Breast Reconstruction The Woodlands
For women who have battled breast cancer and lost one or both breasts in the process, Houston plastic surgeon Dr. Paul Gill performs a range of breast reconstruction in Houston to rebuild the breast as a major component of recovery.
Breast reconstruction is performed after mastecomy or lumpectomy.
In some techniques, an expanding breast implant is used to make space beneath the tissue.
If You’re Considering Breast Reconstruction in Houston
Women who have undergone a single or double mastectomy, and have completed cancer treatment, often choose breast reconstruction in Houston as the next step. More than 90,000 American women underwent breast reconstruction in 2010, a surgery that can be completed immediately after a mastectomy if you are physically and mentally prepared. The surgery, which is often covered by health insurance, may incorporate breast implants or rebuilding of the breast using your own body tissues.
What to Expect in Surgery
A common breast reconstruction procedure uses tissue expansion techniques and implants. After a mastectomy, the skin may need to be stretched over time to allow space for an implant. An expander is placed under your skin and gradually filled with saline to increase the tissue. Once the skin has been adequately stretched, the implant can be placed. The nipple is often reconstructed at a later time.
Skin flaps from donor sites elsewhere on your body may also be used to recreate the breasts.
In the TRAM flap breast reconstruction technique, which is the most popular flap procedure, tissue is removed from your abdomen. In addition to skin, fat and bone, muscle may also be used in this procedure, which can take up to six hours to complete under general anesthesia.
The DIEP flap breast reconstruction technique is very similar to the TRAM technique in that it utilizes tissue from your lower abdomen, but does not involve the removal of muscle. In this procedure, blood vessels are dissected from the abdominal muscle and reattached to blood vessels in the chest wall.
In the SGAP flap breast reconstruction technique, the buttocks is used as a donor site rather than the abdomen. This procedure is often ideal for women who lack sufficient tissue in the abdomen for the TRAM or DIEP techniques.
Recovering from Breast Reconstruction in Houston
As this is a major procedure, you can expect discomfort from surgery to last up to two weeks. During this time, Dr. Gill may prescribe medication to manage pain. Schedule a consultation to discuss the expected outcome and downtime with breast reconstruction. Each patient varies, so it is best to discuss specific details of surgery with your surgeon.
What is Fat Grafting and Breast Reconstruction?
Fat grafting is an adjunct procedure that is utilized in combination with out DIEP flap breast reconstructions and implant base breast reconstructions. It is typically part of a staged process. We perform this to treat any hollow areas, contour depressions, and to provide optimal shape to the breasts. It is typically performed at the second or third stage procedure to allow more natural contour.
How Long Does a Fat Grafting Procedure Take to Perform?
A fat grafting procedure to the breast typically takes 1-2 hours to perform. We identify a donor site, which typically involves the abdomen or the flanks for best contour match and with standard liposuction and special fat harvesting cannulas, we harvest and cleanse the fat, then inject it utilizing small cannulas and a hand-held syringe to areas that are either hollow or need additional enhancement in shape or contour. We find fat grafting to be an excellent adjunct to the breast reconstruction process in providing optimal and natural results. It is imperative that patients understand out of 100% of the fat injected, in the best of studies only 70% will take, therefore we often over-correct areas with the understanding that with time it will settle and provide optimal contour to the patient.
Who is a Good Candidate for a Fat Grafting with Breast Reconstruction Procedure?
Patients that have had implant base breast reconstruction do remarkably well from fat grafting to fill areas or contour where the implant does not fill. This is typically seen in the upper pole of the breast, in addition fat can be grafted between the skin and implant capsule to provide a more natural look and minimize the effects of rippling. Lastly, we also utilize fat grafting in conjunction with DIEP flap procedures to add volume to the flap or to provide optimal shaping at the superior, or upper most part of the breast to provide a more natural slope and contour.
Recovery from a fat grafting to breast reconstruction procedure typically takes approximately 1 week to 10 days. This is an outpatient procedure and typically takes 1-2 hours. Patients are usually okay to return to work within 3-5 days and get back to normal, unrestricted activity by about 10 days. The beauty of this procedure is that incisions are minimal and we can typically hide the incisions within existing scars from previous surgery.
What is an Implant Breast Reconstruction?
