Breast Reconstruction Surgery
Breast Surgery Expert Richmond, VA - Breast Reconstruction
Richmond & Charlottesville VA
Board Certified Plastic Surgeon-Matthew G. Stanwix, MD
The diagnosis of breast cancer begins a journey of making many informed decisions which deeply affect your body and life. Using knowledge as a guide for the journey, allows you to become an advocate for your own well being. As heath care providers, we present patients with the tools and information to build their knowledge as they embark on their journey. This webpage serves as an instrument of knowledge for past, current, and future breast patients of Board Certified Plastic Surgeon Dr. Matthew G. Stanwix as they make informed decisions about breast reconstruction. Remember, Dr. Stanwix is a world expert in breast reconstruction and will be there throughout this journey to guide, lead, or assist you with whatever you may need to succeed.
Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures that Dr. Stanwix performs. Recent advances in medical techniques and devices have made it possible for Dr. Stanwix to create a breast close in form and appearance to a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so patients awake from surgery with a breast mound in place, and are spared the experience of living any moment without a breast at all.
However, bear in mind that post-mastectomy breast reconstruction is not a simple procedure or easy experience. There are many options to consider as you and Dr. Stanwix explores what treatment course is best for you. Importantly, Dr. Stanwix has been meticulously trained in cutting edge microvascular breast reconstruction at The Avon Breast Cancer Center at The Johns Hopkins Hospital. Dr. Stanwix performs a wide variety of breast reconstruction options that only a few plastic surgeons in the world perform! These innovative, state of the art surgical techniques (DIEP flaps, TUG flaps, SGAP flaps) allow Dr. Stanwix to recreate a breast from your belly, thigh, or buttocks tissue that are the most natural and last a lifetime. Because of his unique expertise, Dr. Stanwix has been asked to perform research in microvascular breast reconstruction, author chapters in text books, and is frequenlty invited to present in national/international meetings.
This information will give you a basic understanding of breast reconstruction—when it is indicated, how and when it is performed, and what the journey entails. Along with this it will help to explain the pre surgical plan, the surgical operation, and the post surgical course, as well as results you can expect. However, it cannot answer all of your questions since a lot depends on your individual circumstances. Please be sure to ask Dr. Stanwix if there is anything you do not understand about the procedures or what you can expect.
Sincerely,
Dr. Matthew G. Stanwix
Board Certified Plastic Surgeon
Breast Reconstruction Expert
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What is Breast reconstruction?
Breast reconstruction is the recreation of all or part of a breast which has been surgically removed due to cancer or disease. Dr. Stanwix may recreate the new breast using an implant or tissue taken from another part of your body. The goal of reconstruction is to have natural, soft, symmetrical breasts in clothing.
Can I have breast reconstruction?
Any patient who undergoes removal of a part of the breast (lumpectomy or breast conservation therapy), the whole breast (mastectomy), or preventive removal of the breast (prophylactic mastectomy) is eligible for breast reconstruction. New medical devices and breast reconstructive options allow Dr. Stanwix to recreate breast at the time of mastectomy or after the mastectomy, and to correct misshapen breasts after breast conservation treatment. The best candidates, however, are women who are in good health, do not smoke, and whose cancer, as far as can be determined, will be or has been removed by surgery.
When can I have breast reconstruction?
Breast reconstruction can be done at the time of your mastectomy (immediate) or weeks, months, or even years later (delayed). The decision to have immediate or delayed reconstruction depends on many factors that Dr. Stanwix takes into consideration:
· Breast Cancer Stage
· Breast Cancer type
· Additional Therapies (radiation or chemotherapy) to treat the cancer
· Other medical conditions (such as obesity, heart and lung conditions, smoking)
· Personal Preference and lifestyle you have
Many choose to have delayed reconstruction based on these factors. Some women are not comfortable weighing all the options that have at the time of emotional stress in coping with the diagnosis of breast cancer. Some patients may be advised by Dr. Stanwix to wait because of other health conditions. Also, those with metastatic or inflammatory breast cancers may be advised to delay breast reconstruction. Dr. Stanwix will discuss the advantages and disadvantages with you during your initial visit.
