Breast Reconstruction Surgery

Davinci plastic surgery | Washington dc | steven p. davison, md

BREAST RECONSTRUCTION CAN BE dONE WITH DIFFERENT TYPES Of FLAPS OR IMPLANTS. Dr. DAVISON ALSO DOES RECONSTRUCTION FOR PATIENTS THAT ARE BRCA POSITIVE.

BREAST RECONSTRUCTION CAN BE dONE WITH DIFFERENT TYPES Of FLAPS OR IMPLANTS. Dr. DAVISON ALSO DOES RECONSTRUCTION FOR PATIENTS THAT ARE BRCA POSITIVE.

THE STAGES OF BREAST RECONSTRUCTION

STAGE I – Mastectomy & Expander

Breast Reconstruction usually occurs as a two-stage procedure – starting with the placement of a breast tissue expander – which is replaced several months later with a breast implant. Dr. Davison will place the tissue expander under the same anesthesia as your mastectomy surgery if possible. This is called immediate reconstruction since the process is started at the time of your mastectomy.  You may choose to “delay” the start of reconstruction and wait for a few weeks or months.  This is called delayed breast reconstruction.  Here are the steps involved in mastectomy with expanders:

  1. During the mastectomy your breast surgeon removes skin and breast tissue – leaving the chest tissue flat and tight.  An expander (balloon type expandable device) is put into place under the chest muscle and skin - to serve as a space saver – into which a breast implant is later placed.  The expander is gradually filled with saline solution – over several weeks – and slowly stretches the remaining chest skin and muscle to allow for the future breast implant.
  2. Expander surgery is performed under general anesthesia in an operating room. Often a Biologic tissue barrier is used to create an inner Bra to cradle the expander.
  3. The incision used to perform your mastectomy is used for the expander placement
  4. After placement – the incision is closed
  5. Drains are left in place – and are removed when only 30cc fluid comes up
  6. Healing takes 4-6 months – the surgery takes several hours and is done under one anesthesia.  If delayed expander placement is done – surgery takes 1-2 hours.
  7. Breast implant is placed when Dr. Davison determines the space is sufficient and the expander is removed.  The same incision is used to do implant placement.
  8. A nipple and areola is created typically 3 months later – with additional beautification for both breasts.
  9. Dr. Davison becomes your primary care physician over the next year during this entire process.

STAGE II – Flap Breast Reconstruction

When the remaining chest tissue is inadequate to rebuild a new breast mound – a flap procedure is typically done to create one.  There are a variety of Flap procedures in use today – and not every type is suitable for every woman.  Dr. Davison will determine which is best for you and then tailor that procedure to achieve your goals and beautiful – natural looking breasts. Flap procedures used today include:

MUSCLE FLAP RECONSTRUCTION

Typically used for women with smaller breasts – the Latissimus Flap technique uses your own living tissue – taken from your back - to recreate a new, natural looking breast…

1)  Latissimus Dorsi Flap breast reconstruction involves use of a flap of skin and muscle from the back on the same side as the operated breast.  This is transferred forward to create a new breast that will look and feel natural since it is your own living tissue.  This technique is appropriate for women who have had a mastectomy and who lack excess abdominal tissue – or who have had certain previous abdominal incisions.  The Latissimus Flap technique may be a safer option for women who are at risk for the TRAM Flap technique. Using the Latissimus Flap - the blood supply is highly dependable and there are no abdominal complications.

The Tram Flap is the most common form of living tissue breast reconstruction used today to recreate a natural looking – warm - soft breast…

2)  TRAM Flap breast reconstruction includes two main types of procedures – pedicled flap and the free flap procedure.  In each technique, a portion of skin, fat and muscle is removed from the lower abdomen and transferred to the chest (mastectomy site).  These living tissues are then used to create a new breast mound.  Like the tissue removed during a tummy tuck – the tissue taken from the abdomen during a Tram Flap procedure is very similar.  The Tram Flap procedure can be either pedicled - meaning  it remains attached to its blood supply or it can be a free flap - which is detached from its original blood supply and reattached to a blood supply at its new location. Two scars are created during Tram Flap procedures – a horizontal abdominal scar that runs from hip to hip - and an elliptical shaped scar on the breast. Breast Reconstruction can be performed at the time of the mastectomy - under the same anesthetic - allowing you to wake up with a breast mound in place – or it can be delayed and performed later after you are recovered from your mastectomy and other treatments. 

In spite of wonderful advances – there are drawbacks to using these muscles – so techniques to minimize or eliminate the need for sacrificing muscles in breast reconstruction have been developed…
Today -
Perforator Flaps represent state-of-the-art techniques in tissue-based breast reconstruction.  Perforator Flaps create a natural looking breast – using your own soft, warm, living tissue – without sacrificing muscle function…

3)  DIEP Flap (Deep Inferior Epigastric Perforator Flap) employs excess skin and fat harvested from the lower abdominal area through an incision similar to that used for a tummy tuck.  DIEP Flap reconstruction often results in improved abdominal contour while sparing the rectus abdominal muscle and its overlying fascia. There is significantly less pain, more rapid recovery and the abdominal wall strength is preserved.  DIEP Flap technique offers many benefits for women who can have this method of breast reconstruction. It provides the same tissue as Tram Flap but requires more technical skill and time.

