Breast Reconstruction Richmond
Most women who are diagnosed with breast cancer will require surgery to remove the cancer as part of their treatment. When the entire breast is removed, called a mastectomy, many women are candidates to have a new breast made. There are two general approaches to this, specifically using either a woman’s own tissues, taken from elsewhere in the body, or utilizing a medical device (a breast implant with or without the help of a tissue expander first). Dr. Hubert has extensive expertise in both techniques. Some women need to have only a part of the breast removed (lumpectomy) and typically also have radiation treatment. Although this is known as “breast conservation,” it can sometimes produce severe deformity, depending on your breast shape, and Dr. Hubert may be able to help improve the appearance of the breast using reconstructive surgery. Furthermore, other women might benefit from re-shaping of the breast at the same time as the lumpectomy, and Dr. Hubert might perform, for example, a breast reduction or breast lift combined procedure with the oncologic breast surgeon’s lumpectomy (an “oncoplastic procedure”).
Most women who choose breast implants for breast reconstruction will need to have a temporary “spacer” placed before the permanent breast implant can be placed. This is called a tissue expander. Especially if some skin is removed with the mastectomy, the tissue expander offers several advantages, the main one being that it is adjustable. There is a port built into the expander which, by accessing with a needle, allows sterile saline solution (fluid) to be added or removed. Some fluid is typically put in at the time the tissue expander is placed. The rest of the filling process happens in the office, where Dr. Hubert uses a tiny magnet to locate the port and then injects the saline solution on one or more visits. The tissue expander is placed under the pectoralis muscle on the chest wall, but this only partially covers the expander. Dr. Hubert uses another product, called acellular dermal matrix (ADM), which comes from human tissue donors. It is processed to remove all cells, and it basically is a thin floppy sheet which is sewn from the edge of the pectoralis muscle down to the chest wall, like an internal brassiere. It is very safe without any documented disease transmission. Eventually your own tissues grow into the ADM and replace it.
Tissue expanders help to stretch out the skin of the lower part of the breast, and in fact actually stimulates new skin cells to grow. Because the tissue expander pushes hard from the inside, it becomes quite hard. So once it has created enough skin, a second (outpatient) operation is required to remove the inflated tissue expander and replace it with the soft permanent implant. Breast implants come in many shapes and sizes, and Dr. Hubert will customize your procedure to your body and your goals. A few words about implants: they are filled either with silicone gel or saline solution. Both kinds are equally safe. Despite the law suits and sensational news accounts of the 1980’s and ’90’s, the scientific evidence gathered since that time has shown that breast implants are exceptionally safe, and they have not been shown to cause disease, including connective tissue, rheumatologic, or neurologic disorders. Newer silicone gel implants available today are more stable, maintaining their shape better than older implants. Dr. Hubert has particular experience with these new “gummy bear” implants and has been achieving excellent results with this new technology.
Direct to Implant
In certain circumstances, some women may be candidates for direct to implant (DTI) breast reconstruction. This involves placing a permanent implant at the time of the mastectomy, along with ADM (described above), in a single operation, without using a tissue expander. This is best performed in women who have had previous breast implants, or in women without any sagging of the breasts.
A deep inferior epigastric artery perforator flap, or DIEP (pronounced “deep”) flap, represents the state of the art in breast reconstruction using a woman’s own tissues. This complex surgery removes the skin and fatty tissue from the lower abdomen, detaches it from the body, and reattaches it in the chest to make a new breast. Dr. Hubert is one of a very small number of plastic surgeons in the entire state to offer this reconstructive surgery, and he performs this operation routinely. In fact, Dr. Hubert learned this technique during his plastic surgery residency training in Philadelphia at the University of Pennsylvania, working directly with one of the true pioneers in this field, Dr. Joseph Serletti. A DIEP flap for breast reconstruction may offer many advantages over breast implants, such as a permanent result, fewer revision surgeries in the future, a more natural appearance, especially when matching it to a normal breast on the other side, and the ability to bring in healthy, soft, and unradiated tissue to a breast that may have had severe radiation effects from breast cancer treatment. The surgery is very specialized and technically demanding, and it requires the use of the operating microscope to sew together tiny blood vessels using stitches smaller than a human hair. Some women might not be candidates for a DIEP flap, and Dr. Hubert might discuss other advanced microsurgical options, such as using your inner thigh tissue (a TUG flap) or upper buttock tissue (an SGAP flap), which he also performs.