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. In general, there are two types of approach to breast reconstruction. One uses a woman’s own tissues, taken from elsewhere in the body, to make the new breast. The other option uses a medical device that is not your own tissue, specifically a breast implant, with or without the help of a tissue expander first. Dr. Hubert has extensive expertise in both techniques, so all of your options are on the table.
Many women who choose breast implants for breast reconstruction will need to have a temporary “spacer” placed before the permanent breast implant. This is called a tissue expander. Especially if some skin is removed with the mastectomy, the tissue expander offers several advantages. The main one is that it is adjustable. There is a port built into the expander which 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 magnet to locate the port and then adds the saline solution through a tiny needle on one or more visits. These days, the tissue expander is often placed on top of the pectoralis muscle on the chest wall. Dr. Hubert may also discuss another off-the-shelf product, called an acellular dermal matrix (ADM), which comes from tissue donors. This is used to construct an internal bra around the implant, which helps create a better shape for your new breast. Eventually your own tissues grow into the ADM, and it just becomes a part of your body.
Implant-based Breast Reconstruction
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 a tissue expander pushes hard from the inside, it becomes quite hard. So once it has created enough skin, a second operation is required to remove the inflated tissue expander and replace it with the soft, permanent implant. This second operation is outpatient surgery, so you go home the same day. Breast implants come in many shapes and sizes, and Dr. Hubert will customize your procedure to your body and your goals. He most often uses smooth silicone gel implants for breast reconstruction. Despite what you might read on the internet, these implants are VERY safe. The newer silicone gel implants available today are more stable, maintaining their shape better than older implants. Remember to trust the science!
Direct to Implant Breast Reconstruction
In certain circumstances, some women may be candidates for direct-to-implant (DTI) reconstruction. This involves placement of the permanent breast implant at the same time as the mastectomy, without the temporary tissue expander stage. Acellular dermal matrix (ADM) is required to make the internal bra which holds the implant in position. This works best when chosen for the right patient. Important factors in this decision include whether you already have breast implants, how large your breasts are and how much they might sag, does any skin need to be removed with the mastectomy, and will you need radiation after surgery.
Not every woman with breast cancer needs a mastectomy and reconstruction of the complete breast mound. Some women with small tumors might be a candidate for what is called Breast Conservation Therapy, where the breast cancer surgeon removes only a portion of the breast (called a lumpectomy). Most women having a lumpectomy don’t need the services of a plastic surgeon. But an increasing number are choosing lumpectomy reduction, or oncoplastic breast reconstruction. This is often the choice for women with large breasts who want ot be smaller. At the time of the lumpectomy by the breast surgeon, Dr. Hubert is also involved to reshape and reduce the size of the affected breast. This often is better able to withstand radiation changes (if necessary) and give a better result in the long run. And nobody wants to be unbalanced, so Dr. Hubert does a reduction of the opposite side at the same time. Your breast surgeon will coordinate closely with Dr. Hubert if you are a candidate for this technique.
A deep inferior epigastric artery perforator flap, or DIEP flap (pronounced “deep”), 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 completely from your 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. A DIEP flap for breast reconstruction may offer many advantages over breast implants. These include a permanent result, fewer revision surgeries in the future, a more natural appearance, and the ability to bring in healthy, soft, and non-radiated tissue to a breast that may have had severe radiation effects from breast cancer treatment. The surgery is very specialized and technically demanding. It requires the use of the operating microscope to sew together tiny blood vessels using stitches smaller than a human hair. Click here to learn more about DIEP flap surgery.
Other Breast Reconstruction Options
Another option, if a DIEP flap is not possible, is using tissue tissue from your back, called a latissimus flap. On occasion, an implant might even be combined with a flap of your own tissue, to get the best result. Dr. Hubert is able to perform all of these operations, which means all of your options are potentially on the table. At your consultation, he will discuss your individual situation and come up with the plan that works best for you.
Fat Transfer for Breast Reconstruction
While fat transfer alone is almost never a good option for breast reconstruction, Dr. Hubert often uses highly advanced fat transfer techniques to enhance your breast reconstruction results. Fat transfer, or fat grafting, involves extracting fat from an area of your body via liposuction. The living fatty cells are then separated from the unwanted material and carefully injected into areas of the breast. This technique works well for small areas of irregular contour that were the result of the mastectomy. It removes fat where you don’t want it and moves it to where you do!