The breasts are a key characteristic of femininity and losing them because the life-altering effects of breast cancer can be devastating. If you have recently undergone a mastectomy, lumpectomy or breast biopsy that has negatively affected the size and shape of your breasts, then consider breast reconstruction surgery to restore what breast cancer has taken away.
At Millennial Plastic Surgery, we understand that the breasts are an essential part of your female identity and that losing them can both harm your self-esteem and impact how comfortable you feel in your own body. With both implant and tissue flap breast reconstruction procedures, Dr. David Shokrian can rebuild your breasts and help you regain your self-confidence.
Understanding Breast Reconstruction
Breast reconstruction surgery is different for every patient, since no two patients share the same anatomy or desired results. The procedure can sometimes be performed at the same time as the breast cancer surgery for immediate breast reconstruction, or it may be completed after the initial operation for delayed breast reconstruction.
Breast reconstruction surgery is highly personalized. If just one breast was affected by the cancer diagnosis, then the procedure can be performed only on the breast that requires reconstruction. Breast reconstruction patients also have the option to decide between the use of synthetic implants or tissue grafts taken from elsewhere on the body to rebuild breast size and shape. Some patients may be viable candidates for both options, although some women may enjoy one procedure more than the other.
At Millennial Plastic Surgery, Dr. Shokrian work with their patients individually to determine the ideal treatment plan that will suit their needs.
Breast Implant Procedure
Implant breast reconstruction surgery is typically completed as a two-part procedure. While some women can have their implants placed immediately after their mastectomy for direct-to-implant reconstruction, most women need to wait several months before receiving their implants. Which method is chosen depends on how much breast tissue the patient has left following removal of the breast cancer and whether enough skin remains to allow for placing an implant.
If extra space needs to be created prepare for delayed breast reconstruction, then a tissue expander will be placed in the breast following the mastectomy. The expander will be gradually enlarged over several weeks or months by injecting a saltwater solution through a small valve in the device. Once enough space has been created, and the skin has been adequately stretched, the breast implants may be placed.
Breast implant augmentation is completed under general anesthesia. If possible, the surgeon will place incisions in the same location as the mastectomy scars to eliminate any extra scarring from the procedure. After the incisions have been made, the expander is removed, and the implant is put into place. Patients may choose between silicone or saline implants depending on their preference, and Dr. Shokrian educate them on the difference prior to the procedure to ensure patients make an informed decision.
After the implants have been placed within the breasts, the incisions are sutured shut. The length of the procedure spans between one to two hours.
Recovery and Results
Results following breast implant augmentation will be immediately noticeable, although final results will take several months to develop fully. Patients can usually return home the same day as the procedure and will need to rest for about 48 hours to recover fully. Most patients return to work within one week and can resume more strenuous activities over the course of four to six weeks.
Common side effects include bruising, swelling, tenderness and numbness that can last for three to four weeks. Swelling can take several months to dissipate fully and will temporarily distort the size and shape of the breasts. Compression garments and tight, supportive bras will help minimize swelling. Any surgical drains or non-dissolvable sutures will be removed around one week following surgery.
Final results take about four to six months to completely develop. Incisions will continue to improve with time, eventually fading to thin white lines between 12 and 18 months after the procedure.
Tissue Flap Procedure
Tissue flap breast reconstruction benefits patients who are not candidates for breast implants or would prefer to use natural means to restore their breasts. Several types of tissue flap procedures exist depending on which donor site is chosen for the tissue graft. Common donor sites include the abdomen, back, thighs and buttocks.
The procedure is completed under general anesthesia and can be completed alongside the mastectomy, although some patients may opt to have their breast reconstruction surgery performed at a later date. During the procedure, tissue is removed from the donor site and transplanted to the breasts to rebuild them to their pre-mastectomy size and shape. Surgery can take between three and eight hours depending on the tissue flap procedure completed.
Because tissue flap breast reconstruction requires a tissue graft from another section of the body, the patient will have two scar locations. Unlike synthetic breast implants, tissue flaps will fluctuate in size in correspondence with weight gain or loss. They also have the benefit of feeling more like the original breasts since the tissue is natural. Sometimes, tissue flaps may also be combined with breast implants or fat micro-grafting to provide optimal results.
Not every patient is a candidate for tissue flap breast reconstruction. Since healthy blood vessels are needed to provide live tissue grafts, patients who smoke are not typically good candidates for this procedure. Drs. Everett and Shokrian can determine whether a patient is a good candidate for tissue flap breast reconstruction after an in-person evaluation.
Recovery and Results
Tissue flap breast reconstruction requires a longer recovery period than breast implant reconstruction. Patients will need to spend two to four days recovering in the hospital before returning home. Recovery is more uncomfortable for tissue flap reconstruction since multiple areas of the body are affected by the procedure, especially if breast reconstruction was performed immediately following the mastectomy.
Patients will need to rest and focus on recovery for three to four weeks before being able to return to work and gradually resume their normal activities. Exercise and more strenuous activities can be resumed about six weeks into recovery. Common side effects include discomfort, bruising and swelling, which can be mitigated using compression garments.
Surgical drains will be placed in both the breasts and the tissue flap donor site. They will be removed once they are no longer needed, typically one to two weeks after surgery. Like implant breast reconstruction, results will be immediately visible but will require several months to develop fully. Scars and incision marks will continue to fade and improve for up to 18 months.
Q&A with Dr.Shokrian
Would I benefit more from tissue flap or implant breast reconstruction?
Which procedure you choose for your breast reconstruction depends on several variables and is ultimately a very personal decision. Not all patients are candidates for either procedure, and some may enjoy one more than the other. At an in-person consultation, we will discuss your options in depth and help you make an informed choice that will provide you with your desired results.
Which implant type is right for me?
Both silicone and saline implants provide natural-looking results for breast augmentation. Since saline implants are filled after being placed within the breast, they have the benefit of being highly customizable according to your size preference. Silicone implants come in predetermined shapes and sizes, but they feel more natural due to the thicker, firmer consistency of the gel-like silicone. Which option you decide on is entirely up to you, and we will go over the pros and cons of each type of implant before your procedure.
Should I opt for immediate or delayed breast reconstruction?
Planning when to undergo your breast reconstruction surgery is a deeply personal decision. If possible, opting for immediate direct-to-implant or immediate tissue flap reconstruction can provide a shorter recovery period in the long run. However, not every patient can receive implants immediately following a mastectomy or wants to undergo two operations at the same time. We will help educate you on the benefits of each choice and provide you with our professional recommendation based on your individual needs.
How long will my implants last?
Breast implants are not designed to be lifelong devices, although they do not have a set lifespan. Some women get their implants removed several years after their procedure, while others continue to enjoy their implants for 10 years or more. How long you keep your implants is entirely up to you. In the unlikely event of a rupture, they will need to be removed or replaced. Regular check-up appointments will help verify their integrity, although a leaking implant will typically be visible because of the change in size.
Will the scarring be noticeable?
Scarring is, unfortunately, an unavoidable part of breast reconstruction. However, we believe the benefits of this life-altering procedure far outweigh any scarring present afterward. Scars will also continue to fade with time and can usually be covered with clothing, including bikini tops. We will make every effort possible to minimize scarring by using previous incision lines and making incisions in inconspicuous locations.