Q&A: Breast reconstruction

Interview with TOI’s Dr. Jason J. Rosenberg, M.D.

Q&A: Breast reconstruction
Interview with TOI’s Dr. Jason J. Rosenberg, M.D.


 

What is breast reconstruction?
Breast reconstruction is a service that can be offered to patients who will undergo either partial or complete removal of one or both breasts.

When should breast reconstruction take place?
Reconstruction can be done at the same time that part or all of the breast is removed, and that’s called immediate breast reconstruction. Reconstruction that’s done later on is called delayed reconstruction.

Whether it’s immediate or delayed, the kind of reconstruction that’s chosen is a decision that’s best made with your plastic surgeon and surgical oncologist. What’s most important is making sure the timing of your reconstruction fits with your individualized plan.

How are breasts reconstructed?
There are three main ways: The first method is using breast implants that come off of the shelf, the second way is using tissue from your own body and the third option is a combination of the first two methods.

I’m known as the natural choice for breast reconstruction, because I often use natural tissue reconstruction, and because it’s a particular specialty of mine, having trained at MD Anderson Cancer Center in Houston — the worldwide leader in breast cancer reconstruction.

Who are implants good for?
Implants are a good option for patients who do not have a lot of abdominal or fatty tissue. Implants also tend to work well for patients who are having both breasts reconstructed. It’s challenging to get a single implant to resemble a natural breast on the other side, but when reconstructing both breasts with implants, it’s possible to achieve symmetry. We strive to make both breasts look as similar and natural as possible.

On the other hand, patients who have had radiation therapy are not good candidates for implant reconstruction. Radiation therapy, while important for treating cancer in certain cases, isn’t a good mix with implant reconstruction, because the implants in the radiated field sometimes harden or become distorted.

The upside of using implants for breast reconstruction is that they come off the shelf, you don’t have to have incisions anywhere else and the operations typically are short. The downside is results tend not to be as natural, and this method is limited in patients who have radiation. Implants also require maintenance after they’re put in.

Who should consider natural tissue reconstruction?
Natural tissue reconstruction is an excellent option for many patients, because tissue can be taken from a number of different places on the body — most often abdominal skin and fat

The most common procedure that I do to perform the operation is called the DIEP flap.In this operation, we do a tummy tuck, and instead of throwing away the skin and fat of the tummy, we use it to make a breast.

The upside of the surgery is you’re using your own body tissue, so it gains and loses weight with you, and it produces the most natural feeling and appearing result. Also, once the process is completed, you don’t need to have revisions done five or 10 years down the road.

It’s important to note that the operation takes longer than using implants alone, and it requires a highly specialized set of surgical skills that not all surgeons have. And without that specialized training and a team of people committed to microsurgical reconstruction, the failure rates are high. That being said, the more you’ve done this procedure, the better you get at it, and we have done over 1,500 in our practice.

Beyond that, you have to be in the hospital for a couple of days, and the recovery takes four to six weeks. You’d also experience a couple of weeks of your tummy being sore, and there’s four to six weeks of no heavy lifting or straining. While natural tissue reconstruction requires more recovery than implant reconstruction, the benefit of investing more on the front end is having a more stable long-term result.

Also, if a patient wants a larger breast than their tummy tissue will allow, we can add implants behind it in a future operation to tailor the results. It’s important to note that reconstruction often requires several steps.

Do I need single-stage reconstruction?
In the appropriate candidate, there’s sometimes the opportunity to do a single-stage implant-based reconstruction or a single-stage natural tissue reconstruction.

I participated in a study on this while I was at MD Anderson Cancer Center, and we found that the vast majority of people who have single stage reconstruction actually needed additional stages for revision.While we can attempt to do a single-stage reconstruction with certain patients, we want to set appropriate expectations.

What is oncoplastic reconstruction?
Oncoplastic reconstruction involves a plastic surgeon at the beginning of the process removing part or all of the breast in order for the board-certified plastic surgeon to help plan the appropriate incisions and management of the opposite breast.

Because of the increasing popularity of oncoplastic reconstruction, I think it’s important for plastic surgeons who specialize in breast reconstruction to be available to women when they’re facing these surgical decisions. Patients should talk to us at the very beginning, because we’re familiar with and participate in the full range of reconstructive plastic surgery of the breast

Patients make the final decision regarding their care, and we want to make sure they have all of the information they need to make the best possible choice for them.

To learn more or request an appointment, please contact us.