Breast Reconstruction in Birmingham AL
Plastic Surgery Techniques for Breast Restoration
Breast Reconstruction is designed to restore one or both breasts to near normal shape and appearance following mastectomy, lumpectomy or congenital deformities. Restoring your feminine form and symmetry with breast reconstruction can have immense self-image, self-confidence and qualify of life benefits.
Breast reconstruction generally falls into two categories — implant-based reconstruction and flap reconstruction. Implant reconstruction relies on breast implants to help form a new breast mound. Flap, or autologous, reconstruction uses the patient's own tissues from another part of the body to form a new breast.
The Birmingham, Alabama plastic surgeons at Hedden & Gunn Plastic Surgery strive to make your breast reconstruction experience as positive as possible. Our goal is to use the latest techniques to create a new breast and nipple that mirrors the size, shape and position of the natural breast as nearly as possible.
Breast Reconstruction Candidates
You may be a candidate for breast reconstruction if:
- You are able to cope well with your diagnosis and treatment.
- You do not have additional medical conditions or other illnesses that may impair healing.
- You have a positive outlook and realistic goals for restoring your breast and body image.
Although breast reconstruction can rebuild your breast, the results are highly variable:
- A reconstructed breast will not have the same sensation or feel as the breast it replaces.
- Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
- Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.
Breast reconstruction often involves multiple procedures performed in stages, beginning at the time of mastectomy or delayed.
If only one breast is affected, it alone may be reconstructed. In addition, a breast lift or breast augmentation may be recommended for the opposite breast to improve symmetry of the size, shape and position of both breasts.
Your Breast Reconstruction Consultation
During your breast reconstruction consultation, be prepared to discuss:
- Your surgical goals.
- Medical conditions, drug allergies and medical treatments.
- Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use.
- Previous surgeries.
Your breast reconstruction plastic surgeon will also:
- Evaluate your general health status and any pre-existing health conditions or risk factors.
- Examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolas.
- Take photographs for your medical records.
- Discuss your options and recommend a course of treatment.
- Discuss likely outcomes of breast reconstruction and any risks or potential complications.
- Answer any questions you have about your breast reconstruction.
Breast Reconstruction Risks and Safety
Your plastic surgeon and/or staff will explain in detail the relevant risks associated with your specific surgery. You may be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications. The decision to pursue breast reconstruction does not change your risk of breast cancer recurrence.
The possible risks of breast reconstruction include, but are not limited to, bleeding, infection, poor healing of incisions and anesthesia risks. You should feel free to ask any questions to help you understand the risks.
Patients should also be aware that:
- Flap surgery includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.
- Breast implants carry the risk of breast firmness (capsular contracture), implant rupture and other risks associated with breast implants.
- Acellular dermal matrix products may have a higher chance for complications or problems.
Preparing for Breast Reconstruction
In preparing for breast reconstruction surgery, you may be asked to:
- Get lab testing or a medical evaluation.
- Take certain medications or adjust your current medications.
- Stop smoking.
- Avoid taking aspirin, anti-inflammatory drugs and herbal supplements, which can increase bleeding.
Surgery for your breast reconstruction is most often performed in a hospital setting, possibly including a short hospital stay. Your doctor will likely use general anesthesia. Some follow-up procedures may be performed on an outpatient basis with the use of local anesthesia with sedation. These decisions will be based on the requirements of your specific procedure and in consideration of your preferences and your doctor's best judgment.
Breast Reconstruction Procedure
Breast reconstruction surgery is performed using intravenous sedation or general anesthesia. Your surgeon will recommend the best choice for you.
Flap techniques reposition a woman's own tissue to create or cover the breast mound.
A mastectomy or radiation therapy will sometimes leave insufficient tissue on the chest wall to cover and support a breast implant. In these cases, breast reconstruction usually requires either a flap technique or tissue expansion.
A TRAM flap uses donor muscle, fat and skin from a woman's lower abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.
Alternatively, your surgeon may choose the DIEP flap or SIEA flap techniques, which do not use abdominal muscle but transfer only skin and fat to the chest from the abdomen. If there is insufficient tissue on the lower abdomen, other donor sites such as the buttocks or thighs may be selected (SGAP flap, TUG flap, PAP flap).
A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.
The flap can occasionally reconstruct a complete breast mound, but often the latissimus flap provides the muscle and tissue necessary to cover and support a breast implant.
Tissue expansion stretches healthy skin to provide coverage for a breast implant.
Implant-based reconstruction is an option for women who do not require breast radiation and would like to avoid a separate donor site. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but can be more lengthy.
Tissue expansion usually requires several office visits over 1 to 2 months after placement of the expander to gradually fill the device with saline through an internal valve to expand the skin. Newer air-filled devices may allow patient-controlled expansion at home using a remote dosage controller.
