Bill: How are breast implants supported in a patient that has a mastectomy?
Dr. Childers: Patients that have a skin-sparing mastectomies where the surgeon has been able to preserve a large amount of breast skin can have enough tissue to support the implants and the many times we can perform an immediate reconstruction.
Other times we need to first implant a tissue expander that we put underneath the tissue. Usually it’s underneath the pectoralis major muscle, where we expand the muscle along with expanding the skin. With this process, slowly over time in our office, fluid is placed within the tissue expander and it slowly stretches and gets larger and larger. This stretches the skin so that we can come back later, take out the tissue expander, and put in a permanent implant.
Bill: What are some of the alternative reconstruction procedures where the patient’s tissue is used for reconstruction instead of implants?
Dr. Childers: When we take a patient’s tissue from one part of the body to use for reconstructing the breast we refer to the section of tissue as a flap. The breast is primarily fatty tissue and in this type of reconstruction we are moving a flap of fatty tissue to replace fatty tissue in the breast.
One of the typical areas where patients have fatty tissue available is in the lower abdomen, and often the patient has excess fat in this area. When a patient has excess fat in the lower abdominal area, below the navel, the flap and skin removal is similar to a tummy tuck, so we also achieve some body contouring in this area. A lot of our patients like that, because now they’ve gotten rid of their tummy that they didn’t like. The incision and closure for the abdomen is down at the lower part of the abdomen, which is relatively hidden underneath underwear or a bathing suit. There are scars, but they’re very well hidden in most patients. It’s the same incision as a tummy tuck and pretty much the same thing as a C-section scar.
If the patient does not have enough fat and skin in the lower abdomen, we can use tissue from the back, but there will be a resulting scar on the back. Many women don’t like a scar on their back, because if they are wearing a bathing suit, the scar will likely be visible. There is also the possibility of using the gluteal flap, which comes from the gluteal region or the buttock region of the patient.
In our patient consultations we help them understand the tradeoffs among the many reconstruction alternatives. One key choice relates to the use of a tissue expander and implants vs. using a tissue flap. If a patient doesn’t have enough tissue from the tummy, that generally means they need the tissue expander followed by implant procedure. If they don’t need irradiation and we can insert an expander at the same time as the mastectomy, the patient will be left with only one linear scar in the breast where the general surgeon went through and removed the breast tissue.
Bill: When a woman is seeking a plastic surgeon to discuss breast reconstruction, what specific qualifications of a plastic surgeon should she be looking for?
Dr. Childers: Patients should seek out a plastic surgeon that is board certified by the American Board of Plastic Surgery. That’s like a “seal of approval” from the major national certification board. Breast reconstruction is a specialized field within plastic surgery and it is important to be able to see the kind of work the plastic surgeon has done in terms of reconstruction, so patients will want to view their portfolio of before-and-after photos to demonstrate the results they have achieved. Years of experience and the quality of medical school and other training are other important indicators. The surgeon will need to be able to work in hospitals, so patients are advised to check the surgeon’s hospital privileges.
Bill: Dr. Childers, thanks for providing information for our readers on breast reconstruction alternatives. If prospective patients want to find out more about these procedures, how can they get more information?
Dr. Childers: You are welcome, Bill. I suggest they visit our website for more information. They can visit http://www.BenChildersMD.com.
