A woman’s breasts are an integral part of her femininity and identity. When faced with the loss of one or both breasts, having a plastic surgeon with breast reconstruction experience on your team is an important part of recovery. Dr. Holmes has performed numerous breast reconstruction procedures and understands the loss many women feel after mastectomy. Each woman in need of Reconstructive Breast Surgery has a unique journey. In support of yours, Dr. Holmes will offer you his expertise and guidance through every stage of the reconstructive surgery process.
Is a Breast Reconstruction Right for Me?
Breast reconstruction is a surgical procedure that restores the breasts after mastectomy. For many women, breast reconstruction is a critical part of the recovery process. During your consultation with Dr. Holmes, you will learn about your reconstructive options. For instance, reconstructive surgery may be done at the same time as a mastectomy or delayed months or even years. Another choice includes the type of reconstruction: implant-based reconstruction procedure versus autologous (your own body) tissue reconstruction.
Restoring a woman’s sense of self through breast reconstruction requires thoughtful consultation and true understanding of a patient’s goals. Together, you and Dr. Holmes will determine your best reconstructive plan.
Breast Reconstruction Surgery With Dr. Casey Holmes
Women who have undergone or are planning to undergo a mastectomy surgery for breast cancer have the option of having reconstructive plastic surgery to replace the breast tissue, skin and nipple removed during surgery. During your consultation, Dr. Holmes will evaluate your anatomy, discuss your concerns and thoughtfully design a unique surgical plan that will safely and effectively meet your breast reconstruction goals. His recommendations will depend on many factors that include need for radiation, the quality of your skin and tissues and your personal preferences for breast reconstruction surgery. Dr. Holmes will also work closely with your breast oncologist to coordinate surgical planning.
About The Procedure
Although breast reconstruction using implants can be performed in a single stage, with permanent implants placed at the time of mastectomy, it is more common to perform reconstruction in stages in order to obtain adequate skin coverage. When performed in stages, temporary implants called tissue expanders are placed beneath the skin and muscle of the chest at the time of mastectomy surgery. Over time these expanders are filled with saline until the desired breast size is reached. Dr. Holmes will perform this procedure in the office weekly. Tissue expanders allow the skin and chest muscle to expand to accommodate permanent implants. Once expansion is complete (usually 4 to 6 weeks) a saline or silicone implant replaces the tissue expanders in an outpatient surgical procedure.
As opposed to implant-based reconstruction, autologous tissue breast reconstruction utilizes your own body tissue to reconstruct the breast. Dr. Holmes may take tissue from sites, such as the abdomen or back, to create specific tissue flaps. Compared to surgery with an implant, this procedure is more complex, but also create more natural-looking breast that will change in size as you gain or lose weight and maintain more sensation. It also prevents the need of using a prosthetic silicone implant, which many women prefer. Another benefit is the procedure is performed in a single stage. The most common types of autologous tissue reconstruction include the TRAM (Transverse Rectus Abdominus Muscle) flap, Latissimus Dorsi Muscle Flap, and DIEP (Deep Inferior Epigastric Perforator) flap.
During your consultation, Dr Holmes will thoroughly explain each reconstructive option. Depending several factors including your skin quality, the need for radiation and desired reconstructive outcome, and together with your breast oncology surgeon, they will design a reconstructive plan that is best for you.
Breast Asymmetry Surgery
At the Aesthetic Surgery Center, Dr. Casey Holmes has specialized training in how to correct uneven breasts. You may need a combination of different surgeries such as a breast lift, breast reduction, breast augmentation with implants, or fat grafting. Many women genetically have uneven breasts with the left or right breast bigger than the other. If you have uneven breasts as a result of prior surgery, you may need a revision to correct the asymmetry. After a thorough consultation and physical exam by Dr. Holmes, he will provide recommendations as to which procedure you are best suited for.
Breast Reconstruction FAQs
Immediate reconstruction of the breast occurs at the time of mastectomy. That means that during your surgery, your breast surgical oncologist will perform the mastectomy and once complete, Dr. Holmes will reconstruct your breasts during the same operative setting. Your options in immediate reconstruction include placement of tissue expanders, immediate placement of permanent implants, or autologous tissue reconstruction. The ability for you to undergo immediate reconstruction will depend on the skin quality after mastectomy.
As opposed to immediate reconstruction, delayed reconstruction occurs months or even years after your mastectomy. In certain circumstances women prefer to complete their oncologic treatment prior to undergoing reconstruction. Another reason to delay reconstruction is for poor skin quality at the time of mastectomy. Either way, Dr. Holmes will help make the best choice with you.
There are many options in breast reconstruction and no one choice is best for everyone. Implant-based reconstructions offer the advantage of shorter operative time and recovery, lack of donor site scars (ie the abdomen or back when using autologous tissue reconstruction) and the ability in some cases to undergo immediate single stage reconstruction. However, when using implants one must remember there is always a chance you may need to replace your implants over time.
This is the most common way to perform autologous breast reconstruction, and it requires taking tissue from the abdomen. During surgery, an incision is made just above the pubic area between the hip bones, similar to in a tummy tuck. Dr. Holmes will divide the lower end of the muscle, rotate the tissue, and tunnel it up under the skin to the chest area to create the breast. The upper portion of the muscle remains attached to its original position for blood supply for the tissue flap.
This method is similar to the attached TRAM flap, but requires less muscle. A portion of the abdominal muscle, as well as skin and fat, will be completely removed from the abdomen and moved to the chest to reconstruct the breast. Blood vessels will be reconnected to vessels of the underarm or chest. Because this procedure uses a smaller portion of muscle, abdominal strength will not be affected as greatly and recovery may be easier.
This breast reconstruction approach does not involve removing muscle. Instead, blood vessels in the abdomen that supply blood to the fat and skin in the area are located. These blood vessels, as well as the fat and skin, are removed and placed in the chest to form the breast. The blood supply is carefully reconnected to blood vessels in the armpit or chest. This method typically has the fastest and easiest recovery, although surgery requires more time.
Most patients feel the most discomfort during the first few days after breast surgery. This is largely controlled with an oral pain medication prescribed by Dr. Holmes. After the first few days, you will transition to over-the-counter pain medication. It is normal for the breasts to feel swollen and tender at first, but this subsides over the first few weeks. You will wear a comfortable but supportive bra for the first 4 to 5 weeks after surgery, after which you may transition back to a more normal bra with underwire. Most patients may resume normal exercise 4 to 6 weeks after surgery. Dr. Holmes will be highly involved in your post-operative management and guide you as you gradually increase your activity level.