Breast Reconstruction

Breast Reconstruction Fort Worth Many women require surgical removal of the breast (mastectomy) for a variety of conditions (cancer, severe fibrocystic disease). With modern techniques, reconstructing the breast is often an appealing option. Using either a woman's own tissues or implants, Dr. Kunkel is able to create a breast that may be very natural in appearance. Breast reconstruction is almost always covered by insurance and can make an enormous difference is a woman's self-image. A consultation will provide you with information on the many options available for post-mastectomy breast reconstruction.

Procedures

Breast reconstruction typically involves at least two operations, with the operations being separated by about six or eight months. The different types of reconstruction techniques are discussed below.

Tissue expander—This is probably the most common technique. At the first operation, Dr. Kunkel inserts a temporary device called a tissue expander beneath the skin and chest muscle at the mastectomy site. Saline (salt water) is then placed into the expander at the time of the surgery. However, circulation to the breast tissues may be somewhat compromised at the time of the mastectomy so not too much saline is placed in the expander at this time. Not filling the expander completely at this time allows the tissues to have time to heal. Over the next few months saline is gradually added to the tissue expander through a built-in valve. The patient comes to the office about every 3 or 4 weeks to have saline added. This is easy to do and just takes a few minutes. Over time the expander is filled to a size and shape that the patient thinks fits her overall body shape. When that happens the tissue expander is typically replaced with a longer-term implant, either saline or silicone.

Latissimus flap—This is a common operation, particularly for a woman with breasts that are somewhat droopy (“ptotic”) and who is only going to have one breast removed. Skin, fat, and muscle are transferred from the woman’s back to the mastectomy site. This tissue is draped over a tissue expander or an implant that has been placed in the mastectomy site. This technique allows a little more shaping and sculpting of the breast than just using a tissue expander or an implant alone. The skin, muscle, and fat create a more natural look and feel to the breast. In most cases the tissue expander is later replaced with a long-term implant.

TRAM flap—This is a less common technique today, but remains a good option for the right candidate. This operation uses abdominal skin, fat, and muscle to create a breast; usually there are no breast implants or tissue expanders involved. In most cases there is enough skin, fat, and muscle to be transferred from the abdomen to the mastectomy site to create a breast that looks very similar to the other breast. However, women who have had several abdominal operations, are overweight, have other medical conditions, or smoke are not good candidates for this procedure.

Free tissue transfer—This type of breast reconstruction completely detaches skin, fat, and usually muscle from one area and reconnect the blood vessels of these tissues with blood vessels around the mastectomy site. This is an operation that is performed in some centers around the country. At this time Dr. Kunkel is not performing free tissue transfer breast reconstruction.

Some women decide that they want to have a nipple/areola reconstruction. This is usually accomplished after the breast shape has been created and the woman is happy with her overall size, shape, and symmetry. Nipple reconstruction is a short operation and often is performed under local anesthesia. The areola is made by using color placed by a tattoo technique.

After Surgery

Most women spend one or two nights in the hospital. They are tired and sore for a week or two. Surgical drains may be left in place to prevent a build-up of fluid. Drains are usually removed within a few weeks. The majority of women will want two or three weeks off from work, and they need to arrange for some help around the home for at least one week.

The reconstructed breast will be numb following surgery, but it is possible that some sensation will return as time passes. Scars will fade, but not disappear.

Contact us today to schedule a breast reconstruction consultation! (817) 335-5200

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