Breast Reconstruction

Breast Reconstruction can be an exceptionally rewarding and empowering option for women who receive a Mastectomy as part of their battle to beat breast cancer. There are several different techniques that can be employed to rebuild the breast mound following Mastectomy, each of which can help restore a normal shape, size, and overall appearance to the breast(s). At our practice, board-certified plastic surgeons Stafford Broumand, MD and Daniel Maman, MD offer implant reconstruction, fat grafting, and DIEP flap breast reconstruction. They will work closely with you to customize an approach that most effectively achieves an ideal outcome based on your unique needs and desires.

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Following a mastectomy or trauma to the breasts, breast reconstruction may be able to help:

-Rebuild the breast(s) using an implant and/or the patient’s own tissues

-Restore one or both breasts to their pre-mastectomy size and form

-Enhance the shape, size, and/or symmetry of the breasts

-Improve one’s body image and self-esteem -Restore a sense of femininity and wholeness

Most times the consultation process for Breast Reconstruction begins immediately following diagnosis of breast cancer. Your surgeon will first conduct a physical exam to make sure your particular case can be addressed effectively with Breast Reconstruction. Following the physical assessment, he will cover medical history, family history, social history, and any prior surgical history to make sure he understands the entire picture.

Once your desires are clear, Dr. Broumand or Dr. Maman will then continue the conversation by outlining a customized treatment plan that takes into consideration everything from chest size and hip width to body shape and profile. Your surgeon will also identify what a reasonable goal for the procedure would be, as well as what type of outcome can be expected. This is accomplished through VECTRA® XT 3D imaging—a state-of-the-art system that has revolutionized the breast reconstruction planning process. With this innovative device, you are able select from numerous implant options and view a three dimensional image of how these implants may look on your own body. To get a better idea of how VECTRA® XT 3D imaging works, please view the video below.

When a breast cancer patient has undergone mastectomy and received radiation as part of her treatment, tissues of the breast and chest often become tighter and more firm than normal. Should the patient be interested in Breast Reconstruction, the rigidity of these tissues can make the reconstruction procedure a bit more difficult, particularly when placing a breast implant. However, large-volume fat grafting to the breasts can often be an excellent option for reconstruction patients whose breast tissues have been affected by radiation.

At 740 Park Plastic Surgery, Dr. Maman and Dr. Broumand use the BRAVA® system prior to Breast Reconstruction for patients who have tight breast tissues as the result of radiation treatment. BRAVA® is a preoperative skin and tissue expansion device designed to create enough space in the breast pocket to support the transfer of large fat quantities, as opposed to an implant. Some distinct benefits of BRAVA® are listed below:

BRAVA® can provide patients with either a complement or an alternative to breast implants by creating enough room for large volumes of fat to be transferred. In addition to expanding skin and breast tissues, the BRAVA® system also increases blood flow to the breasts which helps makes the fat transfer process more reliable. BRAVA® can expand tissues that have tightened and hardened as the result of radiation received during breast cancer treatment.

Utilizing external suction, BRAVA® tissue expansion has proven to be a safe process.

Many patients who have received breast implants following radiation treatment for breast cancer report that their pain in the affected tissues went away and that they noticed a greater range of motion, improved sensation, softer skin, and a more natural look after using the BRAVA® system prior to fat transfer.

Our doctors have been fortunate enough to witness the lives of Breast Reconstruction patients who have undergone this fat transfer technique instantaneously change for the better. In fact, the day after the procedure, many patients call our office and are ecstatic and grateful that they no longer have the pain and/or lack of arm mobility often associated with the placement of implants following radiation. Ultimately, breast reconstruction with fat transfer after radiation can be a life-altering event.

In certain cases, a nipple-sparing mastectomy can be conducted prior to these Breast Reconstruction techniques to help maintain more of your own anatomy through the preservation of breast skin and the nipple-areola complex. Additionally, the resulting scar may be better concealed in comparison to that of a standard mastectomy operation. Whether or not this advanced mastectomy approach may be right for you can be discussed in full detail at the time of your consultation with Dr. Maman or Dr. Broumand.

For implant Breast Reconstruction, a tissue expander will first be utilized to create a large enough breast pocket for the selected implant to be placed both safely and effectively. Situated immediately after the mastectomy or some time later (known as a delayed procedure), tissue expanders comes in a range of sizes and shapes to match the dimensions of the desired implant. When a sufficient pocket has been created, the breast implant can then be carefully inserted through limited incisions and positioned securely in place. At this time, fat grafting can also be used to further enhance the contour of the breast(s) for an ideal outcome.

Breast Reconstruction with fat grafting is similar to natural breast enhancement in that fat tissues are removed from one area of the body and relocated to the chest to create a new breast mound. In the weeks before the procedure, the BRAVA® tissue expansion system is employed to create an ideal environment in the breasts for the transfer of fat cells. This process generally involves wearing the BRAVA® device approximately six hours a day (or night) for a minimum of three weeks until there is ample space for large-volume fat transfer. Once this is complete and the reconstructive procedure can be performed, liposuction will first be used extract fat from one or more regions of the body that contain an adequate accumulation, such as the abdomen, thighs, and/or love handles. Upon removal, the fat is filtered, cleansed, and reinjected into the breast(s) until the desired result is attained.

Dr. Maman is one of only a few surgeons in New York City to have received Fellowship training at Harvard University in DIEP (deep inferior epigastric perforator) Flap Breast Reconstruction, which involves the use of tissues taken from the patient’s lower abdomen to rebuild one or both breasts. During the procedure, fatty tissue from the area between the bellybutton and pubic region is removed and transferred to the chest. Tiny blood vessels are then meticulously connected to the repositioned tissues in order to provide ample blood supply for long-term tissue survival. Once the blood vessels are attached, the relocated tissues are carefully shaped to form the new breast mound(s), and the abdominal skin is re-draped to create a flatter, more sculpted abdomen.

Unlike other flap reconstruction methods, DIEP Flap Breast Beconstruction does not require the removal and/or relocation of abdominal muscles, which can help preserve the strength of the abdominal wall while also reducing recovery time and postoperative discomfort. In addition, due to the extraction of lower abdominal tissues, patients often receive the aesthetic benefits of a tummy tuck in the process. Ultimately, by utilizing this technique, our doctors are able to achieve excellent breast symmetry with extremely natural-looking and feeling results.

Recovery from Breast Reconstruction will vary by individual, as well as the specific technique employed. In general, most women can expect some degree of swelling, bruising, and/or tenderness in the breasts and donor regions (if skin/fat tissues were transferred), but these symptoms should diminish over time. Our doctors generally administer an advanced analgesic known as EXPAREL® to help minimize discomfort during the first 48 hours of recovery, and any soreness experienced after this time can often be well managed with medication. The majority of patients will need to arrange for a close friend or family member to provide assistance within the first few days of recovery, as taking care of children and/or lifting heavy items may compromise the healing process. On average, normal daily routines and non-strenuous work can be resumed after about one to two weeks, though vigorous physical activity/exercise should typically be avoided for a minimum of one month.

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