Patients who have undergone a mastectomy, double mastectomy or radiation therapy after breast cancer, or who suffer from a genetic mutation predisposing them to developing cancer (i.e. BRCA) often elect to undergo breast reconstruction surgery. While choosing to undergo a mastectomy can be a traumatic experience, many women find comfort in the fact that exceptional surgical options exist to restore the natural appearance of their breasts. Many former patients have communicated that having reconstructive breast surgery provided them with a sense of satisfaction after the difficult experience of recovering from breast cancer.
Breast reconstruction requires a very high level of surgical skill and precision, and should be performed by a board-certified plastic surgeon with extensive experience in the field of reconstructive breast surgery. Dr. Pacella defines the success of breast cancer reconstruction by one simple standard: the restoration of the breasts to a natural shape, with minimal scarring. As a double fellowship-trained cosmetic surgeon, he adapts the techniques of cosmetic surgery to reconstructing breast tissue for a beautiful, natural shape.
As the Division Head of Plastic and Reconstructive Surgery at the Scripps Clinic and Scripps Green Hospital, Dr. Pacella utilizes a team approach with breast surgeons, medical and radiation oncologists and physical therapists to guide female patients through this challenging time. Dr. Pacella understands the importance of collaborating with the surgical oncology teams of his breast cancer patients in order to ensure that their reconstruction surgery is in alignment with their principal cancer treatment plan, and he employs the most advanced surgical techniques and technologies in order to expedite his patients’ recovery process.
Breast reconstruction procedures and recovery times vary significantly, and are dependent upon the exact nature and details of each patient’s unique circumstances. The reconstruction may be performed at the same time as the mastectomy (immediate reconstruction) or months after the mastectomy (delayed reconstruction).
– Breast cancer survivor and reconstruction patient
Whether you are interested in utilizing an implant (prosthetic breast reconstruction), your own body tissue (autologous breast reconstruction) or a combination of both techniques, Dr. Pacella will discuss all of the options with you. A customized plan will be designed with you, based on your body type, desires and expectations. The most common types of breast reconstructive options include:
Tissue Expander to Implant Reconstruction
In this technique, a tissue expander is inserted underneath the chest wall muscles to create space on the inside of the breast. Oftentimes, a separate tissue prosthetic or sling may be required to support the implant from below. After the skin and muscle are expanded, the final implant can be placed. Reconstructive implants are made of silicone gel and can be round, oval or shaped (i.e. “gummy-bear” implants).
Latissimus Dorsi/Expander Reconstruction
This technique involves repositioning one of the back muscles to the front of the chest to restore the front of the breast to its natural shape. Utilizing the latissimus dorsi muscle can help reduce the tendency for implant rippling and can allow the surgeon to create a smaller scar on the breast. In addition, this technique can be utilized to help save part of the nipple after a mastectomy. This technique can also be employed to counter the effects if breast radiation is required. Dr. Pacella has extensive experience with this technique, particularly when it is utilized in younger women who chose a bilateral mastectomy. Most recently, his results were published in a peer-reviewed publication entitled “Aesthetic and Technical Refinements in Latissimus Dorsi Implant Breast Reconstruction”
TRAM or DIEP Reconstruction
The abdominal tissue can often be used to reconstruct the breast without the need for an implant. The TRAM (Transverse Rectus Abdominus Myocutaneous) flap or DIEP (Deep Inferior Epigastric Perforator) flap procedures are methods of reconfiguring the abdominal tissue to recreate the natural droop of breast tissue. Patients who are very thin are not often candidates for this type of reconstruction. During a consultation, Dr. Pacella can assess whether this procedure is an option bearing in mind the patient’s unique body type and can discuss the benefits of this technique long-term.
Secondary Deformities After Breast Surgery
The results of breast reconstruction can change over time. Aging, gravity, weight change or implant type can affect results after several years. In addition, patients who are treated with lumpectomy and radiation often have secondary deformities that may benefit from revisional breast reconstruction. Dr. Pacella can utilize several techniques to optimize the results in these instances. Existing breast tissue can be repositioned, breast implants can be updated and fat from other locations on the body can be harvested to mask deformities (i.e. fat transfer). Breast lifts, breast reductions or breast augmentations can also be used on the opposite breast to maintain symmetry. Results in these cases are often very successful, even if many years have passed since the first attempt at breast reconstruction.
During your initial consultation, Dr. Pacella will evaluate your anatomy, overall health, clinical situation and personal preferences, in order to determine if primary or revisional breast reconstruction surgery is an appropriate option for you at this time. If necessary, he will collaborate with your oncology team and will select the best surgical options to ensure a safe and successful outcome. Dr. Pacella has earned an exceptional reputation for providing the highest quality of patient care, and he looks forward to helping you achieve the best possible results with your breast reconstruction surgery.