Understanding Breast Reconstruction

By Kristen Penfield

As we direct our attention to Breast Cancer during the month of October, an important focus for women is breast reconstruction after a mastectomy, lumpectomy or biopsy. CNY Cosmetic & Reconstructive Surgery, LLC is a leader in Central New York in the area of breast reconstruction.

Beth Phillips

Beth Phillips

Beth Phillips, RPAC has the knowledge and experience to provide expert care for patients of the Syracuse plastic surgery practice. Phillips began her career as a Physician Assistant at the Cortland Memorial Emergency Room. She furthered her surgical skills and education by working at St. Joseph’s Hospital as a Physician Assistant and the Coordinator of the Surgery PA Department. In 2000, she went into private surgical practice for a highly experienced general surgeon who focused on breast and thyroid surgery. Beth, for the past 11 years has been working with Dr. Deboni, a respected plastic surgeon serving Syracuse, NY. Beth’s knowledge and experience with cosmetic and reconstructive procedures is extensive. Phillips tells us that approximately 40% of the overall patients they treat come for breast reconstruction and that surgery is typically performed after a patient has had a mastectomy, lumpectomy, or biopsy in cases where a lot of breast tissue has been removed.

Phillips says, “While the majority of reconstruction is done using implants, there is something called Autologous Tissue Reconstruction where a patient’s own tissue is used for part or all of the reconstruction. Sometimes there are extenuating circumstances that make implant reconstruction impossible or in other cases, simply patient preference.”

“The most common tissue (called a “flap”),” adds Phillips, “is used from the abdomen. The skin flaps have soft tissue attached to a muscle that has a healthy blood supply to keep the tissue viable or “alive” when placed where it is needed for the reconstruction.”  Phillips notes that the common flaps are: TRAM/DIEP, using tissue from the abdomen, latissimus from the back, gluteal from the buttocks and gracilis from the inner thigh. However, these tend to be much more involved surgeries and not suitable for every patient. This decision should be made in conjunction with your reconstructive surgeon as to whether or not a patient is a good candidate.

Phillips informed us of another procedure that has become more common for patients who have surgical defects from lumpectomy. This is called Structural Fat Grafting.  “This procedure involves liposuction of fat from one area of the body and placing it into an area that is lacking tissue. If done properly, the majority of the fat will survive and fill in the defect.”

Phillips wants to make it clear that mastectomies can be done safely with attention still being paid to the cosmetic outcome. “Based on the stage and location of the cancer, or if the surgery is being performed prophylactically, mastectomies can be ‘skin sparing’ or ‘nipple sparing’ and the decision where the incision can be best hidden are all topics that should be addressed with your breast surgeon and reconstructive surgeon.” In cases where it is safer to remove the nipples, nipple reconstruction is done to make the breasts looks as natural as possible, said Phillips.

Phillips outlines the steps a patient will typically follow after a cancer diagnosis and/or learning they need to have surgery. “A patient will come to us after having seen a general surgeon who is planning on doing their mastectomy. Though she noted different approaches to reconstruction, it is mostly done through implant reconstruction. Phillips said,“General surgeons perform the mastectomy then the plastic/reconstructive surgeon places the tissue expander under the breast muscle to stretch the muscle slowly.” She notes that it is very important to stretch the muscle so it doesn’t thin out. If the patient requires chemotherapy or radiation, when it is completed, the doctor removes the tissue expander and inserts the implants. Sometimes the definitive implant can be placed at the time of mastectomy, this is called a one-stage reconstruction. Beth adds, “Most women can typically drive within two weeks and can go back to work 3-6 weeks following surgery.  To clarify, Beth notes that the tissue expanders are the temporary implants and are filled with saline. Most patients choose silicone for their permanent implants because it tends to give a more natural look and feel. Phillips is aware of the old belief that silicone can be harmful and shares that recent studies have debunked this claim. Silicone is used widely and successfully.

Beth takes a highly personal approach with her patients assisting Dr. Deboni in surgery and meeting with them during office visits and procedures. Her biggest piece of advice? “Women must be informed and know all of their available options,” states Phillips. “As with all major medical procedures, the more information gathered from their doctors, the better. If someone is considering reconstructive surgery in the future rather than immediately following their mastectomy, we highly recommend speaking to a plastic surgeon prior to making this decision. Factors such scar location or planning the surgery around radiation or chemotherapy schedules is beneficial to be considered in advance and can greatly affect outcomes,” she added.

For additional information on breast reconstruction, including a 3D video animation of the process and all other procedures offered at CNY Cosmetic & Reconstructive Surgery visit: www.plasticsurgeryofsyracuse.com