Breast Reconstruction Surgery in South Bend, IN - Tissue Expanding & Sculpting
Is It The Right Choice For You
Not every woman facing a mastectomy feels the need for breast reconstruction, but for many women it is an important next step in their recovery and overall healing. What has changed over the years is the number of options when it comes to choosing breast implants and surgical techniques. If you need help choosing the right breast implants or have questions about mastectomy recovery, contact Dr. Stephen Zucker, your local breast surgeon in South Bend, IN.
Tissue Expanders and Implants
This procedure typically involves at least two surgeries, but has the fewest scars, is the least invasive of all of the options, and has the fastest healing time.
A tissue expander is a balloon placed at the time of the mastectomy and adds about 1 hour of extra surgery time. This procedure usually entails one and sometimes two days in the hospital. Recovery times vary, but typically are in the 2-3 week range.
During weekly office visits over 2-3 months and starting about 2 weeks after placement, the expander is slowly filled with salt water until the desired size is reached. When chemotherapy (if necessary) is completed, the expander is removed and the permanent implant placed. This takes about 1 hour and is done on an outpatient basis.
In the normal mastectomy, after the expander has been exchanged for an implant, nipple reconstruction can then be done. The nipple is created from skin taken locally from the breast—this will be done in the operating room. A tattoo is added later in the office for the areola color.
Expander and implant surgery is an option to weigh against using your own tissue (TRAM flap typically). It may not work as well in radiated settings and may not look or feel as soft and natural as using your own tissue. But the surgery is typically less invasive, takes less time, and healing is generally quicker.
This option utilizes skin and muscle from the back which is tunneled just under the axilla to create a breast mound. Because the back is not fatty, an implant is usually necessary to achieve the desired breast size. The blood supply to this tissue is left intact so failure of the flap is rare. This is a useful procedure for women who have large breasts, have wound healing problems, previous infections of the chest, or have had prior radiation therapy of the chest.
This procedure takes about 3 hours and requires 2-3 days in the hospital. Drains stay in the back for 1 to 3 weeks to prevent fluid collections there. Besides the scar on the breast, there is also a long scar on the mid-back region of the affected side. This scar is placed in a natural fold line that many women have to improve the quality of the scar. Recovery for this procedure is in the 3-4 week range.
For a larger breast size, an expander (rather than a permanent implant) is placed at the time of surgery under the latissimus flap and necessitates extra office visits to fill the expander. A second surgery to replace the expander with a permanent implant is then performed.
Bilateral refers to breast reconstructions on both sides. For various reasons, patients decide to undergo bilateral mastectomies. Some of these patients request bilateral breast reconstructions.
Important Concepts For These Patients
Bilateral breast reconstruction with expanders and implants is still a multi-step procedure with numerous office visits. Operating on both sides is not much more involved than operating on just one side. It is still a 60-90 minute procedure that occurs after the mastectomies. A second operation in the OR is needed to remove the expander, make adjustments, and to place the permanent expander. The second surgery is done as an outpatient, typically 3 months after the placement of the expanders, or after chemotherapy and/or radiation therapy have been completed.
The implants, because they are both round, achieve some added symmetry for the patient. A patient will continue to have weekly office expansions until she feels that the size of the expanders is appropriate for her build, her clothes, and her expectations. The final size depends upon the patient’s expectations for how she will look in clothes.
If the patient has already had radiation to her chest or if there is some wound healing issue, the patient may elect to have an expander on one side, and a latissimus flap for the other side. Rarely, both side latissimus flaps are performed.