What are my reconstructive options if I have a mastectomy?
There are three general options for breast reconstruction after mastectomy:
· Implant only
· Autologous (your own tissue) only
· Implant combined with autologous
During your appointment, Dr. Stanwix will discuss to benefits and problems for each option. This will include the advantages, limitations, disadvantages, risks, and complications of each procedure individualized to your specific scenario. You will also talk about what to expect after reconstruction is performed. It is important to remember that breast reconstruction is a process requiring multiple surgeries to make a final result. Together, you and Dr. Stanwix will choose the best option for you based on:
· Body Shape
· Past Surgeries
· Current Health
· Breast Cancer treatments
· Personal Preferences
Implant Based Reconstruction
The most common technique for implant based reconstruction combines expansion of the remaining skin after mastectomy, and the later insertion of a permanent silicone or saline breast implant. This type of reconstruction requires two separate operations and likely a third touch up procedure (or nipple making procedure). At the same time as your mastectomy, your surgeon will insert a tissue expander beneath your skin and chest muscle. The tissue expander is a silicone (rubber) shell/balloon which can be filled (expanded) with saline (salt water solution) to help stretch the muscle and remaining breast skin to the reconstructed breast size that you want. In the fold of the breast, Dr. Stanwix will inserts an acellular dermal matrix (sheet made of collagen from cow skin, called Surgimend, which is devoid of all cells and acts as a scaffold) creating an internal bra/sling for the tissue expander.
Your surgery takes 2-3 hours for one side to be completed, longer if you are having surgery on both sides. You will be kept in the hospital overnight and will be able to go home the next day. This surgery will require placement of surgical drains to remove excess fluids from surgical sites immediately following the operation. In most circumstances, Dr. Stanwix will remove these drains when you come back from your 1 week or 2 week follow-up visit. If there is a lot of drainage, they will stay in for longer. You are likely to feel tired and sore for one to two weeks after reconstruction and take about 4-6 weeks or longer to feel completely recovered. Most of your discomfort can be controlled by a pain medicine and/or muscle relaxor prescribed by Dr. Stanwix.
The tissue expander is filled (expanded) with saline (salt water solution) through a magnetic port located inside the expander. In clinic, Dr. Stanwix will periodically inject a salt-water solution into the port to gradually fill the expander over several weeks or months. Chemotherapy or radiation may be recommended to you by your oncology team following your mastectomy. If you have these treatments, they may delay the tissue expansion process.
The process continues until the tissue expander size is slightly larger than your desired reconstructed breast size. You may feel a sensation of stretching or pressure in the breast area during this procedure, but most women find it is not too uncomfortable. Filling of the tissue expander usually begins one to two weeks following your mastectomy. Expansion of the expander stretches the skin and muscle to make room for a breast implant, much like a mother’s belly stretches during pregnancy. If there is not enough skin, the expansion process actually causes growth of extra skin. After the skin over the breast area has stretched enough, the expander will be removed in a second outpatient operation and a more permanent implant will be inserted in its place. The nipple and areola (the dark skin surrounding the nipple) are usually reconstructed in a subsequent procedure.
The exchange of the tissue expander for a permanent implant takes about 1 hour for one side, longer for both sides. Dr. Stanwix usually does not place surgical drains, and you can go home the same day as your surgery. You are likely to feel tired and sore for a week or two after the implant exchange, and take 2-4 weeks to recover completely. Much of your discomfort will be controlled by medication prescribed by Dr. Stanwix.
What are the types of permanent implants?
