Restoration of the breast following mastectomy is an integral part of the treatment of breast cancer. Breast reconstruction can happen at the time of mastectomy or at a later date as a separate operation. The timing depends on a variety of factors. These may include the women’s wishes, desires and goals, the type and size of tumor, the possible need for post-operative radiation therapy or chemotherapy. These decisions are made by the woman in consultation with her surgeon, oncologist, and plastic surgeon.
The overall goals of breast reconstruction are to create a breast mound, to achieve a normal and symmetric silhouette, to limit patient morbidity, and to avoid the need for an external prosthesis. In more recent years our goals have progressed to achieve improved aesthetic results regardless of the route. Breast reconstruction can be divided into three broad categories: implants with or without tissue expansion, autologous tissue, and a combination of implants and autologous tissue. Regardless of the type of reconstruction chosen, it typically requires more than one procedure to complete breast reconstruction.
The Timing of Breast Reconstruction
The timing of breast reconstruction is another important factor to consider. Breast reconstruction can occur at either the time of mastectomy or at some point after the initial mastectomy is completed. These two time frames are referred to as immediate or delayed reconstruction.
Most surgeons agree that the aesthetic result and technical ease are improved in an immediate breast reconstruction compared to delayed reconstruction. At centers that perform immediate breast reconstructions, the breast oncologic surgeons typically utilize skin sparing mastectomies. This method of mastectomy allows for local control of the breast cancer while preserving the breast boundaries. When breast reconstruction is performed in the immediate setting, there is no scar contracture to overcome and the skin envelope helps maintain the natural borders of the breast. By preserving the natural skin brassiere, the reconstruction is more straightforward and leads to a reconstruction that is more symmetric to the opposite breast.
In delayed reconstruction, the natural borders no longer exist. The plastic surgeon must recreate the mastectomy defect and redefine the borders. The quality of the chest skin must be critically evaluated, as some patients will have had chest wall irradiation in which case the resulting scar and skin contracture may limit the projection and ptosis of the breast pocket. This may lead to difficulty expanding the skin or may require recruitment of skin for the breast from another part of the body.
In many situations Dr. Haddock utilizes what is termed a delayed immediate approach. This involves placing a tissue expander at the time of the mastectomy. In a delayed fashion this can then be converted to a DIEP flap or PAP flap. If the patient has not determined the route for definitive reconstruction then there is still time to make this decision. This also allows more control over the breast shape and longterm cosmetic result. Dr. Haddock will discuss the options at length so that the patient is completely comfortable with her decision.
Overall, breast reconstruction, either with implants or autologous tissue, has shown to improve the patients’ quality of life by restoring the patients’ sense of self and body image. It does not hinder the treatment of the cancer or hide any recurrences. In fact, breast reconstruction aids in the total recovery of the breast cancer patient through physical and mental rehabilitation.
Breast Reconstruction Options
In modern breast reconstruction there are a number of options for patients. While this is a great advantage over previous years it can be very overwhelming for patients to chose. The most simple way to think about it is in terms of three choices. A patient can chose to undergo breast reconstruction with an implant, her own tissue, or a combination of an implant and her own tissue. The most common methods in Dr. Haddocks practice are implants, DIEP flaps or PAP flaps.
Nipple-Areolar Complex Reconstruction
Reconstruction of the nipple-areolar complex is an important component to complete breast reconstruction as the nipple is the central focus when viewing the breast. This has also been shown to have a major psychological benefit to the patient when compared to those without nipple areolar complex reconstruction. Most methods of mastectomy remove the nipple-areolar complex along with the breast tissue as the nipple contain extensions of the ductal system that are also at risk for neoplastic disease. The resulting initial post-op reconstruction is therefore left without a nipple. Several months later, the patient may elect to undergo nipple reconstruction with local flaps, grafts, or a combination of the two. Tattooing of the nipple and areola can later be performed, completing the reconstruction of the nipple-areolar complex. In some situations a patient might be concerned about the projection of the nipple reconstruction. The surgical reconstruction can be tailored to the patients wishes but in situations where this is not enough a 3D tattoo can be performed as an alternative.
Although most forms of mastectomy remove the nipple-areolar complex, the nipple sparing mastectomy, removes the breast tissue but spares the nipple and areola. A discussion with the surgical oncologist will determine whether the patient is a candidate for this type of procedure. If the patient is not a candidate for a nipple sparing mastectomy, nipple areolar complex reconstruction has been shown to have a positive impact on a patient’s satisfaction with the cosmetic result of the breast reconstruction.
Patient Comments About a Breast Reconstruction with Dr. Haddock
“You know you have a fantastic plastic surgeon when your breast oncologist conducts exam and ask if you are staying current on mammograms and then goes “oh wait… You had breast reconstruction. Your plastic surgeon is amazing!” Well, I think so too. Thanks Dr. Haddock!”
“I can truly say that my experience has been wonderful. Dr. Haddock is a great plastic surgeon who takes pride in his work and makes you feel you are in good hands. He is always there to answer any question or concern. I truly recommend him for any type of plastic surgery because he loves what he does and he is good at it.”
“I am a breast cancer survivor!! And I can truly say that when I look in the mirror I don’t see a daily reminder that I once had cancer that took away the old models of my breast because Dr. Haddock gave me new models that make me feel so good about myself!!”
“I had a DIEP flap and am very pleased with the results. Dr. Haddock was very kind and wanted to make sure I was happy with the results. He discussed options with me that made me feel like I was part of the process. I now refer others to him. I highly recommend him, not only for his surgical skills but also for his caring nature.”
“My experience was great with Dr. Haddock. His staff is so kind and his integrity and bedside manner is wonderful. Of course, the best part is the results.”
“The amazing, caring, genius, artist, surgeon….the only….Dr. Haddock. I am blown away by the standard of care I received by this incredible doctor and his staff.”
“Now I have a better body then I did going into cancer treatment.”
“Dr. Haddock said you’ve got some room on the back of your legs that I could take off, and I was like, ‘OK, that’s kind of a no brainer. This was almost like a mommy makeover.”