Breast Reconstruction

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Houston Breast Reconstruction Specialist

Breast reconstruction surgery is an effective and empowering procedure for women who have undergone mastectomy, lumpectomy, radiation to treat breast cancer, or whose appearance has been impacted by a trauma or congenital defect. For many women, breast reconstruction after cancer is an essential part of the healing process that allows them to feel more like themselves and regain their sense of wholeness and femininity.

Dr. Scott Reis understands the unique and deeply personal motivations of women seeking breast reconstruction at his Houston plastic surgery practice. Not only will he and his entire staff provide you with the highest level of compassionate care, but he will use the full extent of his technical skill and expertise to ensure that you feel beautiful and confident following your breast reconstruction.

Who is a Candidate for Breast Reconstruction?

Women who have had all or some of their breast removed as a prophylactic or cancer treatment may be good candidates for breast reconstruction, as are women who wish to improve the appearance of breasts impacted by trauma or a birth defect.

The ideal candidate for breast reconstruction has completed radiation therapy if necessary, is in good overall health, and does not use any nicotine containing products. 

That said, the decision to undergo breast reconstruction is a highly personal one. There are many physical and emotional factors that need to be carefully weighed by the patient and by Dr. Reis to determine if breast reconstruction is right for each patient’s situation. It is also important to evaluate which type of breast reconstruction will be the best choice based on each patient’s unique presentation. 

One especially important factor in determining whether a woman is ready for breast reconstruction is whether she has realistic expectations regarding the outcome of the surgery. During your breast reconstruction consultation with Dr. Reis, he will explain that reconstructed breasts may not have the same appearance, feel, and sensation as a natural breast, although Dr. Reis’ goal is to have you look better and feel better about your breasts even after reconstruction. 

Additionally, you need to be aware that there will be some scars after your breast reconstruction, either from the procedure itself or from mastectomy. For scar optimization following breast reconstruction, Dr. Reis offers postoperative Fractional Co2 laser treatment.1

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Breast Reconstruction Procedures

The type of breast reconstruction procedure Dr. Reis performs is dependent upon a number of factors, including the general health and age of the patient, her desired breast size, cancer treatment status (ie need for radiation or chemotherapy treatment which will affect timing of reconstruction), and whether there is adequate material to harvest for a flap procedure in autologous breast reconstruction.

Implant-Based Breast Reconstruction

Some patients are candidates to have implants placed at the same time as the mastectomy is performed (direct to implant breast reconstruction), but it is more common for Dr. Reis to place tissue expanders rather than implants at this time.

Implant-based breast reconstruction often requires a staged approach, involving the placement of tissue expanders to gently and gradually stretch the skin of the chest and create space for an implant to be placed. Once Dr. Reis and the patient are satisfied with the size of the pockets created by the tissue expanders, they are removed and replaced with implants during a process very similar to cosmetic breast augmentation surgery.

Autologous Breast Reconstruction

In addition to implant-based methods, tissue expanders are also often used for autologous breast reconstruction (reconstructing the breasts using tissues from the patient’s own body). This is by far the preferable method of breast reconstruction for Dr. Reis. Not only does this form of reconstruction result in breasts that look and feel more natural than implants, but it also helps patients avoid issues and future surgeries frequently associated with breast implants. Additionally, there is extensive data showing that patients who undergo autologous breast reconstruction have better outcomes and greater postoperative satisfaction than women who undergo implant-based breast reconstruction.2

While autologous breast reconstruction often leads to superior patient outcomes when compared to implant-based reconstruction, this procedure requires the advanced skills of a highly-experienced Board-Certified plastic surgeon such as Dr. Reis. Extensive microsurgical skill is required to properly transplant and connect harvested blood vessels and tissues to the vessels in the chest implant site. In fact, all autologous breast reconstruction procedures performed at this practice are done with two surgeons to ensure an expedited, safer process, shorter anesthesia times, and most importantly, overall better patient outcomes.