Permanent implants are silicone shells filled with either salt water solution (saline) or silicone gel. The permanent implants are much softer than the tissue expander used. Saline implants have been approved for use by the Food and Drug Administration (FDA) since 1992. Prior to 1992, silicone implants were used. In 1992, due to silicone leaking and fears that silicone caused illnesses and other diseases, the FDA removed silicone implants from the market. After, 1992, large medical studies were conducted to check the safety of silicone implants. These studies showed there was NO connection between silicone implants and other diseases. In 2006, the FDA again approved the use of silicone implants. The alternative saline filled implant, a silicone shell with salt water, is also available if you choose.
Dr. Stanwix will discuss the risks and benefits for undergoing breast reconstruction with silicone breast implants, and you will receive a short detailed patient brochure to educate you on these. Silicone implants require monitoring with an MRI every other year starting at 3 years after surgery because leaks are not easily detected by exam. On the other hand, Saline implants do not require monitoring because leaks are obvious when the whole breast is deflated. Be sure to discuss current options with Dr. Stanwix. Both types of implants come in a variety of shapes and sizes. Dr. Stanwix will talk about the various types of implants and help you to decide which implant is best for you.
If an implant is used, there is a small possibility that an infection will develop, usually within the first week or two after surgery. In some of these cases, the implant may need to be removed for several months until the infection clear. A new implant can later be inserted at that point.
The most troublesome problem, capsular contraction, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard, sit higher on the chest, and appear smaller. Capsular contraction can be treated in several ways by Dr. Stanwix. Sometimes it requires either removal or “scoring” of the scar tissue, or perhaps replacement or removal of the implant. Radiation therapy dramatically increases the risk of tightness around the implant due to radiation damage of all of the surrounding tissues. Ultimately, there is a very high chance that in the first 10 or 15 years after surgery you will need another surgery to replace a malfunctioning implant or change the breast shape. Dr. Stanwix will discuss autologous options (your own body tissue) at your initial visit, which are a more permanent and natural reconstructive choice.
Using Your Own Body Tissue (Autologous or Flap Reconstruction)
Autologous, also called flap reconstruction, involves using your own tissue from another part of your body to rebuild your breast. The tissue from your back, abdomen (belly), thighs, or buttocks may be used. Sometimes, the tissue can stay connected to its own blood supply and just be rotated (turned) to reconstruct the breast. This is called a “pedicled” or “attached” flaps. Other times, the tissue is disconnected from your body and its own blood supply; it is reconnected to a new blood supply in the chest. This is called a “free” flap. The most common blood vessels to reconnect the tissue are the vessels in your chest called the internal mammary artery and vein. The internal mammary artery is one of the same vessels used in heart surgery.
The name of the flap also changes depending on the area the tissue is taken from (donor site). Tissue flaps taken the back are called latissimus dorsi or T-DAP, from the belly are called a DIEP or TRAM or SIEA, from the buttocks are called the SGAP or LGAP, and from the thigh are called TUG. Most of these surgeries require the skills of microvascular trained plastic surgeon (using a microscope to reconnect blood vessels). Dr. Stanwix has been trained extensively at the Avon Breast Center at The Johns Hopkins Hospital to perform these cutting-edge surgeries. Dr. Stanwix is proud to offer these highly innovated breast reconstructive techniques to the women of in the Richmond, Charlottesville, Virginia, and DC community.
Using Your Belly Tissue
Breast reconstruction using your own tissue (Autologous) has the most natural and lasting results. The words used to name your abdominal tissue change depending on the type and amount of tissue taken. To help explain these words, an understanding of the makeup of your belly (abdomen) is needed. Your abdomen is made up of many layers:
· Top layer-skin
· Underneath the skin is your fat
· Underneath your fat is your fascia [thick, tough layer that helps prevent your intestines from bulging out (hernia) and keeps your muscle in place]
· Underneath your fascia is your muscle, the rectus abdominis, or your “6-pack”
The rectus muscle received blood supply from two blood vessels, the superior epigastric artery and vein, and the deep inferior epigastric artery and vein (DIEP). These vessels spread up the muscle like branches on a tree into smaller vessels that supply the fat and skin tissue. Some different and more superficial vessels are he superficial inferior epigastric artery and vein (SIEA).