4)  The Gracilis Flap technique employs excess skin and fat from the inner thigh to reconstruct breasts with a natural appearance.  When an upper inner thigh flap is harvested as perforator flap without muscle, it is referred to as a Transverse Upper Thigh (TUT) Flap.  Sometimes an inner thigh flap requires a small amount of gracilis muscle be incorporated into the flap to assure an adequate blood supply to the flap.  These flaps are called TUG Flaps – Transverse Gracilis Flaps.  Either flap can be harvested so that the donor site scar is placed discretely on the inside of the upper thigh.  Unlike the rectus abdominus muscle that is missed – the gracilis muscle is a small muscle that is not missed. If this technique is your best choice – Dr. Davison will tailor it to your specific needs to achieve natural looking results.

STAGE III – Beautification – Balance - Symmetry

The goal in all breast reconstruction surgeries is to achieve symmetry and balance between both breasts and natural looking breasts.  Beautification is started several weeks or months after your reconstruction process is complete – and you are healed nicely. Beautification involves creating balance between the two breasts – breast contour – adjusting flaps as needed – and nipple/areolar reconstruction. It can also include surgery of the other breast such as a Breast Lift or Breast Reduction.

STAGE IV – Nipple Tattooing

Nipple tattooing is the final stage in breast reconstruction and involves nipple beautification through tattooing.  Tattooing defines the dark area of skin surrounding your nipple and areola.

IMPLANT RECONSTRUCTION:

Some women are able to go through a one-stage process by having the permanent implant placed at the time of the mastectomy, however, most women require a two-stage process using a tissue expander before the implant placement.  A breast implant is a round or tear-shaped silicone shell – filled with saline or silicone gel.  It is placed behind the chest pectoral muscle to augment the breast. Implant reconstruction involves IV stages the same as flap reconstruction. 

 STAGE I – Mastectomy & Expander
Breast Reconstruction usually occurs as a two-stage procedure – starting with the placement of a breast tissue expander – which is replaced several months later with a breast implant. Dr. Davison will place the tissue expander under the same anesthesia as your mastectomy surgery if possible. This is called immediate reconstruction since the process is started at the time of your mastectomy.  You may choose to “delay” the start of reconstruction and wait for a few weeks or months.  This is called delayed breast reconstruction.  Here are the steps involved in mastectomy with expanders and implants:

  • During the mastectomy – your oncology surgeon removes skin and breast tissue – leaving the chest tissue flat and tight.  An expander (balloon type expandable device) is put into place under the chest muscle and skin - to serve as a space saver – into which a breast implant is later placed.  The expander is gradually filled with saline solution – over several weeks – and slowly stretches the remaining chest skin and muscle to allow for the future breast implant.
  • Expander surgery is performed under general anesthesia in an operating room. Often a Biologic tissue barrier is used to create an inner Bra to cradle the expander.
  • The incision used to perform your mastectomy is used for the expander placement
  • After placement – the incision is closed
  • Drains are left in place – and are removed when only 30cc fluid comes up
  • Healing takes 4-6 months – the surgery takes several hours and is done under one anesthesia.  If delayed expander placement is done – surgery takes 1-2 hours.
  • Breast implant is placed when Dr. Davison determines the space is sufficient and the expander is removed.  The same incision is used to do implant placement.
  • A nipple and areola is created typically 3 months later – with additional beautification for both breasts.
  • Dr. Davison becomes your primary care physician over the next year during this entire process.

STAGE II - Implant Reconstruction & Symmetry
After your expander has done its job and you are ready for the permanent implant, Dr. Davison will use the same incision to remove the tissue expander and place the permanent implant behind the pectoral muscle.  At this time he also works on symmetry for both breasts. 

STAGE III – Nipple/Areola Reconstruction and STAGE IV – Nipple Tattoo
Stage III and IV for Implant Reconstruction involves the same procedures as outlined above under Flap Reconstruction.

WHY CHOOSE A BOARD CERTIFIED SURGEON?
When considering any surgery it is most important to know and trust your surgeon. Dr. Davison is triple board certified and fellowship trained – which means he has specialized training and experience in three subspecialties, and he has met and exceeded the rigorous standards set forth by each board.  To be fellowship trained means that, in addition to his med-school training and residencies, he has had several additional years of specialized surgical training for reconstructive plastic surgery procedures.

At DAVinci – Dr. Davison strives to provide a “patient centric” experience,
combining the supreme elements of art and surgical science.

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Steven P. Davison, MD

Steven P Davison - board certified plastic surgeon

Breast Reconstruction
Plastic Surgeon
Washington, DC and Northern Virginia

Dr. Davison is board certified and fellowship trained with a special interest in breast cancer reconstruction.  His unique and desirable skillset places him in a special league of surgeons who can provide unequaled expertise in full-spectrum plastic and reconstructive surgery.  He is able to effectively deal with other cancers as well, including melanoma and successfully manages many  surgeries of the body, both cosmetic and reconstructive.  Dr. Davison’s interest in breast and body contouring facilitates in his creation of a natural, aesthetic breast that is pleasing to the patient and grants him hundreds of happy patients.