An implant base breast reconstruction is an option we give patients who they do not desire to utilize their own tissue or do not have adequate tissue to perform reconstruction. Another reason we might choose an implant base reconstruction is due to shorter operative times and less inter-operative risk to the patient. The way we perform an implant base reconstruction is determined by the patient’s anatomy. In some cases we can perform a straight to implant breast reconstruction, which is a single stage procedure, but in many cases we perform a tissue expander breast reconstruction. A tissue expander breast reconstruction involves placing a partially filled implant underneath the skin and muscle, often with utilization of a dermal graft. The dermal graft aids in shaping the lower 1/3rd of the breast, preventing scar formation, and providing added protection to the implant. This tissue expander is partially filled during the mastectomy surgery. Upon discharge from the hospital and follow up from the office, we will begin adding fluid to the expander in the office until the desired size is reached. Upon reaching ideal size, we will then discuss removal of the expander for a softer shapelier implant. This is a second outpatient surgery and typically requires 1-2 hours to perform. In some cases, asymmetry procedure to the opposite breast may be performed or in the case of a bilateral reconstruction, both expanders can be exchanged for implants. Once the implants are in place and the patient is allowed to heal; shape, size, and symmetry can be easily assessed and we determine if a nipple reconstruction is necessary or any other grafting procedures. In certain cases, we can utilize fat grafting, which is liposuctioned fat injected over the implant giving a more natural appearance. This is determined based on the patient’s anatomy and can only be performed once the permanent implants are in place.
How Long Does a Tissue Expander Breast Reconstruction Take to Perform?
A tissue expander breast reconstruction takes from 30 minutes to 1 hour per side to perform. This is much shorter in time compared to some of the tissue base reconstructions, which is a definite advantage to certain patients. During the second stage, we perform a tissue expander to implant exchange this procedure will also take 1-2 hours.
How Do You Perform a Tissue Expander Breast Reconstruction?
The tissue expander is placed underneath the pectoralis muscle after the mastectomy procedure is completed. Since the pectoralis major muscle can only cover the upper 2/3rds of the implant we place a dermal graft over the lower 1/3rd of the implant. This allows complete protection of the implant, along with potentially minimizing scar formation, and a more aesthetic better shape. After surgery, we observe the patient overnight in the hospital to ensure good pain control and also to observe the mastectomy skin post-surgery.
Who is a Good Candidate for a Tissue Expander Breast Reconstruction?
The best candidates for a tissue expander breast reconstruction are women who desire the least surgery possible and the quickest return to normal activity. The implant base breast reconstruction offers the lowest short term risk because surgery is quick and there is no additional downtime compared to if the patient simply had a mastectomy performed. This means the patient will still stay in the hospital 1-2 days and will typically be back to normal activities by 2 weeks. The downside to tissue expander surgery is that it carries more long-term risk compared to autologous reconstruction. This means that the implants are prone to capsular contracture or scar formation, infection can occur due to rejection or fluid collections, and implants are prone to rupture. Therefore we find patients choose implant reconstruction because they want the least amount of short-term risk and understand they may have slightly higher long-term risk.
What are Realistic Expectations to Have when Performing a Tissue Expander Breast Reconstruction?
Depending on a patient’s anatomy tissue expander or implant base reconstruction can provide a nice acceptable result. Our goal with implant base reconstruction is to provide size, shape, and symmetry in clothing. It is often not possible to obtain ideal shape, size, and symmetry without clothing utilizing the implants. Tissue reconstruction is far more superior when it comes to natural look, feel, and shape; however, tissue flap surgery comes with greater short-term risk.
Any Other Information That Can Be Provided?
At Gill Plastic Surgery in Houston and Woodlands, Texas we perform over 200 breast reconstruction procedures annually. We believe in a team centered approach, working closely with your breast surgeon and medical oncologist to provide optimal results. In addition our experienced office personnel provide excellent physical and emotional support, helping walk our patients through the process of reconstructing a breast after cancer.
In conclusion, at Gill Plastic Surgery, we offer the most cutting edge breast reconstruction techniques in Houston and the Woodlands area and we believe the utilization of fat in conjunction with both implant and tissue based reconstruction has allowed us to deliver our best results and optimal outcomes to our patients.
Breast Reconstruction in Houston
For more information about breast reconstruction in The Woodlands or contact Gill Plastic Surgery at 281.853.5308 or contact us by using the online email form to schedule a consultation.