The tissue taken from your abdomen can consist of all layers, or only some layers. Also, the tissue may be moved staying attached to the blood supply (TRAM), or disconnected from its blood supply and connected to a new blood supply in the chest (free flap). The amount of tissue, and blood supply used to create your new breast determines the name of the breast flap. Dr. Stanwix will help decide which type of flap is best for you.
The Transverse Rectus Abdominis Muscle Flap (TRAM)
This flap consists of skin, fat and the “6-pack” muscle itself, typically with some fascia. The TRAM flap is usually rotated on its remaining blood supply (pedicled) or disconnected from its own blood supply and reconnected to the blood in the chest (free flap). Since this flap involves removing your muscle, and sometimes your fascia, there is a higher risk for bulging of your intestines (hernia) or weakness at your waist.
The pedicled TRAM flap is not the first breast reconstructive choice of Dr. Stanwix, but may have to be an option depending on your body. The problem with the TRAM flap is that taking the abdominal muscle can have adverse effects
· Weakness
· Bulging
· Hernia
In this type of surgery, the skin, fat and abdominal muscle is used and the tissue may remain attached to its original site, retaining its blood supply. By doing so, there has to be a tunnel beneath the skin of the chest, creating the breast reconstruction. Also, because the blood supply of the superior artery and vein is not as good as the lower vessels (DIEP), there is a tendency to firm areas where the fat hardens (fat necrosis). This may cause concerns or cosmetic problems in the future.
Abdominal Muscle Sparing and Perforator Flaps
Advances in surgical techniques have allowed surgeons to lessen the amount of muscle or fascia that is used for abdominal (belly) flaps. Now, Dr. Stanwix avoids taking any muscle or fascia by using the small blood vessels spreading up from the muscle to the skin called perforators (DIEP) or from the more superficial source called the superficial inferior epigastric artery and vein (SIEA). Both the DIEP and SIEA are muscle sparing and use no muscle with the belly tissue, lowering the chance for bulging of your intestines (hernia or bulge), and weakness of the muscle itself. There are three types of muscle sparing flaps that Dr. Stanwix performs:
1. Free Deep Inferior Epigastric Perforator Flap (DIEP): A flap made up of belly skin and fat ONLY. The flap is disconnected from its own blood supply and then reconnected to the blood supply in the chest using the deep inferior epigastric artery and vein and its perforators. This the most common procedure performed by Dr. Stanwix. Not only does the fat and skin removed at the time of surgery reconstruct a supple, naturally appearing breast, but it also provides for a “tummy tuck” effect!
2. Free Superficial Epigastric Artery Flap (SIEA): A flap made of belly skin and fat ONLY. The flap is disconnected from its own blood supply and then reconnected to the blood supply in the chest using the superficial inferior epigastric artery and vein and its perforators. Since the superficial epigastric artery and vein are very small, and only exist in about 30% of patients, few can have this flap.
Regardless of which of these three innovative techniques Dr. Stanwix performs, they are more complex than implant based reconstruction. Scars will be left at both the tissue donor site (lower belly) and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the reconstructed breast is made entirely with your own tissue, the results are more permanent, natural, and there is no concern about implant complications. In some cases, you will have the added benefit of an improved abdominal contour.
You will be requires to stay in the hospital for three nights. During this stay, Dr. Stanwix and nurses will monitor your flap to make sure that it is receiving enough blood supply. No matter what type of flap is used, problem with the blood supply can occur. The color, temperature, and pulse of the skin will be checked. A machine that listens to your blood flow (Doppler) and another which looks at how much oxygen the flap is getting (Vioptix) will help to monitor also. If your flap has blood supply problems, Dr. Stanwix may have to take you back to the operating room to fix the problem. This happens in less than 10% of patients. If the problem cannot be fixed, approximately 2-3% of all patients, another method for your breast reconstruction will be offered.
