Dallas Breast Reconstruction

Breast reconstruction can occur either at the time of mastectomy or at some point after the mastectomy is completed. These two time frames are referred to as immediate and delayed reconstruction.

Most surgeons agree that the aesthetic result and the technical ease are improved in an immediate breast reconstruction compared with a delayed one. At centers that perform immediate breast reconstructions, the breast cancer surgeons typically use nipple-sparing or skin-sparing mastectomies, which preserve the breast skin (and, in a nipple-sparing mastectomy, the nipple). These methods allow 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 tightening to overcome, and the preserved breast skin helps maintain the natural borders of the breast. By preserving that natural skin brassiere, the reconstruction is more straightforward and leads to a result that is potentially more symmetric with the other breast when only one breast is being reconstructed.

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 has to be critically evaluated: if you have had radiation to the chest wall, the resulting scarring and skin tightening may limit how far the breast projects forward and how naturally it hangs (ptosis of the breast). That may make the skin difficult to expand, or may require recruiting skin for the breast from another part of the body.

In many situations Dr. Haddock uses what is termed a delayed-immediate approach. This involves placing a tissue expander (a temporary implant that holds and stretches the space) at the time of the mastectomy, which can then be converted to your own tissue (DIEP flap, PAP flap, or LAP flap) in a delayed fashion. It keeps the focus at the time of the mastectomy on your cancer care: because the definitive reconstruction happens as a separate step, neither the cancer treatment nor the reconstruction has to be compromised to accommodate the other. If you have not yet decided on the route for definitive reconstruction, this approach also allows more time to make that decision, and more control over the breast shape and the long-term cosmetic result. Dr. Haddock will discuss the options at length so that you are completely comfortable with your choice.

Overall, breast reconstruction — with implants or with autologous tissue — improves quality of life by restoring your sense of self and body image. It does not hinder the treatment of the cancer, and it does not impact recurrence rates. Breast reconstruction has been shown to aid in the total recovery of the breast cancer patient through both physical and mental rehabilitation.

Reconstruction of the nipple-areolar complex (the nipple and the darker circle of skin around it, the areola) is an important component of a complete breast reconstruction, since the nipple is the central focus when viewing the breast. For many patients it is the step that makes the result feel finished. Most methods of mastectomy remove the nipple-areolar complex along with the breast tissue, because the nipple contains extensions of the milk ducts that are themselves at risk for disease. The initial post-operative reconstruction is therefore left without a nipple.

For the best result Dr. Haddock recommends either a nipple reconstruction together with an areolar 3D tattoo, or at a minimum a 3D tattoo for the entire nipple-areolar complex. This is typically performed about three months after the size and shape of the breast are as desired. If you are concerned about how much the reconstructed nipple will project, that can be tailored — within the limits of your own tissue. How much projection can be built depends on the thickness of the tissue at the site: making the nipple smaller is generally straightforward, while making it larger is not always possible. Where tissue thickness limits what surgery can achieve, a 3D tattoo can enhance the appearance of projection — without the nipple projecting through clothing.

Although most forms of mastectomy remove the nipple-areolar complex, a nipple-sparing mastectomy removes the breast tissue but spares the nipple and areola. A discussion with your surgical oncologist will determine whether you are a candidate for that procedure. If you are not, nipple-areolar complex reconstruction is often an important part of how satisfied patients are with the cosmetic result of the breast reconstruction overall.