News in Breast Reconstruction Surgery

There is more than one way to reconstruct a breast after mastectomy. More and more women are opting for reconstruction at the exact same time as mastectomy. Many women with the “breast cancer gene” are also having this combination surgery electively, before they are stricken with cancer.

When doing this sort of immediate reconstruction, I usually rely upon a medical device called a tissue expander. How it works is the breast surgeon does the mastectomy and then I step in. I prepare a pocket much in the same way we would if it were a breast implant case. But the tissue is tight, because of the breast removal, which may or may not include the nipple-areola. Because of this tightness and thinness of the skin, I add a new layer called a dermal matrix implant. This is skin from a donor that has been sterilized and purified so that it is not reactive to our patient. I insert the tissue expander beneath that and do a plastic surgery closure on the skin.

A tissue expander is much like a saline breast implant with one big difference. It has a metal port that allows me to add more saline to it and expand, or stretch the skin in the weeks that follow. I see my patient weekly and gradually the expander makes room for the final implant. A month or two after the first stage we do another, more minor surgery to replace the expanders with the final implant. The result is sometimes more aesthetically appealing than the patient’s original breasts.

In cases where the patient does not want an implant, and only one side is being reconstructed, there is another option. The DIEP flap. That stands for Deep Inferior Epigastric Perforators flap.

Here’s how works: We take a section of the abdominal skin and it’s attached fat and do a tummy tuck. Then we save the little blood vessels that go to the skin, rather than just cut them as we do when we are tucking a tummy. We carefully preserve these vessels, the veins and arteries because we are going to plug them in to blood vessels in the chest. It is very meticulous work that involves using a microscope to place tiny sutures in to the blood vessels and attach them like a miniature plumber would attach pipes. It’s a long surgery but he best surgeons work in teams to help reduce the surgery time and increase success rates.

California law mandates insurance to cover breast reconstruction surgery. Because of this law, better techniques, genetic testing and the publicity of reconstruction (ie: Angelina Jolie) the popularity of breast reconstruction has sky rocketed. These women are some of my most grateful patients