You will also have 3-4 surgical drains depending on if one or two breasts are reconstructed. In most circumstances, these drains will remain in for 1-2 weeks; if they have a lot of drainage even longer. The recovery time for flap reconstruction is about 6-8 weeks. You will be sore for about a week or two and then begin to improve every day; however, it is normal to feel fatigued in the weeks following surgery.
Other Methods of Free Autologous Tissue
· Using your buttocks tissue (SGAP): This type of reconstruction is reserved for patients who do not have enough skin and tissue on the belly, have had previous belly surgery to preclude a DIEP, do not want implants, and have enough buttocks tissue to recreate a breast. These flaps are made of skin and fat from the buttocks. Their blood supply is disconnected from the buttocks and then reconnected to the internal mammary artery and vein in the chest. You will have a scar hidden in the bikini line and slight indent around the donor site area from where the tissue is taken. The SGAP is a great alternative and provide for a natural and moderate volume breast.
Listen to Elizabeth's overwhelmingly positive experience from an SGAP by Dr. Stanwix and how it improved her life after numerous problems with implant reconstruction:
Elizabeth's procedure has gone international because of its success!!! Visit her story from the Australian Website: Under The Red Dress
· Using your thigh tissue (TUG): The transverse upper gracilis (TUG)flap is made up of skin, fat and muscle from the thigh. The gracilis muscle that is taken is considered “expendable” and patients do not report any weakness after surgery. The TUG is usually done for patients who do not have adequate skin in the buttocks or belly. The TUG flap is a small sized flap and thus can only be used for those that do not require a large volume breast reconstruction. The incisions from the TUG are hidden in the groin area. This area is warm, moist and dark, and undergoes a lot of motion while sitting, standing, or using the bathroom which makes it a higher risk for poor healing and infection.
· Using your back tissue (Latissimuss Dorsi & T-DAP): The latissimus dorsi flap from your back is made up of skin, fat, and muscle (latissimus dorsi muscle). The T-DAP flap is made up from skin and fat ONLY. Both the latissimus dorsi and the T-DAP flaps remain attached to the their blood supply, and are rotated through the arm pit to recreate the breast on the chest. This scar is often hidden in the bra strap on the back. Often, the flaps are not large enough to recreate a breast, and an implant will be required under the flap. Usually, Dr. Stanwix reserves this surgery for partial breast (lumpectomy) reconstruction. People generally do not have a problem from missing the muscle in the back and continue their normal daily living. However, if you are a competitive rock climber, swimmer, or tennis player, you may be affected and show weakness. That is why Dr. Stanwix prefers to use the TDAP flap and save the muscle for you and your active lifestyle. Unlike all of the free Autologous tissue procedure above, this surgery require only a one or two hospital day stay.
You will be requires to stay in the hospital for two to three nights. During this stay, Dr. Stanwix and nurses will monitor your flap to make sure that it is
receiving enough blood supply. No matter what type of flap is used, problem with the blood supply can occur. The color, temperature, and pulse of the skin will be checked. A machine that listens to your blood flow (Doppler) and another which looks at how much oxygen the flap is getting (Vioptix) will help to monitor also. If your flap has blood supply problems, Dr. Stanwix may have to take you back to the operating room to fix the problem. This happens in less than 2% of patients.
You will also have 3-4 surgical drains depending on if one or two breasts are reconstructed. In most circumstances, these drains will remain in for 5 days to 2 weeks; if they have a lot of drainage even longer. The recovery time for flap reconstruction is about 6-8 weeks. You will be sore for about a week or two and then begin to improve every day; however, it is normal to feel fatigued in the weeks following surgery.
