirely normal when nude, they will look good in a bra or bathing suit. It is important to understand that breast reconstruction is an involved process that can take upwards of a year to achieve optimal results. The first surgery you undergo will involve a hospital stay, followed by quick day surgeries to complete your result. You can expect to be off of a work a minimum of 2-6 weeks depending on the surgical procedure you undergo.

Procedures:

I. Tissue Expanders:

The first option for recreating breasts involves using tissue expanders and eventually breast implants to create fullness. A tissue expander is a like a temporary implant that is placed under your chest muscle either at the time of mastectomy, or at a later date. The surgery can take 1-1 ½ hours of surgical time per breast and involves a one day hospital stay. The tissue expander has a special port that will allow for your surgeon to add saline to your expanders to fill them up and expand your chest during clinic appointments. This is a staged procedure that will take several months and multiple office visits to get you to your desired breast size. Once your chest size goal has been met, your tissue expanders are removed during a day surgery. Permanent silicone or saline breast implants are then inserted into the pocket that was created by the tissue expanders. Depending on your individual situation, you may need future surgeries to reach your desired look. Expect to be off of work at least 2-3 weeks with the initial tissue expander placement. It is important to avoid any heavy lifting for at least one month following surgery, (no lifting anything heavier than about a gallon milk).

II. Muscle Flap Surgery:

There are also options for reconstructing breasts that involve using your own skin, fat and muscle from a donor site on another area of your body. Since every person has a unique situation and body type, your surgeon will help guide you toward the best procedure for you that will yield the safest and most satisfying results. Breasts created with your own tissue usually result in a more natural look and feel, as compared with the tissue expander process. However, keep in mind, the following procedures will result in additional scarring at the tissue donor sites.

A. TRAM: Transverse Rectus Abdominis Myocutaneous Flap

The TRAM is a major surgical procedure that involves using your own abdominal skin, fat and muscle to create and contour one or both breasts. This surgery can be upwards of 6-12 hours of surgical time and a 2-4 day hospital stay. The recovery from this surgery, as compared to the tissue expander procedure, is a greater length of time. As with all reconstruction options, your surgeon will guide you in deciding the right surgery for you. This surgery is best for women who have some excess belly fat. Here, the Transverse Rectus Abdominis Muscle is partially released and lifted up to form a new breast(s). Since your surgeon is harvesting this tissue from your abdomen, you also will end up with a tummy tuck. The abdominal wall will be reconstructed with a piece of mesh. It is important to remember that this surgery will involve a scar across your lower abdomen and the breast area. These scars are all easily hidden with most underwear or swimsuits. Also, it is vital to avoid sun exposure to your abdomen for one year following surgery, since your skin may not be as sensitive to excess heat and could result in severe sunburn. Since your new breasts are created from your own tissue, they may feel natural. However, the skin sensation and coloring will be different since the skin and tissue came from a different area of the body. Many women are however, pleased with their flatter abdomen as a result of the surgery. It is important to keep in mind that only certain people are good candidates for the TRAM flap surgery. Since it can involve an extended recovery, it is very important to be fairly healthy going into the procedure. Smokers, those with prior abdominal surgeries, chronic diseases or cardiac conditions may not be the best candidates. Recovery from this surgery is longer than with the tissue expander process. Since your abdomen has been reconstructed, you must plan to be off work and avoiding any strenuous activity for about 4-6 weeks after surgery. It is important to have someone that can assist you at home during your recovery. Dr. Burgess will prescribe narcotic pain medication, ibuprofen, a muscle relaxant medication, antibiotics and a stool softener to assist you in your recovery. Patients have multiple follow-up visits to ensure that their healing process is on track.

B. Latissimus Dorsi Muscle Flap:

This surgery involves using your own back muscle, called the latissimus dorsi, to recreate your breast. Here, your back muscle is released and brought forward through a tunnel in your armpit to form the new breast. You may also need an implant to achieve breast fullness. This surgery is often times reserved for patients that have had prior radiation. The procedure takes several hours and will leave a scar at the donor site. The recovery period is also longer than with the tissue expander placement surgery. It is important to avoid any strenuous activity for 4-6 weeks, and to plan to have at least several weeks off of work.

III. Creating Nipples:

Once your new breasts have been created by one of the above procedures, you may consider having your surgeon add nipples. This procedure is a day surgery and involves harvesting skin and tissue from a donor site, usually on the lower abdomen. As with all donor sites, you will have a scar where the tissue was removed. This scar is easily concealed under clothing, however. Your surgeon will fashion the donor tissue into a nipple that will add the finishing touch to your entire breast reconstruction process. The new nipples will not have the same sensation as your natural nipple and results can vary from person to person. After surgery, you will have thick, protective dressings over your new nipples to assist in the healing process. It is extremely important to protect your nipples from any rubbing or shearing action for several weeks out after surgery, to allow the skin graft to take. You may want to have a cosmetic tattoo for the nipple to darken or even out the skin color.

Sources: www.breastcancer.org/tips/reconstruction/types/tram.jsp mmw 4-18-08