Breast Reconstruction

What is breast reconstruction?

Breast reconstruction is a reconstructive procedure performed following a mastectomy. It helps restore the natural look and feel of a woman’s breast. Breast reconstruction can allow clothing to fit better, help maintain the natural proportion of a woman’s body, and most importantly boost the self-confidence for women that have lost one or both breasts to mastectomy. Breast reconstruction is most generally a multi-staged procedure, meaning there are general at least 2 surgeries to achieve the final result.

What is Allograft (Alloderm) Breast Reconstruction?

Allograft Reconstruction is a type of breast reconstruction using a tissue expander. It was popularized by Dr. Karl Breuing, Dr. McClellan’s mentor, and an Assistant Professor of Plastic Surgery at Harvard Medical School. Dr. McClellan learned the technique and participated in many of the early cases while a rotating Plastic Surgery Resident at Brigham and Women’s hospital.

Please see this YouTube lecture which Dr. McClellan discusses how Allograft (Alloderm) breast reconstruction can be performed after your skin sparing mastectomy.

Who performs a mastectomy?

General Surgeons or Oncologic Surgeons perform removal of the breast tissue for cancer, called a mastectomy. It’s critical that there is a good working relationship between plastic surgeon and the general surgeon in order to optimize patient outcome. Good teams that work together frequently get good safe results. Dr. McClellan understands this concept and is blessed to work with outstanding general surgeons every day. Dr. McClellan operates with William Burns MD, Andrew Heiskell MD, Roger King MD, Mark Johnson MD, and Todd Tallman MD. These general surgeons work at Heiskell, King, Burns, Tallman Surgical Associates and Morgantown Surgical Associates.

What type of incision is used to perform a mastectomy?

The standard incision used for mastectomy is a simple ellipse around the nipple areola complex. When this incision is closed its becomes a straight line across the chest. This type of incision has been used for more than 40 years to complete the mastectomy. Dr. McClellan doesn’t like the surgical look that this straight line creates. This led him to design a new incision for the skin sparing mastectomy. He designed the “Lazy Lateral” skin incision specifically for the skin sparing mastectomy. This incision provides a more natural breast shape and projection for the woman while giving outstanding visualization for the cancer surgeon to remove tissue and lymph nodes. Please see the paper below that Dr. McClellan wrote on the design of a better, more aesthetic, mastectomy incision to improve patient outcome and satisfaction.

What is a skin sparing mastectomy?

A skin sparing mastectomy is a procedure in which a woman’s breast tissue is partially or completely removed but the soft supple breast skin is left behind. This may be due to breast cancer or as a preventative measure if you are more genetically inclined to develop breast cancer. By leaving more of the skin envelope behind the plastic surgeon is able to place more saline in the tissue expander at the time of surgery and speed up the reconstructive process.

See Dr. McClellan’s live surgical video below demonstrating the skin sparing mastectomy in the operating room with Dr. William Burns of  Heiskell, King, Burns, Tallman Surgical Group

How long do I wait between getting a mastectomy and beginning breast reconstruction?

Breast reconstruction surgery may be performed immediately following a mastectomy or at a later date. The timing of the reconstructive surgery is based on the patient’s preferences, health, and other needs.

What is the first step in breast reconstruction?

The first step in Allograft Breast Reconstruction is the creating of a sling from the pectoralis major muscle to the chest wall using treated dermis. By creating this “hammock” of dermis the plastic surgeon is able to place the tissue expander behind the muscle and inflate it with a moderate amount of saline. The surgeon is able to get a jump start on the inflation process in this manner and shorten the reconstructive timeline by many months compared to older ways of breast reconstruction.

Please see Dr. McClellan’s video below demonstrating his technique for allograft breast reconstruction.

What is a Tissue Expander?

Generally the first step in breast reconstruction is the insertion of a tissue expander beneath the pectoralis muscle and remaining breast skin. The tissue expander is basically a soft balloon that is gradually inflated with a saline (saltwater) solution during visits to the hospital. There is a small metal port on the Tissue Expander which the Surgeon can find with a magnet and then place a needle through the skin in to the port. Then the saline solution can be safely placed into the Tissue Expander.  The process of expanding the breast area is done so that the skin can stretch and there is room for the implant of your chosen size.

Have there been improvements to Tissue Expanders?