Your New Look
Your reconstructed breast may feel slightly firmer and look rounder or flatter than your natural breast. It may not have the same contour as your breast before mastectomy, nor will it exactly match your opposite breast. However, small revision surgeries performed by Dr. Stanwix may improve the contour and symmetry. These differences will generally be apparent only to you. Therefore, you should decide what differences you would like to change, and discuss them with Dr. Stanwix. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery. Dr. Stanwix is involved in trying to understand how the quality of life of a woman changes after free flap surgery when compared to implant based reconstruction through ongoing research. Women who have breast reconstruction may go through a period of emotional readjustment. Just as it took time to get used to the loss of a breast, a woman may feel anxious and confused as she begins to think about the reconstructed breast as her own.
Follow-up/Revision Procedures
Most breasts reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery, or revisions, may be required to enlarge (augmentation), reduce, or lift (mastopexy) the natural breast to match the reconstructed breast. It is almost always performed to improve the symmetry, shape, size, and/or contour of the reconstructed breast itself. Often, improvements in the contour and symmetry of the reconstructed breast are accomplished by using fat grafting. In this procedure, fat is taken by liposuction from an area of the body (belly, thighs, buttocks) and then injected into the reconstructed breast where symmetry and contour is needed. These secondary procedures are outpatient procedures and rarely require the use of drains. The recovery time is based on the extent and complexity of the procedure, but usually ranged from a few days to a few weeks.
Nipple and Areola Reconstruction
Once you and your surgeon are happy with the shape, size, and symmetry of your breast reconstruction, and you have had time to heal, you may consider having nipple reconstruction. Your reconstructed nipple will be different than a natural nipple. It will not be able to have temperature or other sensations and not be as “perky” as the other side.
If you choose to have your nipple reconstructed, there are different options. First, you can choose to have a 3-D tattoo only and no surgery at all. A second option, and most common, is to use the skin of your reconstructed breast to recreate a nipple. This nipple bump will be the color of your reconstructed breast skin, and will not have an areola (colored portion around the nipple). The areola and nipple can then be colored using a tattoo. The tattooing can be done at Dr. Stanwix's office or at a local tattoo parlor. The third option is not to have a nipple reconstructed at all. Dr. Stanwix will help you to decide which option is best for you.
How long will it take to finish my breast reconstruction?
The length of time can vary depending on the number of surgeries you need or want and the need for other breast cancer treatments, such as radiation or chemotherapy. The reconstructive process generally takes 6 months to one year no matter what type of reconstruction you choose if not further cancer treatment is necessary. Some patients will require multiple revision surgeries to balance the reconstructive breast with the natural breast, and recreate a nipple. The timeline to completion will vary for each patient, but a general guide is:
- First surgery: mastectomy(with tissue expanders or a reconstruction immediately with a permanent implant or free autologous tissue)
-Wait about 3 months for healing or 6-12 months if you need chemotherapy or radiation-
- Second Surgery: if you had tissue expanders at the time of your mastectomy this will be when Dr. Stanwix will recreate your breast (permanent implant or free Autologous tissue) Skip if you had a permanent implant or Autologous tissue at the time of mastectomy
-Wait three months for healing-
- Third Surgery: Surgery to make changes to the size and shape of your reconstructed or natural breasts as needed.
-Wait 2-3 months for healing
- Fourth Surgery: Adding a nipple and any last touch ups to your breasts.
What if I may need or will have radiation therapy?
Radiation affects every patient differently, but can cause hyper-pigmentation (skin color changes like a sunburn), and changes in the texture and quality of the skin, muscle, and tissues inside the breast pocket after mastectomy. This firmness of the tissues is known as radiation fibrosis. To prevent this radiation fibrosis from damaging the breast reconstruction, Dr. Stanwix may recommend having a staged surgery, using a tissue expander beneath the breast at the time of mastectomy, especially if you are planning on having Autologous tissue for reconstruction. Dr. Stanwix may recommend having a tissue expander if you are having radiation therapy because there are increased risks for complications with tissue expanders while undergoing radiation therapy. If you are having an Autologous (tissue) breast reconstruction, Dr. Stanwix alternatively may choose to perform your reconstruction at the time of your mastectomy, but make the breast larger in volume to allow for the radiation fibrosis changes to the reconstructed breast.
