Dr. Charlotte Ann Rhee is a Board Certified Plastic and Reconstructive Surgeon in Huntington, Long Island NY that specializes in breast reconstruction surgery. The most common technique combines skin expansion with implant insertion. First, Dr. Rhee inserts a balloon expander beneath the skin and chest muscle where the reconstructed breast will be located. A saline (salt water) solution is then injected into the expander through a tiny valve beneath the skin over a few weeks or months, eventually filling it and stretching the skin. The expander may then be left in place or replaced with a permanent implant. A final procedure reconstructs the nipple and areola (dark area of skin around the nipple). Some patients do not require tissue expansion and begin with the implant.
Another, more complicated type of implant reconstruction involves the creation of a skin flap using tissue from other parts of the body. If the flap is not large enough to serve as the new breast by itself, an implant is then inserted beneath it. Tissue for the flap consists of skin, fat and muscle from the back, abdomen or buttocks and may either be surgically removed and reattached (free flap, requiring a microvascular surgeon) or remain connected to its original blood supply and “tunneled” through the body to the chest (pedicled flap). Advantages over implant insertion are a more natural look and feel for the breast and abdomen, and elimination of any risks associated with silicone implants; disadvantages are scars at the breast and donor-tissue site, and longer recovery.
Both implant insertion and tissue flap surgery are followed by nipple and areola reconstruction. The reconstructed breast will probably look and feel different from the natural breast. Further surgery may be desired to adjust the natural breast to better match the reconstructed one, although a perfect correspondence in size, shape and height is unlikely.
Secondary Breast Reconstruction
Many patients undergoing breast reconstruction procedures will require additional surgery in order to achieve a natural, aesthetically-pleasing breast appearance. These secondary surgeries may be performed to correct abnormalities or deformities caused by the flap or implant, to recreate the nipple and areola, or to just further enhance the appearance of the treated breast. Women should expect revision surgery as a common follow-up treatment for breast reconstruction surgery.
Any breast corrections required are usually performed at the same time as the procedure to recreate the nipple and areola, in order to reduce operating costs and recovery times. Nipple reconstruction is usually performed after initial swelling has subsided and additional treatments have been completed. Women undergoing chemotherapy can usually undergo secondary surgery about a month after treatment is finished, while those undergoing radiation therapy may be advised to wait several months.
One of the most common problems after breast reconstruction is abnormalities within the flap, including flaps that are too large or abnormally shaped. Correction of these problems can usually be performed using minimally invasive techniques to reduce the amount of additional trauma to the breast.
If the flap is too large, excess skin within it can be gently removed, while flaps that are too small or irregularly shaped can be corrected with fat injections taken from other areas of the body. There is a chance that some or all of this fat may not be accepted by the body, and additional procedures may be needed to achieve the desired results.
Similar to the risks of breast augmentation, patients who undergo breast reconstruction with implants are at risk for rippling of the implant, which is highly visible under the skin in the breast area. There is also a risk of capsular contracture, which is a shrinking of the scar tissue (capsule) that causes feelings of tightness in the breast, often affecting women who have undergone radiation therapy. These issues can often be corrected through revision surgery that removes the capsule or reshapes the implant pocket shape for safe, more aesthetically-pleasing results.
Nipple Areola Reconstruction
Initial breast reconstruction procedures focus solely on crafting the breast mound, while reconstruction of the nipple and areola are performed as part of a secondary surgery that completes the reconstruction process. This is done after the breasts have fully healed and after all forms of cancer treatment are completed. It is best to achieve satisfaction with the breast shape before performing this procedure.
Nipple reconstruction may be performed using one of several techniques, including tissue and cartilage flaps, skin grafts and tattooing. Before treatment, Dr. Rhee will discuss these options with you to determine which method is best for you. Some patients may choose not to reconstruct the nipple at all and are satisfied with the appearance of their breast.
Risks of Revision Surgery
Revision procedures are often more complicated than initial surgery and may bring about additional risks. Dr. Rhee will discuss these risks and answer any questions you may have prior to the decision to undergo treatment to ensure your safety and full understanding of the procedure.
If you are interested in learning more about our Breast Reconstruction Procedure, call 631-424-6707 today to schedule an appointment.