Breast Reconstruction – A Balance of Experience, Science, and Art

Breast reconstruction is achieved through a variety of plastic surgery techniques that attempt to restore a breast to a normal shape, appearance and size following mastectomy. Multiple procedures may be involved, typically performed in stages and can either begin at the time of your mastectomy or be delayed until later. In any case, expert surgeons in the specialty say it can be one of the most challenging as well as rewarding plastic surgery operations in existence today.

Breast reconstruction generally falls into two categories: implant-based reconstruction and flap reconstruction. Implant reconstruction relies on breast implants to help form a new breast mound. Flap (or autologous) reconstruction uses the patient’s own tissue from other parts of the body to form a new breast.

Which is Best for You?

A number of factors should be considered when choosing which option is best for you:

• Type of mastectomy
• Cancer treatments
• Your body type

And breast reconstruction doesn’t always have to be done on both breasts! If only one breast is affected, it alone may be reconstructed. Also, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size, shape and position of both breasts.

“It is a learned art….”

“Breast reconstruction is a learned art,” says Stafford Broumand, MD, a board certified plastic surgeon in New York City. “To make someone who’s had a mastectomy and lost the volume or their breast and the shape of their breast, to make a breast from basically skin, that is the art of breast reconstruction.”

Dr. Broumand tells The Plastic Surgery Channel there certainly is not just one solution for breast reconstruction. “There are different ways to reconstruct the breast and I talk with my patients going from the simplest, having no reconstruction, which is generally not what we recommend,” he says. “To an implant type reconstruction, and the most complicated type would be using your own tissues for the reconstruction. But in that center category of having an implant to reconstruct your breast, we usually do it in a staged procedure.”

It’s not typical that a plastic surgeon approaches a breast reconstruction operation without prior consultations with other physicians. “We are coordinating with the breast cancer surgeon and our patients for a way to reconstruct a breast basically from skin. And that’s what we do,” Dr. Broumand adds.

Using Tissue Expanders Can Be Extremely Beneficial

Dr. Broumand likes to employ the use of tissue expanders whenever possible, in order to produce “more” skin from which to work and reconstruct, especially in the case when just one breast is being reconstructed.

“Generally, we stage it with an expansion of the skin because the skin is quite delicate after having a mastectomy,” Broumand explains. “We gradually stretch that skin so that we can then put in an implant as volume for the breast. Then we either take their fat, either from their hips or their abdomen, and then layer it over that final implant so that it looks like the opposite side.”

Surgical Expertise is Mandatory, but so is an Artful Eye

Especially when we’re talking about fixing something ‘that may be considered broken,’ Dr. Broumand stresses that while having a board certified plastic surgeon is absolutely essential for breast reconstructions, you also want to find someone who you relate to on an aesthetic basis as well.

“It’s basically painting on a canvas,” Dr. Broumand says. “You start with primer and then you get the colors in and then you get the shape and the shading. That’s exactly what we’re doing to reconstruct a breast.”

Make the Decision That’s Right for You

Whatever your age, relationship status, sexual activity, or orientation, you can’t predict how you will react to losing a breast. It’s normal to feel a full range of emotions: anxious, uncertain, sad, and mournful about giving up a part of your body that was one of the hallmarks of becoming a woman. Moving forward, you now have the opportunity to determine what you want to have happen next. First, you must do some careful thinking and delving into your feelings in order to figure out what is best for you. When consulting with an experienced, board certified plastic surgeon, all the options can be understood, considered, and one finally selected.