DIEP Flap Breast Reconstruction
The preferred option for autologous breast reconstruction is the DIEP (deep inferior epigastric perforator) flap method. With this method, Dr. Reis harvests skin, fat, and blood vessels from the patient’s lower abdomen without damaging the abdominal muscles. He then uses these harvested materials to form breasts, meticulously connecting blood vessels to ensure that tissues remain alive and form breasts that look and feel natural. An added benefit of this type of breast reconstruction is that patients are left with a flatter, tighter abdominal area—since the tissue harvested is the exact same that is excised during a tummy tuck.

Dr. Reis and the team at My Houston Surgeons have developed a tissue-sparing approach for both the harvesting and the microsurgical phase of autologous breast reconstruction, which allows them to make smaller incisions in the abdominal fascia, fully spare all abdominal muscles and nerves and avoid painful rib harvesting which directly results in a faster easier recovery and improved overall patient outcomes and experience. This, combined with their nerve block form of anesthesia, means that patients can return home the day after their surgery as opposed to the national average of 3 to 5 days in the hospital. These factors, combined with peerless technical skill, have led My Houston Surgeons to publish the lowest complication rate after autologous breast reconstruction in the world.3

PAP Flap Breast Reconstruction
When a patient has inadequate or unavailable skin and fat to harvest from the abdominal area to form breasts of her ideal size (for example, if she has already undergone a tummy tuck or is just naturally slender), Dr. Reis will often employ a PAP (profound artery perforator) flap procedure. Here, tissues are taken from the upper inner thigh to reconstruct breasts. Similar to the abdominal tissue taken in a DIEP flap being the same as that taken during a tummy tuck, the thigh skin and tissue harvested during a PAP flap are the same as that removed in a medial thigh lift, making it another ideal autologous tissue donor site.

Stacked Flap Breast Reconstruction
PAP flap breast reconstruction can be performed by itself, but because the upper thigh harvest site often holds insufficient tissue to reconstruct breasts, it’s more often used in combination with another flap. Often, a PAP flap is combined with a DIEP flap when the patient is slender and does not have sufficient abdominal or thigh tissue to create adequately sized breasts alone. This approach combining two flaps together to reconstruct a single breast is known as stacked flap breast reconstruction.

Breast Reconstruction Risks

Any surgical procedure carries some risk of complications, but working with a highly experienced plastic surgeon who specializes in breast reconstruction like Dr. Reis can help a woman feel confident in the outcome and safety of her procedure.4

Risks associated with breast reconstruction include:

– Infection
– Poor incisional healing
– Microvascular complications associated with autologous reconstruction
– Breast implant complications, such as capsular contracture or leakage
– Asymmetry

Your Breast Reconstruction Consultation in Houston with Dr. Reis

If you have undergone a mastectomy to treat or prevent breast cancer, you already know how deeply personal the decision to undergo breast reconstruction is. Dr. Scott Reis and each member of his staff are dedicated to helping you fully understand all breast reconstruction options available to you and to ensuring the optimal outcome for your unique case. To learn more about breast reconstruction in Houston with Dr. Reis, please contact us to schedule your private consultation.

References
1 American Society of Plastic Surgeons. Breast Reconstruction Candidates. Available: https://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction/candidates. Accessed August 28, 2020.
2 Toyserkani NM, Jørgensen MG, Tabatabaeifar S, Damsgaard T, Sørensen JA. Autologous versus implant-based breast reconstruction: A systematic review and meta-analysis of Breast-Q patient-reported outcomes. J Plast Reconstr Aesthet Surg. 2020;73(2):278-285. doi:10.1016/j.bjps.2019.09.040. Accessed August 28, 2020.
3 Martinez CA, Reis SM, Rednam R, Boutros SG. The Outpatient DIEP: Safety and Viability following a Modified Recovery Protocol. Plast Reconstr Surg Glob Open. 2018;6(9):e1898. Published 2018 Sep 14. doi:10.1097/GOX.0000000000001898. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191230. Accessed September 23,, 2020.
4 American Society of Plastic Surgeons. Breast Reconstruction Safety. Available: https://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction/safety. Accessed August 28, 2020.

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Dr. Scott Reis has either authored or reviewed and approved this content.