Breast Reconstruction - Dr. Danielle DeLuca-Pytell M.D. » Dr. Danielle DeLuca-Pytell M.D.

Breast Reconstruction

“Every woman diagnosed with breast cancer should meet with a plastic surgeon before beginning treatment. Early planning is key for an optimal aesthetic outcome.”

Common name – Breast Reconstruction. Technical name/also known as – Lumpectomy reconstruction, Implant reconstruction, Flap reconstruction.

Benefits of Breast Reconstruction

For women diagnosed with breast cancer, a consultation with a plastic surgeon early after diagnosis is imperative, even—and especially—if a woman is considering a lumpectomy. For most patients, breast reconstruction is now commonly performed immediately, meaning, at the same time as mastectomy or lumpectomy. While this adds an additional decision to be made during what is an overwhelming time, the importance of the involvement of a plastic surgeon early is essential.

Immediate breast reconstruction has been shown not only to be a safe option, but more importantly, has been shown to benefit overall well-being of the woman treated.

How it is done:

There are essentially three types of reconstruction: reconstructing a breast after lumpectomy or breast conservation, reconstructing a breast after mastectomy with an implant, or reconstructing a breast after mastectomy with a flap (or your own body’s tissue).   If a woman chooses, the unaffected breast may also be changed for symmetry. Sometimes, breast disease is present in both breasts at the time of diagnosis.

Lumpectomy reconstruction: for cancer that is not encompassing the entire breast, often, a plastic surgeon can work with a breast surgical oncologist to optimally remove the cancer while rearranging the remainder of the breast tissue. Called aesthetic oncology or oncoplastic surgery, plastic surgeons often rely on cosmetic breast techniques such as breast lift or breast reduction to conceal the removal of the cancer. A symmetrizing operation is done on the unaffected breast to make the breasts look more even.

Mastectomy reconstruction with an implant: for cancer in many areas of the breast or for women who opt for this, implant reconstruction after mastectomy can be performed. Often this is done with a tissue expander, or a temporary adjustable implant, that allows the reconstructed breast to be gradually enlarged once healing is completed. A biologic material called acellular dermal matrix (ADM) provides shape and support of the lower portion of the breast as well as additional coverage over the implant. At a later date, the adjustable implant or expander is removed and a more permanent implant placed. If a woman plans for a bilateral (double) mastectomy, the operation is performed on both sides. If not, a symmetrizing operation may be performed at a later time. Reconstruction of the nipple and areola are not usually performed at the time of mastectomy, but later in the reconstructive process.

Mastectomy with flap reconstruction: For some women undergoing mastectomy, using her own tissue may be a choice. This may use skin, fat, and muscle from the abdomen or back, though other sites may also be considered. This operation involves a second surgical site (a donor site) and involves the longest recovery. The blood supply to the flap may remain attached to the body (pedicled) or attached after removal to a new blood supply (free, or by microsurgery). Reconstruction of the nipple and areola are not usually performed at the time of mastectomy, but later in the reconstructive process.

Upside

With immediate reconstruction, there is no point where a woman is without a breast, though the nipple may be absent. Evidence shows that immediate reconstruction is psychologically beneficial. As breasts are associated with beauty and femininity, breast reconstruction is chosen by most women undergoing breast cancer treatment. Federal law covers mastectomy reconstruction as reconstructive (not cosmetic) well as procedures to improve symmetry with the unaffected breast.

Downside

Mastectomy reconstruction from beginning to end is a long process—usually a year. It is not unusual for women to require additional procedures after the initial breast reconstruction operation. Ancillary procedures to improve symmetry or shape may be needed. Nipples which remain after nipple sparing mastectomy or which have been reconstructed will not have sensitivity. For symmetry, it is often necessary to operate on both breasts even if only one is affected by cancer.

Who pays for this

This operation is usually paid for by insurance, though precertification may be required. Insurance plans vary, so some out of pocket cost may be required.

My Post-Operative Bra Suggestions

Please click this link for suggested bras to be worn after surgery.

