Breast reconstruction involves creating an aesthetically pleasing breast after a lumpectomy or a mastectomy. There are a variety of ways to do this, such as using a breast implant or your own tissue from your abdomen or back. Recreating a breast with an implant begins with stretching the skin with a tissue expander to make a pocket for the breast implant. Then, the expander is removed and a soft, natural looking breast implant is placed. If using your own tissue is desired and adequate tissue is available, the breast is recreated by moving the excess abdominal tissue up to the chest. This can be done by using the muscle with the abdominal skin (TRAM flap – Transverse Rectus Abdominis Muscle flap) or using the skin only and microscopically reconnecting the blood vessels (DIEP flap – Deep Inferior Epigastric Pedicle flap.) Women who have breast reconstruction have a better outlook on life and feel better about themselves. This was proven in a study done in part by Dr. Schreiber: “Breast Reconstruction in the Elderly: Preserving Excellent Quality of Life.” Girotto, John A. MD; Schreiber, Jeffrey MD; Nahabedian, Maurice Y. MD, FACS. In order to complete the reconstruction, Dr. Schreiber can create a new nipple using some of the new breast skin and tattoo an areola, both done right in the office. Having received the Patients’ Choice Award from patients rating Baltimore plastic surgeons, Dr. Schreiber is devoted to his patients and to achieveing all of their aesthetic goals.
Reasons for Considering Breast Reconstruction
Breast Reconstruction – General Procedure
After the lumpectomy or mastectomy is completed, Dr. Schreiber will proceed immediately with your breast reconstruction. In certain circumstances, it may be more advantageous to delay the reconstruction (if radiation is required after the mastectomy.) If you choose to undergo expander/implant reconstruction, Dr. Schreiber will gently place a tissue expander underneath the muscle and remaining skin. Then, in the ensuing weeks, the expander will be slowly filled with sterile saline (via a built-in port in the expander) until the desired size is reached. A second operation will be required to exchange the expander for implants. The nipple and areola are reconstructed in the office under local anesthesia only.
Using your own tissue is another option for breast reconstruction, and this can also be done immediately after the lumpectomy or mastectomy. If a TRAM flap is chosen, the abdominal tissue is dissected out, rotated to the mastectomy site, and sculpted into a breast. This flap is based on the rectus abdominis muscle which supplies the new breast with nutrients.
If a DIEP flap is chosen, the abdominal tissue is dissected out, no muscle is taken, and the blood vessels to the abdominal tissue are re-connected to the blood vessels underneath a rib in the chest to supply the new breast with nutrients. This procedure takes longer, but has the added benefit of not taking the rectus abdominis muscle. Using skin from the back is also a viable option. During this procedure, the excess skin from the back is rotated to the mastectomy site. The latissimus dorsi muscle is used to supply nutrients to the new breast in this technique.
***Every patient is unique, and each form of reconstruction is tailored to fit each patient’s desires under each specific situation. Please consult with Dr. Schreiber to find out which form of reconstruction will fit you the best and give you the results that you want.
Dr. Schreiber performs breast reconstruction at Northwest Hospital in Randallstown, Maryland, the SurgiCenter of Baltimore in Owings Mills, Maryland, Greater Baltimore Medical Center in Towson, Maryland, and at St. Joseph Medical Center in Towson, Maryland. All of these facilities are easily accessible from Towson, Baltimore City, Baltimore County, Pikesville, Ruxton, Lutherville, Howard County, Annapolis, and Washington D.C.
Breast Reconstruction – Recovery Process
The recovery process depends on the type of breast reconstruction chosen. If you choose expander/implant reconstruction, plan on spending 1-2 days in the hospital for recovery. Please allow 6 weeks before returning to exercise. Also, small drains will be placed, and we’ll teach you how to take care of them. If you decide to undergo reconstruction using your own tissue, please plan on spending 3-5 days in the hospital. This also involves avoiding exercise for 6 weeks and the placement of drains. Dr. Schreiber is committed to pain relief and making sure your post-operative recovery is as comfortable as possible. He is available 24/7 for any questions, and he takes pride in getting back to his patients right away.
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