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Breast reconstruction plastic surgery
To get answers to the most frequent questions about breast reconstruction
plastic surgery, nipple/areolar reconstruction, and selecting
a plastic surgeon, please select one of the links below:
What are the risks of nipple reconstruction?
Nipple reconstruction is very safe and usually can be done without
general anesthesia. Probably the most common problem encountered
is a delayed loss of projection of the nipple. Very rarely the
tissue used to reconstruct the nipple can become necrotic (die)
resulting in loss or deformity of the reconstructed nipple.
What about long term nipple projection?
Probably the greatest challenge in nipple reconstruction is maintenance
of long-term projection.
A 1999 study from Northwestern University involving flap based
nipple reconstruction revealed that nipple projection gradually
decreased over time but stabilized at about nine months. Little
change in projection occurred following one year even in those
patients followed for up to eight years.
In this study, about 40 percent of the nipple projection obtained
at surgery was retained on long-term follow-up. There was no significant
difference in nipple projection for breasts reconstructed with
implants versus TRAM flaps. The strict adherence to avoiding direct
pressure upon the nipple for at least three months is very important.
(Reference: Few, J.W., et. al., Long-Term Predictable Nipple Projection
following Reconstruction. Plast. Reconstr. Surg. 104: 1321, 1999).
How is the areola reconstructed?
Most plastic surgeons prefer to recreate the areola with an intradermal
tattoo. This method is an office-based procedure performed under
local anesthesia that generates no additional scarring. The color
can be custom mixed to match the opposite areola.
An alternative technique involves harvesting a skin graft from
the inner thigh, labia or opposite areola. Harvesting produces
an additional scar in the donor area and has lost some popularity
with the advent of areolar tattooing.
Left breast reconstruction
with saline implant and
nipple/areolar reconstruction
Is the areolar tattoo permanent?
All tattoos fade gradually over time. The areolar tattoo can
be retouched as needed.
When is nipple/areolar reconstruction
performed?
Timing is largely a matter of patient and surgeon preference.
Nipple reconstruction with a local flap can be performed once
wound healing from the mound is complete and the location of the
nipple can be determined with certainty.
A reasonable waiting period is between one and three months postoperatively
depending upon wound healing and whether a contralateral procedure
was performed.
The areolar tattoo can be performed once the nipple has fully
healed. Areolar reconstruction utilizing a skin graft is usually
done at the time of nipple reconstruction.
What are "touch-up" procedures
in breast reconstruction?
Touch-up procedures are simply secondary procedures designed
to enhance the aesthetic result of a breast reconstruction. They
commonly involve changing the size or location of an implant,
revision of scars, contouring utilizing liposuction or some other
means, and refining the inframammary crease as well as the nipple
and areola.
The type and combination of procedures are designed for each
specific clinical situation and are usually brief and limited
in scope.
Can reconstruction be performed following
lumpectomy and radiation therapy?
In recent years, so called "conservative surgery" for
breast cancer has dramatically increased in popularity. Formerly,
virtually all breast reconstruction was dedicated to the total
reconstruction of the breast following mastectomy.
Today, however, techniques have evolved to reconstruct the deformities
that result in the breast following lumpectomy. As a result of
surgery, radiation therapy, weight change or other factors, approximately
20% - 30% of patients have a residual deformity after conservative
treatment of breast cancer. These sequelae can range from asymmetry
with no deformity of the treated breast to a major deformity of
the breast requiring mastectomy.
What reconstructive options are available
following lumpectomy and radiation therapy?
One possibility is to contour the opposite breast to match the
treated breast. Because this approach avoids surgery on the irradiated
breast, it is safe and reliable.
If the appearance of the treated breast is unacceptable, some
alternatives include implant placement, local rearrangement of
breast tissue and use of the rectus muscle to fill in the area
of tissue loss.
Each defect must be approached on an individual basis to determine
the best choice for each patient.
Rarely severe deformities of the irradiated breast such as marble
breast, tissue necrosis and/or significant volume loss can occur.
These deformities may be best treated with mastectomy and immediate
reconstruction with a myocutaneous flap.
How do I choose my surgeon for
breast reconstruction?
It is important to select a surgeon who is experienced and knowledgeable
in the various techniques of breast reconstruction.
While all surgeons are biased by their training and experience,
it is probably best to avoid a surgeon who utilizes the same reconstructive
technique for all patients.
Surgeons who are certified by the American Board of Plastic Surgery
have completed an accredited residency in Plastic Surgery and
passed a rigorous set of examinations, and in our opinion are
the physicians most qualified to perform breast reconstruction
procedures.
What alternatives to breast
reconstruction are available?
We believe that each woman should have the right to choose whether
or not to have breast reconstruction. Some alternatives to reconstruction
are:
- No reconstructive efforts;
- Use of a prosthesis (form) in the brassiere such as those
made from cotton, silicone or foam;
- Use of a custom prosthesis.
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To contact Connecticut plastic surgeon Dr. Joseph B. O'Connell about any cosmetic surgery procedures, please fill out
our contact form or call us at (203)
454-0044.
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