Yes there have been improvements to Tissue Expanders in order to help improve the outcome and cosmetic result following breast cancer reconstruction. Various projections, re-enforced ports, and stability tabs are some of the newest additions. Dr. McClellan has invented a new tissue expander which may prove one of the more significant improvements in the last decade. He has added an integral drain into the Tissue Expander wall. This drain allows the Plastic Surgeon to both drain unwanted fluid or blood and also place antibiotics into the pocket around the tissue expander. This capability is important and may prevent other surgeries to remove the implant due to a complication such as an infection or hematoma. Using this specialized port it may be possible to have a mastectomy and reconstruction without a post-operative drain! See how Dr. McClellan’s specialized Tissue Expander works in the video below.

Dr McClellan has also created a better way to implant the Allograft for Breast Reconstruction. 

Dr McClellan has devised a way in which to improve the incorporation of the allograft into your native skin envelope. By sewing the allograft to your skin envelope the integration of the allograft is much faster reducing your chance of seroma and infection. See how he does it in the video below.

 

When is the final Breast Implant placed in Breast Reconstruction?

The silicone or saline breast implant is placed during the second stage of breast reconstruction. Once the Tissue expansion has been completed then a soft breast implant is placed. This implant can be a silicone or saline implant. Depending on whether you have a partial or complete mastectomy, you may be able to skip the tissue expander and go directly to a permanent silicone implant. Silicone implants have several advantages over a saline implant; however, it is important for you to discuss what your individual needs and desires are with Dr. McClellan as you plan your reconstructive pathway.

Are there Muscle Flap alternatives to Implants for Breast Reconstruction?

Some women prefer not to have an artificial implant placed in their bodies and opt for a natural graft or tissue flap reconstruction. This type of reconstruction gives your breasts the most natural-looking and feeling breasts. There are several types of tissue flap reconstruction. Here is a list and brief description of the forms of tissue flaps:

  • The TRAM (transverse rectus abdominus musculocutaneous) flap breast reconstruction is a procedure that involves the transfer of skin, fat, and muscle from the lower abdomen to the chest to create a new breast. A TRAM flap creates a very natural looking breast and usually does not require the use of an implant as long as a woman has enough excess skin and fatty tissue in her lower abdomen.
  • The latissimus dorsi muscle flap procedure removes this large muscle from the back along with skin and underlying fatty tissue and uses them to reconstruct the breast. The inclusion of fatty tissue helps create a more natural looking breast. The flap itself is only about one inch thick and even with the additional fatty tissue; this procedure usually requires an artificial implant in addition to the natural breast tissue in order to make the reconstructed breast match the size of the unaffected breast.
  • The deep inferior epigastric perforator (DIEP) flap procedure, like the TRAM flap procedure uses skin and fatty tissue from the lower abdomen to form the reconstructed breast. Unlike the TRAM flap technique, the DIEP flap procedure keeps the abdominal muscle intact, which speeds recovery and preserves abdominal strength after the procedure.
  • The S-GAP, or superior gluteal artery perforator, flap procedure uses skin and fatty tissue to reconstruct the breast taken from the upper part of a buttock. This procedure is a good option for women that have more fatty tissue in their buttocks rather than their abdomen.

How is a Nipple made after mastectomy for breast reconstruction?

The nipple is generally created from your own tissue using a “skate flap”. This method is reliable and provides an excellent nipple that is long lasting and maintains its projection. Please see Dr. McClellan’s video on nipple reconstruction.

What type of Breast Reconstruction is best for me?

It is important for you to discuss what your best options are for breast reconstruction with your surgeon. A reconstructive plan is as unique as the patient is so your best options may be different than another patient’s. To discuss your breast reconstruction with Dr. McClellan, please contact our office to schedule a consultation. Dr. McClellan has written an extensive paper on the various options for breast reconstruction from breast implants to muscle flaps. Please read Dr. McClellan’s paper below, Current Concepts in Breast Reconstruction. It will be a great starting point to understanding your options following mastectomy and will serve as a great way to generate questions during your consultation.

Where does Dr. McClellan perform surgery?

Dr. McClellan performs surgery at Mon General Hospital. Patients come to have breast reconstruction from throughout West Virginia and Western Pennsylvania. Its not uncommon for patients to drive from Beckley, Charleston, Clarksburg, or Parkersburg West Virginia. We have made arrangements with Residence Inn of Morgantown to accommodate out out of town patients for their overnight stays and post-operative visits.

 

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