If Dr. Stanwix recommends having a tissue expander, you may undergo radiation treatment with the tissue expander in place. Then later, Dr. Stanwix will replace the expander and reconstruct your breast with autologous tissue or an implant of your choice. For an autologous reconstruction, this prevents the nice, soft reconstructed breast from undergoing changes due to radiation, but not for an implant.
Studies have shown that patients who have radiation therapy are at an increased risk for problems with permanent implants. These problems include capsular contraction (scarring and lifting of the breast), infection, and wound healing problems necessitating the removal of the implant. Dr. Stanwix will help you to make an informed decision if you are to undergo radiation therapy.
What if I may need or will have chemotherapy?
Breast reconstruction should not delay you getting chemotherapy. Sometimes, your medical oncologist will want to wait until your incisions are fully healed and your drains have been removed prior to starting your chemotherapy. If you have a tissue expander placed at the time of your mastectomy, you may have your chemotherapy while undergoing tissue expansion. Tissue expansion may continue as long as you are comfortable, have no infections, and your blood counts are stable. Dr. Stanwix prefers to fill your expanders about 2 days before your chemotherapy dose, as this is when your blood counts are highest.
Does breast reconstruction increase the risk of my cancer returning or make it harder to detect breast cancer?
NO. The risk of breast cancer returning (recurrence) depends on the stage of the breast cancer, the type of breast cancer (hormone receptors), and additional therapies (chemotherapy or radiation) used to treat breast cancer. Reconstruction has no know effect on the recurrence of cancer in the breast, nor does it generally interfere with detecting cancer if it does not return. The surgical, medical, and radiation oncologist will discuss your risk of cancer recurrence with you and decide upon the methods or tests used to detect the cancer. Dr. Stanwix may recommend continuation of clinical breast exams on the reconstructed breast. If your breast reconstruction involves a silicone implant, the FDA recommends that you get an MRI to check for rupture at 3 years, and then every 2 years after that.
Making a Decision
Many options are available for breast reconstruction. Dr. Stanwix will recommend the best options for you based on your body size, shape, medical issues, personal values, personal preference, cancer, and need for chemotherapy or radiation. As you consider the options recommended by Dr. Stanwix, ask yourself the following questions:
· How do I want to look in and out of my clothes?
· How much time am I willing to spend recovering from surgery?
· What physical activities do I participate in that could be affected by surgery to my belly, back, or buttocks.
Use the answers to these questions to help you chose what option you like
Surgical Complications and Risk
Many women who must lose their breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with these procedures. During the consent procedure Dr. Stanwix will discuss all the risks and benefits of the procedures.
The plastic surgery procedure recommended for you is safe, is likely to have benefits for your body, and is well planned. You have requested this because you seek a change in your body, to improve and heal it.
There are certain aspects of your healing that we will have no control over-how predictable healing is will depend on your skin, underlying muscle and bony structure, and hereditary influences as well as dietary factors. Be patient, neither you nor Dr. Stanwix can speed up your body’s healing mechanisms. Slight irregularities and under correction or small scars may result. Minor correction later is preferable to excessive operation and over-operation at the initial procedure.
Plastic Surgery procedures are not magical. They are technically detailed procedures designed to improve specific aspects or your breast reconstruction. Plastic surgery does not perform miracles. It is a combination of art and science, and it is not an exact science. Some of the factors involved in the outcome (such as your specific healing characteristics) are not within Dr. Stanwix’s control, and therefore is it not possible to guarantee and result.
