Beverly Hills Breast Reconstruction

Treatment Overview

First, you will meet with Dr. Anita to share your concerns and discuss the results that you hope to achieve. This will be followed by a review of your medical history and a focused physical exam. Dr. Anita will then go over the risks and activity restrictions, and give you time to ask questions. For any immediate breast reconstruction procedures, our office will coordinate the reconstruction with the surgical oncologist’s office.

The reconstruction journey involves a number of steps, and after discussing what you are interested in and a good candidate for, the reconstructive steps for that type of reconstruction can be planned out. Prior to the surgery, you will fill out consent forms.

Breast reconstruction can be done using a variety of methods, ranging from implant-based reconstruction (tissue expander followed by exchange for implant; or direct-to-implant) to tissue-based reconstruction (either pedicled flap or free flap).

General anesthesia will be administered for this surgery and we recommend that you arrange to have someone drive you to and from the surgery appointment.

Different Types of Beverly Hills Breast Reconstruction

The three main types of breast reconstruction are implant based reconstruction, autologous tissue flap, or free tissue transfer. No matter what type of reconstruction surgery you choose in Beverly Hills, rebuilding a breast and achieving symmetry with the opposite breast is a process that typically requires a series of steps over the course of a year, and possibly more.

The first step is reconstructing the breast(s) that had cancer. If only one breast was reconstructed, the next step is a procedure on the opposite breast to make it match. The third step is either a touch up needed to make sure both breasts match as closely as possible, or nipple reconstruction for the side without a nipple. After a nipple reconstruction, the last step is nipple tattooing to restore the color to the nipple and areola.

Implant Based Reconstruction

Implant based reconstruction is a good option for women who underwent bilateral mastectomy, already have implants, have little bulk for possible donor sites for using their own tissue, and want to minimize downtime or have the quickest recovery possible. It is important to note that this breast rebuilding is not as predictable of an option for Beverly Hills patients who have undergone radiation therapy.

The first step in implant-based reconstruction is typically having a temporary device called a tissue expander placed under the pectoralis muscle on the chest (the exception being “direct-to-implant reconstruction” if a candidate). Tissue expanders are inflatable devices that have a magnet and injection site or port. Fluid is injected through the port into the expander at a series of office visits. The amount injected per visit depends on many factors, including the condition of the skin overlying the expander, the final goal amount, and patient comfort.

Next the tissue expander is removed, and the final implant is placed. The implant chosen may be round or shaped. If the opposite breast needs to be addressed with a breast lift, a breast reduction, or augmentation, it may be addressed at this surgery or a separate surgery.  Since the breast has been removed in a mastectomy, there is little to camouflage the borders of the implant. In some cases, it is helpful to perform fat transfer to the breast along the upper border of the implant to provide a smoother contour.

Autologous Tissue Based Reconstruction

Autologous tissue-based reconstruction means skin and tissue is used from one part of the body, and rotated into position to create a new breast. Examples of this type of reconstruction include the pedicled TRAM (transverse rectus abdominus myocutaneous) flap, and the pedicled latissimus dorsi flap. For the TRAM flap, skin, subcutaneous fat, and rectus abdominus (abs) muscle, are taken from one side of the lower abdomen and tunneled below the skin and brought out at the breast to create a new breast mound. For the latissimus flap, the tissue rotated forward comes from the back.

The advantage of this Beverly Hills surgery is that there is no implant involved, and the tissue tends to hang or drape in a way that resembles the natural breast shape. Another advantage is the flattening effect on the abdomen, if using a TRAM flap, since in order to close the donor site the abdomen is closed in a manner similar to a tummy tuck. The latissimus flap involves taking tissue from the back, and the incision is created in a way that the final scar can lay in the bra line.

In order to be a candidate for this surgery, there needs to be enough tissue at either the abdomen or back to create a breast, and this tissue cannot be previously operated on. This flap typically gives a smaller volume, and if the goal volume for reconstruction is greater than a B cup, you may need an implant in addition to this flap.

Free Tissue Transfer (Free Flap)

Free tissue transfer is different from the above options because it involves complete separation of skin and tissue from one area, including its blood vessels, and reattaching these vessels to blood vessels in the chest under an operating microscope.

This procedure takes significantly longer than the other techniques, and involves close postoperative monitoring and care, typically requiring at least one night stay in the intensive care unit. The total hospital stay tends to be around five to six days. While both the operating room time and recovery time are the longest for this type of Beverly Hills reconstruction, it does create natural appearing breasts and can transfer a significant volume of tissue.

The most common donor site for tissue is the lower abdomen, and different variations include the free TRAM flap, muscle-sparing TRAM flap, DIEP (deep inferior epigastric perforator) flap, and SIEA (superficial inferior epigastric artery) flap.

• Length of Surgery: Varies based on immediate versus delayed reconstruction, which type of reconstruction, and which step of reconstruction.
• Anesthesia: General
• Post-Op Activity: Avoid strenuous activity for 6 weeks.
• Return to Work: 5-14 days

Please Note: These are general estimates that may or may not apply to you individually.

Frequently Asked Questions

What is Reconstructive Breast Surgery?

Reconstructive breast surgery typically refers to plastic surgery to reconstruct a breast mound and nipple after mastectomy for breast cancer.

How is Breast Reconstruction Done?

Breast reconstruction can be done using a variety of methods, ranging from implant-based reconstruction (tissue expander followed by exchange for implant; or direct-to-implant) to tissue based reconstruction (either pedicled flap or free flap).

How Does a Breast Expander Work?

A breast expander is a silicone shell that is inserted with a small amount of fluid inside, and gradually inflated with more fluid, allowing the skin to stretch and grow to accommodate the growing size. It allows the body to gradually generate more skin, in an area where the skin is tight, such as after mastectomy where both skin and breast tissue are removed.

Is Breast Reconstruction Safe?

Breast reconstruction risks vary based on which type of reconstruction is performed, and also which step in reconstruction (earlier procedures tend to be greater in scope than later procedures). In addition, the risk also depends on one’s overall health status.

Can I Get Breast Implants After a Mastectomy?

Yes, one can get breast implants after mastectomy. Depending on what you are a candidate for, this may involve an initial step of tissue expansion, followed by exchange for an implant, or if you are a candidate- you may be able to go straight to implant.

How Long Does a Mastectomy Take to Heal?

Mastectomy is the removal of the breast and nipple areola complex, and typically one can go back to work 10-14 days later.

How Much is Breast Construction Surgery?

Breast reconstruction is typically covered by insurance, though there may be out-of-pocket costs. Those costs depend on a number of factors, and requires additional information to answer. To provide you with accurate pricing information, we invite you to book a complimentary Pre-Consult Phone Call with our Patient Care Coordinator by calling 310.205.0212. During that phone call, important information will be discussed and ballpark pricing will be provided.

Does Insurance Cover Mastectomy Reconstruction?

Insurance is mandated to cover mastectomy reconstruction, and also for symmetry procedures for the opposite breast if needed.

Who Could Have Their Breasts Rebuilt?

Breast reconstruction in Beverly Hills refers to rebuilding breasts following cancer surgery, such as a mastectomy, or trauma. Even patients who undergo a limited mastectomy such as a segmental resection, or a lumpectomy, may be candidates for breast reconstruction.

If you’re ready to learn more about a breast reconstruction, book a free appointment with Dr. Anita Patel today.