Breast Reconstruction in Manhattan Beach, CA

Most women who undergo mastectomy are offered the possibility of immediate breast reconstruction under the same anesthetic. I strongly believe that it is a woman’s right to have her body restored to as close to normal as possible following the removal of breast cancer. The requirement for health insurance to cover not only breast reconstruction, but also balancing procedures and nipple reconstruction, is mandated by statute in most states.

To women who have not had reconstruction at the time of their original mastectomy, and who have perhaps already undergone radiotherapy and/or chemotherapy I would offer ‘delayed’ reconstruction. Occasionally, delayed reconstruction is planned ahead, particularly when post-operative radiotherapy is contemplated.

The method of reconstruction is individualized to each patient. It is highly desirable that surgery be tailored to the individual’s requirements. To make this feasible, it is essential for the surgeon to be not only familiar but skilled in all the modalities of breast reconstruction. It is a sad fact that when your only tool is a hammer, the whole world looks like a nail! Factors that influence the choice of procedure must be fully discussed with the patient. These include:

• Age
• Type of cancer
• General medical condition
• History of smoking and diabetes
• Size and shape of the normal breast
• Radiotherapy
• Abdominal scars
• General adiposity
• Recreational activities and sports
• Extent of disease
• Extent of surgery
• Patient’s wishes (last but not least)

Basically, there are two types of breast reconstruction: those involving the patient’s own tissue (autogenous) and those utilizing implants (alloplastic).

Use of the patient’s own tissue involves the harvesting of a large section of skin and fat from a donor area and transplanting it to the chest. Such procedures are known as free tissue transfers. Circulation to the tissue is reestablished by microvascular anastomosis (the joining together of small blood vessels under a microscope). Functional impairment at the donor site is eliminated by the use of ‘Perforator Flaps’ such as DIEP, SIEA and SGAP flaps, in which the muscle is spared and only fat and skin are taken. The donor sites for these perforator flaps include: the lower abdomen(‘DIEP’ and ‘SIEA’ flaps, where, as a bonus, the patient gets a tummy tuck); the buttock (‘GAP’ flaps), the inner thigh (TUG flaps) and the back (‘TDAP’ flap). Whatever the donor site, the surgeon takes particular care to eliminate or at least minimize the amount of muscle taken with the flap, so as to maintain normal function both in day to day living and in recreational activities. Perforator flaps are technically demanding and they are only performed regularly in a few centers in the United States and abroad. Older methods of free tissue transfer such as free or pedicled TRAM flaps require the sacrifice of muscle and sometimes the tunneling of tissue, with a greater risk of hernia and functional loss. It is therefore important for the patient to know the kind of free tissue transfer that is being offered and be educated in the specific advantages offered by perforator flaps.

Implants may be saline or gel-filled. They are often used after the initial placement of a tissue expander at the time of mastectomy. A tissue expander is like an empty implant with a metal valve on the front. Over a few weeks, the tissue expander is inflated at the doctor’s office by his injecting saline into the valve. The expander gets larger and gradually stretches the skin in preparation for placement of the definitive implant. This takes place at a second procedure. The increasing use of ‘skin sparing’ mastectomies reduce the need for expansion so that implants may be inserted immediately. Often I use a human-derived collagen product such as Alloderm in conjunction with the patient’s own pectoral muscle to create a well protected pocket to accurately protect and position the expander or prosthesis.

Nipple reconstruction is likewise offered to all patients. This may be performed as day surgery – often under local anesthetic – usually about four months after the initial reconstruction. When this is combined with a ‘skin-sparing’ mastectomy, the scarring is mostly hidden and the resulting appearance is virtually normal. I frequently perform balancing procedures and scar revisions at the same time as nipple reconstruction to obtain the best result humanly possible for the patient involved.

At your initial consultation, I shall take a detailed history and perform a thorough examination with the object of establishing the options available, formulating a treatment plan and ensuring that any pre-existing medical conditions may be appropriately managed to minimize risk at the time of surgery. You will have ample time to ask questions and discuss your options in a professional yet friendly setting. The surgery itself will be carried out in a safe hospital environment and you will have a board certified anesthesiologist giving the anesthetic. Your time off work will depend on the method used and the physical activity required in your occupation. I will discuss this with you on an individual basis.

For more information about having breast reconstruction in Manhattan Beach California – contact Dr Boyd today at 310.882.6261

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