Have You Suffered From A Mastectomy Or Breast Disfigurement?
- Breast Reconstruction – Quick Glance
- Breast Reconstruction Trim Flap
- Breast Reconstruction Potential Risks
- Breast Reconstruction Postoperative Care
Are you a cancer victim? Have you suffered a debilitating disfigurement due to a mastectomy? Are you ready for breast reconstruction to restore your dignity?
Breast reconstruction is primarily for patients who have had a mastectomy secondary to breast disease or breast cancer. The breast tissues and nipples are excised by the general surgeon. The plastic surgeon then would perform breast reconstruction to help recreate a breast mound to achieve a natural looking breast.
This process will require appreciative communication between the breast surgeon and plastic surgeon. Reconstructive options may be a tissue expansion followed by implants placement, a TRAM FLAP (Transverse Rectus Abdominus Myodutaneous Flap Latissimus Muscle, or an Implants Free tissue transfer.
Schedule your breast reconstruction consultation with Dr. Vu to determine which breast reconstruction option is best for you.
Schedule Your Breast Reconstruction Consultation With Dr. Vu Today By Calling 503.297.8555 or Toll Free 866.297.8522.
This is a procedure covered by CosmetAssure. Learn how Dr. Vu protects you from any potential financial burden from complications by visiting our Complications Assurance page.
Breast Reconstruction – A Quick Glance
Who Is A Breast Reconstruction Candidate?
If you are missing skin and breast tissue following a mastectomy.
Breast Reconstruction Intended Results
Creation of a “breast” that looks essentially normal in clothes and near normal without clothes.
Breast Reconstruction Procedure
- A flap of skin and muscle is elevated from the upper outer back and rotated to the breast defect.
- The blood supply is left intact in the armpit (axilla).
- Usually, but not always, an implant is placed under the flap to provide the correct volume to the reconstructed breast.
- The back defect is closed directly.
- Nipple/areolar reconstruction is delayed until later and is elective.
Breast Reconstruction Recuperation and Healing
- Breast reconstruction is a major procedure requiring several days of hospitalization. Discomfort of the back and reconstruction site will be present for several weeks.
- Full use of the area will require about six weeks of healing.
- All of the sutures will be removed within a month.
Breast Reconstruction Other Options
Additional procedures that would enhance the result are enlargement, lifting, or reduction of the opposite breast, and/or nipple (areolar) reconstruction.
Breast Reconstruction Insurance Guidelines
Usually covered by insurance.
NOTE:
- The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation.
- All surgical procedures have some degree of risk.
- Minor complications that do not affect the outcome occur occasionally.
- Major complications are unusual.
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Breast Reconstruction – Trim Flap
Who Is A Trim Flap Candidate?
If you have loss of breast tissue and skin following mastectomy — one or both sides. If you have loss of breast tissue only following subcutaneous mastectomy If you have a desire for larger breasts (uncommon).
Trim Flap Intended Results
Reconstruction of a missing breast(s) or replacement of breast tissue.
Trim Flap Procedure
A flap of lower abdominal wall fat, muscle (and usually skin), is transferred to the area of missing breast tissue with its own blood supply. In a standard TRAM Flap, the blood supply is within the rectus muscle(s) which is left attached at the lower edge of the rib cage. In a Free TRAM, the blood vessels are reconnected to vessels in the axilla. In a Turbocharged TRAM, the muscle is left attached superiorly, but the inferior vessels are connected in the axilla creating a double blood supply. The abdominal donor site is closed as in a Tummy Tuck, leaving a horizontal scar and a tighter abdomen. An attempt is made to create a “normal” breast mound and shape at the first operation, but subsequent smaller procedures are frequently necessary. Nipple/areolar reconstruction is performed at a later date and is elective.
Trim Flap Recuperation And Healing
A TRAM Flap Breast Reconstruction is a major procedure performed in the hospital and requiring at least several days of hospitalization. Ambulation will begin the day after surgery and be reasonably comfortable within 10-14 days. Complete recovery usually takes about 6 weeks. The abdominal donor site causes the most discomfort during healing.
Trim Flap Other Options
Additional procedures that will enhance the result are enlargement, lifting, or reduction of the opposite breast, and nipple/areolar reconstruction.
Trim Flap Insurance Guidelines
Almost always covered by insurance.
NOTE:
The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are rare.
View Breast Reconstruction Photos
Breast Reconstruction Potential Risks
No surgeries are performed without risks. Dr. Vu’s goal is to perform the planned procedure, take extra precaution during surgery, and most important of all is to be safe and yet achieve utmost optimal outcomes. Following are some of the potential risks that are commonly discussed about regarding breast augmentation.
A: Necrosis
With reduced blood flow, partial flap failure may occur. If the tip or end of the flap necroses, there will usually be enough healthy tissue remaining to obtain a good result. A second surgery will be required to remove the dead tissue and perhaps a third procedure to readjust or reposition the remaining tissue. If all or most of the flap dies because of poor blood supply, the necrotic tissue will need to be removed and the reconstruction completed with an alternate method (usually a latissimus dorsi flap from the back).
B: Hernia formation
During the operation, the rectus muscle (or muscles) is elevated from its bed and the defect repaired. Rarely, the repair fails with time and a protrusion develops. If there are indications that this might happen, some type of mesh will be used to repair the area of potential hernia formation. If a hernia does develop following surgery, mesh is usually placed at a second procedure.
