Breast Reconstruction

The Procedure

Dr. Simon has a special focus in his practice which involves the care of breast cancer patients. In order to perform these duties effectively, Dr. Simon works closely with a multi-disciplinary team of physicians, including: a surgical oncologist specializing in breast cancer surgery, radiation oncologists and medical oncologists. Working together and communicating effectively with the variety of doctors involved in a breast cancer patient’s care is paramount to a successful outcome.

CERTIFIED

Your Surgical Experience

There are choices to be made when a patient faces a diagnosis of breast cancer. Many of these decisions are made during the consultation with the surgical oncologist. Dr. Simon will also review the options and surgical plan from the oncologist and aid patients in the decision making process.

If you are a smoker, you may be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Dr. Simon utilizes several medications during the surgery that will lead to increased comfort in the postoperative period. A long acting local anesthetic will be placed in the area under the muscle along with the implant which will significantly decrease postoperative pain.

Before & After Gallery

Breast Conservation Surgery (A Portion of the Breast Tissue is Removed)

– Lumpectomy: Surgery to remove a tumor and a small amount of normal tissue around it. – Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy. Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy – called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after and always through a separate incision. Although these options do not involve removing the entire breast , there are times when a plastic surgeon will be involved to aid in reconstructing the breast even if not completely removed.

Surgical Treatments Removing the Entire Breast

– Total mastectomy: Surgery to remove the whole breast that has cancer – also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after through a separate incision. – Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscle. Dr. Simon will typically recommend the use of special types of breast implants called tissue expanders for the initial stage of breast reconstruction. These special implants are temporary, placed to aid in stretching the remaining tissues (muscle and skin) to allow creation of the new breast mound and ultimately placement of a soft, natural-feeling silicone gel implant.

Breast Reconstruction Options

There are multiple options for reconstruction of the breast. Two main categories of reconstructive techniques are: – Surgery involving transplanting tissue (skin / fat / muscle) from one area of the body (typically abdomen or back) to the chest to reconstruct the breast. – Surgery involving the use of breast implants. – Hybrid surgery – involving the use of patient’s own tissue and implants. The surgical techniques involving use of patient’s own tissues (typically from the abdomen or back) are usually reserved for salvage options – in the case of problems with implants based reconstructions or in cases involving radiation therapy as part of the breast cancer treatment plan.

Important Points About the Reconstructive Process

The stage of development of the cancer when it was discovered

The follow-up treatment that you will require

Your overall health

Your chest structure and overall body shape

Your healing capabilities (which can be affected by smoking, alcohol and various medications) – Smokers, or those exposed to secondhand s smoke, will be advised to eliminate exposure to nicotine immediately to reduce the negative effects on wound healing.

Prior breast surgeries

Bleeding tendencies

Infections

Possible shifting of the implant

Scarring from the incision

Predisposition to develop a hardened capsule around the implant

Additional Information:

– Reconstruction surgery is usually performed on an inpatient basis in an operating room, under general anesthesia, when it begins at the same time as your mastectomy. Patients can expect a 1- 2 night stay in the hospital.

– Some of the stages, such as nipple reconstruction, or placement of the implant after soft tissue expansion, can be done as an outpatient procedure.

– When Dr. Simon is involved in the breast reconstruction process, he will design the incision that will be utilized for the mastectomy or lumpectomy and assist the general surgeon in this portion of the surgery. The incision design will be determined to give each patient the best possible result. For example, in certain breasts, Dr. Simon may design the incision to effectively perform a lifting of the remaining skin and tissues to produce a better, more aesthetically pleasing final result. This type of cooperation between the plastic surgeon and general surgeon is essential to obtaining the best result possible both from the oncology standpoint and reconstruction side.

– Recovery – patients will be required to limit their activity level for approximately 2 weeks after surgery. Patients will typically be instructed that they may return to work after this time period. Most patients will be able to resume more strenuous physical activities, such as exercise, after period of six weeks. Often, patients will also be referred to physical therapy after a mastectomy by the general surgeon.

Tissue Expanders

– Placement: A tissue expander is a balloon-like device made from elastic silicone rubber. To place the expander during a mastectomy, the general surgeon removes skin as well as breast tissue. To create a breast-shaped space for the breast implant, a tissue expander is placed under the remaining chest tissues (muscle and skin).

– The process: It is inserted unfilled or with a small amount of saline, and over time sterile saline fluid is added by inserting a small needle through the skin and into the tissue expander’s filling port. As the tissue expander fills, the tissues over the expander begin to stretch gradually. The tissue expander creates a new breast-shaped pocket for a breast implant. These expansions are performed in Dr. Simon’s office. The process starts within a few weeks of surgery and typically is continued every week or two until completion. The end point of expansion will be determined for each patient by Dr. Simon with consideration of the patient’s goals as far as breast size.