A second surgical procedure is needed to replace the expander if it is not designed to serve as a permanent implant.
Using a breast implant to create a breast mound can be an addition or alternative to flap techniques. Surgeons may also use an implant as a temporary placeholder during other breast cancer treatments until you are ready for more involved flap reconstruction techniques. Saline and silicone implants are available for reconstruction.
Your surgeon will help you decide what is best for you. Reconstruction with an implant alone usually requires tissue expansion. Direct-to-implant breast reconstruction may be an option for some women undergoing mastectomy with certain tumor characteristics and breast shapes.
For women who are not candidates for nipple-sparing mastectomy, breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola. Techniques usually involve folding skin to create the shape of a nipple followed by tattooing. Three-dimensional nipple-areolar tattooing may be used alone to create the appearance of a realistic nipple with the illusion of projection. Breast reconstruction outcomes can often be enhanced with staged revision procedures that improve symmetry, use liposuction with fat grafting and improve the appearance of the donor site.
Breast Reconstruction Recovery
Following your breast reconstruction surgery, gauze or bandages may be applied to your incisions. An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.
Your plastic surgeon will give you specific instructions on how to care for yourself after surgery. Following these instructions is essential to the success of your breast reconstruction. The instructions may include:
- How to care for your surgical site(s) following surgery.
- Medications to apply or take orally to aid healing and reduce the risk of infection.
- Specific concerns to look for at the surgical site or in your general health.
- When to follow-up with your plastic surgeon.
Healing will continue for several weeks while swelling decreases and breast shape/position improve. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.
Seek medical attention immediately if you experience shortness of breath, chest pains or unusual heartbeats after going home. You may require hospitalization and additional treatment if any of these complications occur.
The surgical incisions should not be subjected to excessive force, abrasion or motion during the time of healing.
Breast Reconstruction Results
The final results of breast reconstruction can help lessen the physical and emotional impact of mastectomy. Most women feel that any trade-offs are small compared to their quality of life improvement and the ability to look and feel whole.
Over time, some breast skin sensation may return and scar lines will improve, although they will never disappear complet ely. Careful monitoring of breast health through self-exam and other diagnostic techniques is essential to your long-term health.
Although good results are expected from your breast reconstruction, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure, and additional procedures may be necessary.
Breast Reconstruction Words to Know
- Areola: Pigmented skin surrounding the nipple.
- Breast augmentation: Surgical breast enlargement, or augmentation mammaplasty.
- Breast lift: Surgery to lift the breasts, or mastopexy.
- Breast reduction: Reduction of breast size and breast lift by surgery.
- Capsular contracture: A complication of breast implant surgery which occurs when scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm.
- DIEP flap: Deep Inferior Epigastric Perforator flap, which transfers skin and fat from the abdomen.
- Donor site: An area of your body where the surgeon harvests skin, fat and muscle to reconstruct your breast, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.
- Fat grafting: A surgical technique that transfers fat obtained by liposuction to enhance breast reconstruction by adding volume under the skin.
- Flap (autologous) techniques: Surgical techniques used to reposition your own skin, fat and muscle to reconstruct or cover your breast.
- General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
- Hematoma: Blood pooling beneath the skin.
- Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
- Latissimus dorsi flap: A surgical technique that uses muscle, fat and skin tunneled under the skin and tissue of a woman's back to the reconstructed breast and remains attached to its donor site, leaving blood supply intact.
- Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
- Mastectomy: The removal of the whole breast, typically to rid the body of cancer.
- PAP flap: Profunda Artery Perforator flap, which transfers skin and fat from the upper thigh.
- SGAP flap: Superior Gluteal Artery Perforator flap, which transfers skin and fat from the buttock.
- SIEA flap: Superficial Inferior Epigastric Artery flap, which transfers skin and fat from the abdomen.
- Tissue expansion: A surgical technique to stretch your own healthy tissue and create new skin to provide coverage for a breast implant.
- TRAM flap: Transverse Rectus Abdominis Musculocutaneous flap, a surgical technique that uses muscle, fat and skin from your own abdomen to reconstruct the breast.
- TUG flap: Transverse Upper Gracilis flap, which transfers skin, fat and muscle from the inner thigh.
Procedure Information © American Society of Plastic Surgeons
Breast Reconstruction restores your feminine form with a breast of near normal appearance following mastectomy.
Birmingham, AL Office & Surgery SuitesHedden & Gunn Plastic Surgery
140 Village Street
Birmingham, AL 35242
205-980-1744 or 800-HeddenMD * Dr. William Hedden, Dr. Stephen Gunn
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Questions About Breast Enhancement?
To learn more about Breast Reconstruction in Birmingham, AL, please contact the plastic surgeons at Hedden & Gunn today.
To schedule your consultation at the earliest possible date, please call 205-980-1744.
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