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Breast Reconstruction Surgeries

Breast reconstruction most commonly involves recreating the breast shape following a mastectomy on one or both sides. This is a very involved topic that is best discussed in detail at your 1-hour consultation with Dr. Bateman so he can tailor your plan based on: your medical history, surgical history, your breast shape, your opportunity for a nipple-sparing vs. skin-sparing mastectomy (a decision discussed with both Dr. Bateman and your breast surgeon), the upcoming treatments such as chemotherapy or radiation, and your previous history of radiation.

There are four main options for breast reconstruction. The common theme for all of the reconstruction options is that they are staged procedures (almost always more than one), and that they all have both pros and cons, and Dr. Bateman will discuss all of these options with you to help to determine which is right for you:

  1. Direct-to-implant reconstruction – In cases of nipple-sparing mastectomies and reasonable reconstruction size range goals, or, in cases of previous breast augmentation, we can often skip the tissue expander stage of the reconstruction and place the final implant at the time of the mastectomies. We will certainly discuss details of this further at your consultation, but a number of factors need to work in your favor to be able to accomplish this – particularly a robust blood supply in the skin immediately following the mastectomy portion of your surgery. Ultimately our goal is always to go direct-to-implant if you are a candidate, but this is a decision we finalize during the operation.
  2. Tissue expander followed by an implant In cases where you are not a candidate for direct-to-implant reconstruction (for instance, if you need to have skin-sparing mastectomies, or in you’ve had previous radiation, if the blood supply is not adequate in the mastectomy flap, or if you have previous mastectomies without reconstruction), a tissue expander will be placed at the time of the initial mastectomies. This allows the skin to recover following the mastectomy, prior to stressing it further with the full volume of the implant, and it and it gives the skin time to stretch to better accommodate the implants at a later date. This tissue expander is an air-filled device (similar to the shape of an implant), which we then access in the office to volumize with saline over the course of a few weeks during recovery. You then schedule a second surgery to replace the tissue expanders with silicone implants, but the timing for this surgery varies greatly (~3-15 months) depending on what, if any, additional breast cancer treatments will be needed (such as chemotherapy or radiation therapy).
  3. Latissimus flap – This is most commonly performed to help correct post-radiation problems such as asymmetry, capsular contracture or infection. This procedure utilizes the latissimus muscle from your back and a small portion of the skin and fat overlying it. The muscle and skin are rotated through a tunnel from high in your armpit from your back, and brought around to the chest to replace a portion of  the damaged radiated tissue on the breast. This will require an initial tissue expander in order to have adequate volume for the breast reconstruction which will be exchanged for a silicone implant at a second surgery.
  4. TRAM or DIEP flap – Although Dr. Bateman no longer performs TRAM or DIEP flaps, they are available through other providers in Denver. These are reconstruction options that utilize your lower abdominal tissue to recreate the breast mound. When distant tissue is utilized for breast reconstruction, the blood supply must be maintained through a pedicled flap (TRAM flap) or a free flap with microsurgery (DIEP flap).  A TRAM flap utilizes a portion or all of the rectus abdominis muscle (one side of your 6-pack muscle) for each side, and this muscle is rotated up into the reconstruction pocket; vs the DIEP flap technique spares the rectus muscle by surgically detaching the the blood supply with the abdominal skin and fat, and then re-attaches it onto the chest under a microscope. 

Fat Grafting to Reconstructed Breasts – This is one of our favorite finishing touches for breast reconstruction. We perform liposuction from one area of the body and process the fat that we remove. This fat can then be re-injected over the implant, within the mastectomy flap, in order to smooth contours, help correct wrinkling, and sometimes even improve the overlying skin quality. Obviously, you need enough fat to donate from another area of the body, and our goal is for as much of the fat to incorporate into your tissue and maintain over time. We know not all of the fat initially sticks around where we place it, and some women might require a second round of fat grafting for aesthetic improvement. We offer fat grafting to nearly all of our reconstruction patients because it can make a large difference in the final result and our patients are typically thrilled with this final step of reconstruction. (FYI, fat grafting also works beautifully for naturally volumizing faces — ask us more about this option!)

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