Dr. Stanwix does guarantee his credentials, best effort, honest education, training, and compassionate care individualized to your needs. Dr. Stanwix is a Board Certified Plastic Surgeon invested in your care and your outcomes; however, no result is ever totally perfect. If you feel that you can focus on the degree of improvement instead of any small imperfection, then you will enjoy the result of your operation. If small imperfections will prevent you from focusing on the degree of improvement, then you should probably reconsider your surgical choices.
Not every imperfection should be operated on. Repeat operation involves more risks and is thus less predictable. It is illogical to envision the prefect body or body part and try to create that image on your body. Dr. Stanwix wants to work with you during your breast reconstruction journey and make it more harmonious. All plastic surgery procedures are tradeoffs of risks and benefits, and the decision is yours. Dr. Stanwix is excited to be a part of the decision making process and will help you carefully and deliberately.
In terms of breast reconstruction, the usual risks of surgery can occur, but are relatively uncommon: pain, chronic pain, bleeding, infections, fluid build-up, excessive scarring, wound healing problems, blood clots in the legs, and difficulty with anesthesia. With any surgery, smokers should be advised that it can increase problems with wound healing, resulting in conspicuous scarring and prolonged recovery. Additional complications such as asymmetry, bulges, numbness, implant rippling or exposure, failure or loss of implants, and partial or complete loss of flaps may occur depending on your breast reconstruction surgery. Dr. Stanwix will discussion these complications with you during your appointment. Rarely, these complications are severe enough to require a second operation.
Preparing for surgery
You can begin talking about reconstruction as soon as you are diagnosed with cancer, or when you find out that you are genetically predisposed to cancer. Dr. Stanwix will work together with you to develop a strategy that will put you in the best possible condition for reconstruction.
After evaluation, Dr. Stanwix will explain which reconstruction options are most appropriate for your age, health, anatomy, body type and goals. Be sure to discuss your expectations openly. Post mastectomy reconstruction can improve your appearance and renew your self confidence---but keep in mind that the desired result is an improvement and not perfection.
Once you have scheduled a surgery date, Dr. Stanwix will provide you with specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain medications or vitamins. Dr. Stanwix will also give you information regarding blood work and tests needed prior to surgery. Dr. Stanwix will have you undergo a CT scan prior to any free tissue breast reconstruction.
After surgery
Your first follow up visit following your surgery will be within the first 5-7 days after you are discharged from the hospital. At this visit, Dr. Stanwix will see how your newly reconstructed breasts are healing, as well as your donor sites. You may have one or more of your drains pulled if they are ready, sutures may also be removed, and a thorough examination will assure that you are on the proper post-operative track. Dr. Stanwix will discuss the next step in the process and answer any questions you may have regarding activity or anything else.
Feeling yourself again
Many women want to know when they can get back to doing everyday things like driving, carrying shopping bags, or doing housework and gardening. This will vary depending upon the type of surgery you have had and upon you as an individual.
It is usually fine to start driving again when you feel that you could safely do an emergency stop or moving the steering wheel around suddenly and are NOT taking any pain medicine. Some women find this possible to do within a few weeks of surgery, and others find it takes longer. Some automobile insurance companies have specific guidelines about when you can drive again after an operation, so it is helpful to check with them before doing so.
Follow the advice of Dr. Stanwix about when to begin stretching exercises and normal activities. As a general rule, you will want to remain from any overhead lifting, strenuous sports, and sexual activity for three to six weeks following reconstruction. You should also be referred to a physical therapist both before and after your surgery for exercises to help with recovery.
Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Never place a heating pad or ice pack on your breast after you have had a mastectomy for the risk of possible burns or frost bite. Ask Dr. Stanwix about the possibility of a highly innovative technique of reconnecting nerves during DIEP flap surgery.
Thank You
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Dr. Stanwix would like to thank you for choosing him to provide your care. Dr. Stanwix looks forward to working with you to restore your femininity and support you looking and feeling your best!