Breast Reconstruction

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Few surgical procedures require as much communication between Dr. Topol and you the patient as breast reconstruction associated with mastectomy.  The reasons are that usually more than one procedure is necessary and timing of these procedures can be delayed weeks or months if chemotherapy or radiation therapy will be needed.  This should not discourage patients from having reconstruction because current techniques are producing very excellent results.

Dr. Topol will see you at least twice before beginning the reconstruction process with you.  There is much to discuss and the information just can’t be adequately communicated and understood after only one visit.  There are always additional questions and issues to discuss a second time.  As with all procedures or treatments in our office, Dr. Topol strongly encourages you to have your spouse or significant other to attend the consultations.

Breast mound reconstruction is basically performed using either your own tissue (called autologous),  or artificial material such as a saline implant.  Sometimes your own tissue will be combined with an implant as in Latissimus muscle reconstruction. Depending on various factors related to your anatomy you may be a candidate for one,  two or all three options.  Reconstruction can be performed immediately at the time of the mastectomy (this is the most common timing—but is not for every women), or on a delayed basis after the mastectomy and after any additional therapy (chemo, radiation).  This decision is based on your physical and emotional state at the time of the planned mastectomy and Dr. Topol feels it is very important to discuss this in detail.  Federal law protects women and allows each woman to decide on the timing and the amount of surgery to have and mandates insurance coverage for you to achieve symmetry of size and shape of BOTH breasts.

Autologous reconstruction is commonly achieved using the TRAM flap—which employs one half to two thirds of the skin and fat of the abdomen between the belly button and pubic area from hip bone to hip bone transferred to the chest to reconstruct the breast with real living tissue.  The tissue donor site in the abdomen is closed in the form of a tummy tuck  to improve abdominal contour.  This is a beautiful but complex procedure that results is a very natural looking and feeling breast.  Because of its complexity, surgery may take 4 to 5 hours and various risks to the healing of the transferred tissue may occur.  Dr. Topol will review this in great detail with you.  Surgery is done in the hospital usually with a 3 day stay in hospital post-operatively.  Initial recovery takes about two weeks—usually you feel back to normal after a month.  Unrestricted physical activity is allowed by three months.

Breast mound reconstruction with saline implants (occasionally also with tissue expanders)  is the other option for reconstruction.   If done at the time of the mastectomy, often only an implant  may be needed to give adequate volume restoration.  The shape of the breast is usually a bit more forward projecting with minimal droop or ptosis.  This may require surgery on the opposite breast to achieve symmetry of shape.  Risks here involve the implant—infection, distortion, firmness being the most significant.  Dr. Topol will review these in great detail with you.  Surgery is done in hospital usually with an overnight stay.   Pain is related to the stretch on the muscle and may last a few weeks although medication may be needed for only a week or so.  You can normally return to work after a week or two

Latissimus muscle flap reconstruction involves transferring a piece of skin and its underlying muscle from the back through a tunnel under the skin of the armpit to be brought out on the chest usually over an implant (unless your breast volume is very small) to reconstruct a breast mound.  This procedure adds padding over the implant and brings in additional skin to promote a softer shape to the breast.  Major risks involve fluid draining from the back area where the muscle was taken—this must be removed via a drain tube, the scar on the back and potential weakness if you canoe or kayak .   If radiation therapy will be needed and you know this in advance, this technique can be done after the radiation to bring in healthy non-radiated tissue for the mound reconstruction (called delayed reconstruction).  Surgery takes about 3 hours and usually a two day stay in hospital is needed.  Recovery takes about two weeks to feel normal and about a month before vigorous exercise.  Photos of this procedure will be reviewed with you during your consultation. 

Once the breast mound is reconstructed, nipple areola reconstruction can be performed.  Various techniques can be used all normally done under local anesthesia in the minor procedure room.  A nipple bud is made or a part of the opposite nipple can be transferred and one this heals (about a month) the areola can be reconstructed usually by tattoo.

Again, the surgical plan will be reviewed in great detail and Dr. Topol and our staff will work with you and your family every step of the way.  Please give us a call if we can help you with your reconstruction or if your initial reconstruction was done elsewhere and needs revision.  Dr. Topol sees many patients for revision of their reconstructions.