What to expect

Length of operation

2-8 hours (depending on procedure and extent of operation).

Anesthesia used

General anesthesia, you will be asleep and monitored the entire time.

In or out patient

Patients often stay overnight in the hospital, and possibly longer depending on the surgery.

Side effects

Temporary swelling, bruising, and some pain are common initially. Drains are almost always used, and these may stay for a long time. If a donor site is used (for flap reconstruction), you may be required to sleep in a flexed position after surgery for a period of time.

Risks of procedure

All surgery carries risk. I recommend patients carefully weigh the benefits of having surgery against the potential risks which may arise.  Pain, bleeding, infection, damage to surrounding structures, need for other operations, asymmetry, inability to guarantee a bra size, contour irregularities, scar, sensory changes, wound healing delays, dissatisfaction with appearance, deep vein thrombosis, pulmonary embolism, death. A complete list of risks will be discussed with you before surgery.

If you smoke, it is imperative that you quit six weeks both before and after surgery.  To better understand why, please click the following link:

Smoking and Plastic Surgery

“This is one of the most gratifying yet challenging procedures I perform. I get to know a lot about my patients, their lives, and their families since the treatments are ongoing. I still stay in touch with many of my patients long after their surgeries have been completed.”

– Dr. Danielle DeLuca-Pytell

Your Next Step

Call or email us to schedule an appointment and find out if you are a suitable candidate for this procedure.

Our phone number

Give our office a call Monday to Thursday, 9am to 5pm, Friday 9am to noon.

248-273-7700

Our email address

You can also email us anytime with questions.

info@delucapytell.com

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Testimonials for Dr. Danielle DeLuca-Pytell

 

See what Dr. DeLuca-Pytell’s patients have to say about their surgical experience.

Follow the link to read some of the many letters received by Dr. Danielle DeLuca-Pytell.

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Before and After Gallery

When you come into the office for your appointment, you will be able to see more ‘before and after’ photos of this procedure including different options.

Breast Augmentation18

Side effects

Temporary swelling, bruising, and some pain are common initially. Drains are almost always used, and these may stay for a long time. If a donor site is used (for flap reconstruction), you may be required to sleep in a flexed position after surgery for a period of time.

Risks of procedure

All surgery carries risk. I recommend patients carefully weigh the benefits of having surgery against the potential risks which may arise. Pain, bleeding, infection, damage to surrounding structures, need for other operations, asymmetry, inability to guarantee a bra size, contour irregularities, scar, sensory changes, wound healing delays, dissatisfaction with appearance, deep vein thrombosis, pulmonary embolism, and death. A complete list of risks will be discussed with you before surgery.

If you smoke, it is imperative that you quit six weeks both before and after surgery. To better understand why, please click this link:  Smoking and Plastic Surgery

 

Recovery time

If healing proceeds as expected:

Rest at home (princess treatment) 2 weeks (no housework or exercise) or until drains are removed. Outsource housework and child care while you rest. Walk around the house, but do not work out.

Return to gentle exercise and household chores at two weeks or once drains are removed (whichever is last), but no heavy lifting or strenuous activity for six weeks.

Return to full activity 6 weeks after surgery.

Returning to Work

This depends on the type of work that you do.   Many women can return to sedentary work at three to four weeks, though not everyone is ready to return to work by then. Surgery affects different people differently. If your work is more strenuous, six weeks off work may be needed.

Length of results

Long lasting, but maintenance may be required if implants are used for reconstruction.

Time​ until final appearance

Often a year or longer depending on treatment.

 

Other information

A list of bras that can be worn after surgery are available here (insert hyperlink for bra sheet here).

Your appointment with Dr. DeLuca-Pytell

When you visit the office for your appointment, we will talk about the side effects and risks of this procedure. You will have the chance to ask any questions you might have.

Don’t forget: it is your body!  There is no such thing as a bad or silly question!

Contact us

Give us a call to schedule your appointment.

Our phone number

  • 248-273-7700