C: Abdominal wall weakness
As part or all of the rectus abdominus muscles are severed to allow transposition(moving) of the lower abdominal tissues to the breast position, some loss of abdominal strength (as required to do activities such as “sit ups”) may occur.
D: Achieving symmetry
The reconstructed breast will probably NOT be exactly the same shape or size as the opposite breast. If the volume is the same and you look “good” in a bra, you may have achieved the desired result. If the opposite breast is significantly larger, a breast reduction may be appropriate. If the opposite breast is smaller, you may wish to have an implant. Dr. Vu will carefully explain all your options.
E: Abdominal wall appeal
A side benefit of TRAM Flap Reconstruction is that you receive a Tummy Tuck as a bonus. Because of the demands of the operation, the resulting abdominal scar may not be quite as attractive or as well located as a Tummy Tuck done for cosmetic appearance only. Your scar, however, will fade and soften over several months. The lower abdomen will be flatter and tighter. Initial reduced sensation usually improves during the first year.
F: Seroma
Pockets of fluid under the skin of the lower abdomen called Seroma are common minor complications. Drains are used postoperatively to help prevent these from forming. Despite this precaution, several needle aspirations in addition to prolonged(4 weeks) elastic binder use may be necessary.
G: Umbilical (belly button) deformity
This may result from the rearrangement of tissues necessary to close the abdominal donor site. The umbilicus may be displaced to either side of the midline or at a higher or lower level than prior to surgery.
H: Numbness
The reconstructed breast mound has no sensation immediately following surgery. Partial sensation may develop with time.
I: Areas of hardness
Occasionally, some of the transferred fat becomes partially necrotic even though the skin and most of the fat survives normally. If this occurs, there may be areas of hardness where the areas of necrosis become “calcified.”
J: Additional surgery
Nipple: If you wish nipple reconstruction, a secondary procedure will be required later. The goal of the first operation is to transfer the abdominal tissue to the breast area and reconstruct missing breast tissue. Obviously, the best possible attempt will be made to complete the reconstruction in one stage. Second and even third or more are sometimes necessary to achieve the best possible result.
I: Asymmetry
The best possible reconstruction may not make the new breast look like the other side. A surgical procedure on the opposite breast is frequently indicated to equalize size or reduce sagging.
J. Alternatives
The alternatives to breast reconstruction with a distant flap include: no reconstruction at all, reconstruction with an implant or expander, or using an alternate type of distant flap. All other surgical procedures have risks.’
K: Smoking
Smoking reduces capillary flow in your skin. We advise you not to smoke at all during the first 10 days after any skin flap surgery.
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Breast Reconstruction Postoperative Care
Special attentions are placed during your postoperative period. My goal is to make sure that you are comfortable after you leave the surgery center, and have proper instructions how to take care of yourself in order for you to have a pleasant surgical experience.
A: Position
Because elevation of the TRAM Flap involves removal of abdominal skin, fat and muscle, you will experience some difficulty standing up straight for 2 or more weeks.
During this period you may find it more comfortable to place a pillow under your knees while in bed. The tightness will gradually disappear as you heal and progressively use your body muscles for the activities of daily living. Please make no special attempts to stretch or pull the abdomen straight during the first two or three weeks of healing.
During the postoperative period, avoid heavy pressure to the reconstructed breast.
B: Activity
You will experience some pain for 10-20 days and will not feel like resuming sports or heavy exercise for at least 6 weeks. After the first two weeks you may resume moderate walks. Too much initial activity can prolong swelling and healing.
C: Use of ice packs
Cold or ice packs help to reduce swelling, bruising and pain. Use frozen peas in a soft pack or crushed ice cubes in a zip-lock bag. If the cold is too uncomfortable, reduce applications.
D: Dressings
Your incision lines will probably be covered with Steri Strips or tape. You will probably have an elastic abdominal binder to provide gentle pressure, to give you stability and to reduce swelling. If it feels too tight or causes pain, take it off. We do not want the binder to interfere with circulation to the skin which could cause blistering or skin loss!
The binder can be removed temporarily for laundering.
E: Showering and Bathing
You may shower even though drains are still in place. Water and soap will not hurt your incision lines. If you are weak or slightly unstable, we suggest you sit on a stool in the shower and have someone nearby in case you need help.
F: Drains and drain care
Dr. Vu will probably place drains into the abdominal surgical area at the time of surgery. Secure the bulb of the drain to your clothing or abdominal binder with a safety pin. Whenever the bulb fills or expands to 50% or more, empty the bulb by opening the plug at the top, and pour out the fluid contents.
Do not attempt to remove the bulb from the tubing. Squeeze the bulb to re-compress it and put the plug back into the hole at the top in order to maintain the vacuum. If the bulb fills rapidly after emptying
it, or you need to empty it more than 3 times a day, please call the office.
G: Sun exposure
We recommend that you protect your scars from the sun for a year after surgery. Even through a bathing suit, a good deal of sunlight can reach the skin and cause damage. Wear a sun block with an SPF of at least 15 when out in sunny weather.
View Breast Reconstruction Photos
Schedule Your Breast Reconstruction Consultation With Dr. Vu Today By Calling 503.297.8555 or Toll Free 866.297.8522.
Breast Augmentation, Portland, OR
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