Many women who receive a breast cancer diagnosis consult a surgeon to discuss mastectomy and reconstruction options. In general, the goal of breast reconstruction is the generation of adequate breast skin to house an implant and sufficient volume to provide symmetry, but reconstructive options are usually tailored to a specific individual.
Oftentimes, women seeking unilateral/bilateral mastectomy and reconstruction procedures consult multiple physicians, which can add confusion to the shock of receiving a breast cancer diagnosis. This is largely because these consultations generate a lot of new information, as each specialist a woman consults will invariably offer his or her opinion regarding the best course of action. Additionally, the amount of time involved as each appointment is made in sequence can delay treatment and prolong the uncomfortable course a woman travels as she awaits care.
For the past 20 years, Board Certified Dr. Daniel Greenwald of Bayshore Plastic Surgery has tried to simplify this process by becoming the point person for women seeking mastectomy and reconstruction procedures in Tampa, St Petersburg, Clearwater, and other communities in Florida. He was trained extensively in oncologic breast surgery and plastic and reconstructive surgery, allowing him to not only be a single source of information regarding surgical treatment and reconstruction options, but also to perform mastectomy and breast reconstruction in one setting.
Mastectomy and Reconstruction Options
The primary consideration during mastectomy is the surgical removal of cancer and appropriate sampling of regional lymph nodes, which helps determine whether cancer cells have spread to these nodes (metastasized) and whether a specific treatment is required. In cases where a complete mastectomy and reconstruction aren’t warranted, a lumpectomy (removal of a cancerous tumor) is performed, followed by radiation. When mastectomy is advised, reconstruction may follow, using modern techniques and equipment to provide the most efficient care.
In general, surgeons conduct mastectomy and reconstruction in a manner that achieves one of the following outcomes:
- Leaves enough remaining breast skin to house an implant immediately after mastectomy
- Facilitates the growth of skin through an expansion process of several weeks or months
- Creates a breast pocket using tissue transferred from another area of the body with an adequate blood supply. This technique can be used immediately following mastectomy or some time after.
These surgical options will be specifically tailored for a patient’s unique situation, and may include any of the following:
- Immediate implant reconstruction – Immediately following mastectomy, silicone breast implants are placed in the breast pockets.
- Tissue expander/implant reconstruction – An expandable implant that can be filled with solution over a period of several weeks or months is placed beneath skin and muscle during mastectomy. Gradual filling of the expanding implant promotes tissue expansion that enables breast reconstructive surgery and placement of the permanent implant at a later date.
- TRAM flap – A portion of skin, fat, blood vessels, and muscle from the transverse rectal abdominus muscle in the abdomen is used to create a pocket for the implant; the tissue is harvested in the same way that it would be for an abdominoplasty, or tummy tuck.
- DIEP flap – A portion of skin and fat from the lower abdomen fed by blood vessels known as deep inferior epigastric perforators is used to form the breast pocket. This is a less invasive option than the TRAM flap procedure, as the rectus muscle and fascia are left largely intact.
- Latissimus flap – A portion of skin, fat, and blood vessels from the latissimus dorsi muscle in the upper back is used to create a breast pocket. This procedure can be performed with or without implants.
For certain candidates, Dr. Greenwald may recommend bilateral mastectomy, with risk-reducing prophylactic mastectomy on the other, cancer-free breast prior to reconstruction of both breasts. This option is typically reserved for women who are diagnosed with breast cancer early in life and/or have a significant family history of breast cancer. Additionally, Dr. Greenwald can refer patients to specific physicians for optimal coordination of adjuvant therapy. This coordinated approach helps to significantly shorten the course of surgical treatment.
Contact Bayshore Plastic Surgery today at 888-840-3199 for more information about our mastectomy and reconstruction procedures.