There are several breast reconstruction methods, and the many options available can feel overwhelming during an already difficult time. Dr. Asif Bhatti is committed to ensuring that each patient understands her options and feels comfortable and confident in the decision she and Dr. Asif make together.
Breast Reconstruction
Implant Reconstruction
Reconstruction of the breast using a saline or silicone permanent implant is one option. This is performed in two stages. The first stage involves placement of a tissue expander underneath the pectoralis muscle. This is typically done at the same time as the mastectomy. Over the following few weeks, once your incisions are well healed, we expand these “balloons” through a small port accessible right underneath the skin with injectable saline. Once you have reached a size that you like, we schedule you for the second stage, removal of the expander and placement of the permanent implant.
The initial surgery takes approximately 1-2 hours in addition to your mastectomy surgeon and depending on whether we are reconstructing one or both of your breasts. The initial hospital stay is usually 1-2 days.
For the second stage surgery where we remove the expander and place a permanent implant, you can return home that same day. This second surgery takes only an hour or two. The total recovery time for implant reconstruction is 3-4 weeks for the first stage and approximately 1 week for the second.
There are many good reasons why implant reconstruction might be the best option for you, although it is best to keep all of your options open as you discuss your treatment with our surgeon.
Autologous Tissue Reconstruction
Autologous tissue reconstruction is offered to patients through two different techniques: a pedicled (or attached) flap or by a free flap microsurgical technique. Because Dr. Asif specializes in microsurgery, we are able to provide you with a free flap for reconstruction of the breast. The “free” flap is named as such because in order to perform this operation, the tissue is “freely” removed from your body for reattachment.
The most common donor site for breast reconstruction is the abdomen. Here there are three major flaps that we can use for your reconstruction: the SIEA (superficial inferior epigastric artery flap), the DIEP (deep inferior epigastric perforator flap) and the free TRAM (or transverse rectus abdominis myocutaneous flap). Another newer less common site for breast reconstruction is the upper inner thigh using the myocutaneous gracilis flap or TUG flap. This flap has the added benefit of giving you a natural breast without leaving you with any functional deficit as the gracilis is a redundant muscle of the adductor muscles in the thigh. Dr. Asif performs all of these operations on a routine basis, both for one sided and two sided defects. Ask him during your consultation which flap will be best for you.
On average, operating time for these flaps is 4-8 operating hours, depending on if we are reconstructing you with one or two breasts. You will always spend at least two to three days in the hospital for the nursing staff to monitor your new tissue reconstructions. Total recovery time for the abdominal based tissue flaps is 6-8 weeks. For the gracilis or TUG flap the recovery is even faster, closer to 3-4 weeks. Most patients are completely happy with their first surgical results and a few require revisions, but you can expect to return to full activities within 2-3 months.
Nipple Sparing
A nipple-sparing mastectomy, is a way to remove breast tissue, and save the breast skin and nipple. This allows the woman to maintain her nipples, in which the traditional mastectomy does not. The nipple-sparing procedure removes cancerous breast tissue, and removes the ducts and tissue behind the nipple. The surgeon leaves most of the breast skin, creating a natural skin envelope, or pocket, that is filled with a breast implant or with the patient’s own tissue from another part of her body. The nipple-sparing techniques significantly improve the cosmetic outcome and gives a nice option for patients but not appropriate for all patients.
It is important to remember that not all patients are candidate for this procedure. It is important to consult with your breast surgeon and your plastic surgeon to find out if you are a good candidate for this type of breast reconstruction.
Nipple Reconstruction
After breast reconstruction you can decide if you’d like to have your nipple reconstructed. Nipple reconstruction is done after the reconstructed breast has had time to heal.
The nipple would be reconstructed from the surrounding skin at the desired placement. Dr. Asif makes small incisions and then elevates the tissue into position, forming and shaping it into a living tissue projection that mimics the natural nipple.
The new nipple can then be tattooed to add color and create the areola around the nipple.
3D Nipple Tattooing
3-D nipple tattoos are a non-surgical option and offer very realistic results. This is accomplished by real tattoos that use oscillating needles coated with pigment. This approach essentially creates a “picture” of a nipple and has no physical dimension, but it can look quite real.
What to Expect
Before and After Surgery
Pre-Operation
One week before surgery you’ll meet with Dr. Asif’s staff to have pre-operative visit. On the day of surgery, you will be seen and have an opportunity to meet with Dr. Asif. He will review your procedure with you and perform an exam to confirm that you’re in good health for your surgery. You may have paperwork to complete or be given prescriptions to fill; we may also take “before” photos. As always, we will answer any questions and discuss any concerns so that you feel completely confident as your surgery approaches.
Final Preparation
One day before your surgery, confirm the arrangements for your procedure (including transportation) and to prepare your home for a relaxing and comfortable recovery. Shower with antibacterial soap, avoid eating or drinking after midnight, and be sure to follow any other specific instructions provided by Dr. Asif and our staff. Please remember to avoid Aspirin, Vitamins and other homeopathic medications unless specifically discussed with Dr. Asif and staff.
Surgery
Please plan to arrive early to check in and prepare for your procedure. You should wear loose-fitting, comfortable clothes, and leave jewelry and valuables at home. You can expect to remain in the recovery room for several hours following completion of the surgery. When you get home, start taking your pain medication and antibiotics, and limit your activity for at least the next 24 hours.
Recovery
We will schedule follow-up appointments as necessary throughout your recovery. Dr. Asif will assess your healing, remove or change dressings, and document your results. Based on your progress, he will also let you know when you can expect to resume normal activities.
