Dr. James D. Namnoum | Board Certified Plastic and Reconstructive Surgeon
Breast Procedures
Breast Reconstruction
Breast reconstruction is for women who wish to rebuild their breasts after breast cancer treatment. Dr. Namnoum is a pioneer in the development of the most current and advanced surgical techniques to rebuild a natural looking breast at the same time as the breast cancer surgery or even years later. His primary focus is creating an aesthetically beautiful reconstruction for each patient. In most cases this involves enhancing the preoperative appearance to give a more beautiful post-mastectomy breast.
Each reconstruction patient is different. Factors such as the severity of the cancer, the patient’s breasts before surgery, and the amount of tissue available after a mastectomy or lumpectomy determine the type of reconstruction that will be performed. The first goal of breast surgery is to cure the cancer if present and this need directs the recommended reconstructive option.
For the patient with a genetic risk (BRCA 1, BRCA 2, CHEK2 gene, or familial high risk breast); a nipple sparing mastectomy with direct to implant reconstruction with an anatomical implant, immediate fat grafting, and mastopexy as warranted can create a visually beautiful enhancement of the preoperative breast. These technical advances enable a mostly ’one-step’ approach to breast reconstruction and are cosmetically indistinguishable from pure aesthetic breast surgery. A secondary minor procedure to refine the mastopexy or graft additional fat may be desirable for both patient and surgeon. In some cases, a pre-pectoral, minimally invasive approach can be used to avoid any donor site deformity and undesirable animation effect postoperatively.
These sophisticated techniques are often extended to patients with smaller breast cancers away from the nipple areolar complex deemed suitable candidates by their breast oncological surgeons.
There are a variety of methods of breast reconstruction including the use of an implant, tissue expander, latissimus flap plus an implant or expander, or TRAM flap techniques including perforator flaps (DIEP). Adjunctive procedures include fat transfer, use of ADM, and nipple areolar reconstruction.
A patient who has good skin laxity and who has enough preserved tissue after mastectomy surgery can often have an anatomically shaped implant inserted immediately following mastectomy. Patients who do not have enough lax breast tissue for reconstruction or want to be significantly larger postoperatively will require tissue expanders to make room before breast implants can be inserted.
Some patients may benefit from a hybrid reconstruction using tissue from the upper back (latissimus flap) and an implant or tissue expander. These patients can expect a complete return of function with appropriate [postoperative physical therapy to regain strength and flexibility. Most return to preoperative competitive tennis and golf. Latissimus flap and implant reconstruction are ideal for patients requiring skin sparing mastectomies or who have a history of prior breast radiation. They can be very useful in salvaging a poor result. Latissimus flap breast reconstruction when combined with anatomically shaped implants and fat grafting results in aesthetically beautiful breasts and can yield long lasting excellent results frequently surpassing the preoperative appearance of the breasts.
The final option for breast reconstruction involves autologous tissue only (no implants) usually harvested from the lower abdomen (DIEP, Free TRAM, Pedicle TRAM). The advantage of this approach is the ability to avoid breast implants; this is also the disadvantage as implants add significant aesthetic power to the end result. This type of reconstruction is ideal for the patient with excess lower abdominal tissues and more than adequate extra tissue to fill the mastectomy defect. None of these procedures should be confused with tummy tucks as they all weaken the abdominal wall to some degree particularly in bilateral reconstruction, have a longer recovery than other techniques for breast reconstruction, a higher failure rate, and can result in abdominal bulges and (rarely) hernias especially with advancing age and weight gain.
In some instances, the breast can be reconstructed using liposuction fat only as donor material. This has the advantage of building a breast completely out of body tissues while avoiding the potential complications traditionally associated with tissue flaps. It generally requires the use of an external tissue expansion device for a period of 2 to 3 weeks prior to fat transfer and requires multiple rounds of (2 to 3) treatment. The big advantage is the body sculpting which is combined with breast reconstruction that avoids the use of implants.
For some patients the finishing step involves nipple areolar reconstruction. Modern technology allows surgeons to recreate a natural looking nipple by using a nipple mound flap to reconstruct the nipple. However, patients can also opt for a cosmetically tattooed nipple applied by a Tattoo procedure makeup technician.
Patients who have breast reconstruction elsewhere and have step-off deformities of the upper chest and cleavage areas due to a lack of soft tissue fill are usually candidates for fat transfer procedures to soften, fill in defects, and refine their results. Excess fat is removed from other areas by liposuction, purified, and re-injected into the breast area and chest to add volume, correct contour deformities, and soften the tissues.
For more information about breast reconstruction, please contact our office today. A consultation will provide the opportunity to discuss your unique situation and consider the wide variety of options available to you.
