Oncoplastic Surgery St. Louis - Breast Reconstruction Technique Missouri
An oncoplastic procedures is a combined breast conservation procedure between a breast cancer surgeon (onco-) and a plastic surgeon (-plastic). Dr. Cabbabe and your breast surgeon plan surgery together to optimize your result. Incisions are planned together in order to produce the best cosmetic result possible and minimize the future effects of radiation damage, which causes permanent/irreversible damage.
Essentially, a breast reduction or breast lift/mastopexy type procedure is utilized in order to fully remove the cancer then re-shape the breast in order to prevent cavities from forming that may fill with fluid then contract and deform the breast after radiation. The result may be significant asymmetry with discrepancies in breast cup size between the breasts or shifting of the nipple – areola complex off the center of the breast. These procedures are generally covered by insurance companies.
If you are scheduled for a lumpectomy or excision of a mass from your breast, then you are a candidate for this procedure. Since most lumpectomy surgeries require post – operative radiation, the result can be a deformed breast with significant asymmetry compared to the other side. These are very difficult to correct after radiation and more complicated. Healthy women who have large breasts or droopy (ptotic) breasts are excellent candidates for this procedure. Smoking increases the risk of complications.
Preparing for Surgery
Dr. Cabbabe will ask that you refrain from taking any aspirin, plavix, Coumadin or any other type of blood thinner. If you are taking chemotherapy, this may need to be finished or held prior to surgery.
Scars will vary depending on size and shape of breast and previous incisions from biopsies. After you have been marked by Dr. Cabbabe and the breast surgeon, the breast surgeon removes the mass from the breast. Following this, Dr. Cabbabe reconstructs the breast to provide the best shape and result possible. A breast lift or breast reduction may be needed on the other breast in order to improve symmetry.
Antibiotics are given before the procedure and drains are sometimes used if lymph nodes are removed. If this procedure is done by itself, most patients are able to go home the same day. If you are having an axillary dissection, you may stay overnight. Patients are able to shower the next day and go home in a bra. Early range of motion is done with the arms. Patients will generally follow-up within 1 week and then approximately 3-4 weeks later and then in several months. There may be some numbness on the breast which improves with time.
Recovery is approximately 1-2 weeks depending on the procedure performed on the breast (reduction versus lift) and the amount of fat removed. Most women who have this procedure done will be up and about the next day, moving around although they may need pain medication occasionally.
Dr. Cabbabe strives to make the procedure as easy and comfortable as possible for his patients. Before surgery, patients may receive anti-inflammatory pain medications that do not cause bleeding. At the time of surgery, local anesthesia numbing medicine is used that is long – lasting into the breast. After surgery, early range of motion is begun and pain medications are given.
Before and Afters
Bleeding may occur after surgery and necessitate a return to the OR. Most women have asymmetry before surgery and asymmetry may be present after surgery. Patients still receive radiation and this affects the cosmetic outcome. There may be areas of skin that are slow to heal, including the nipple – areola complex. Scars may become thick and irritated and require revision surgery. Rare complications such as blood clots, fat embolism, injury to surrounding structures, pulmonary embolus and death may occur. Revisions may be needed.
Types of Reconstruction:
- Fat Grafting
- Oncoplastic Breast Reconstruction (one – stage)
- Tissue Expander – Implant (two – stage)
- Tissue Expander – Implant with Acellular Dermis (two –stage)
- Implant with Acellular Dermis (one-stage)
- Latissimus Flap (one – stage)
- Latissimus Flap with Expander – Implant (two – stage)
- Latissimus Flap with Implant (one-stage)
- Conventional TRAM (one – stage)
- Free Muscle – Sparing TRAM (one –stage)
- DIEP Flap (one – stage)
- SIEA Flap (one – stage)
- SGAP/LGAP (one – stage)
- Fat Transfer Breast Augmentation
- Breast Implant Reconstruction (One-stage)
- Breast Implant Revision Surgery
- Breast Tissue Expander – Implant Reconstruction (2-stage)
- Latissimus Flap Breast Reconstruction
- Latissimus Flap Breast Reconstruction with Implant (1-stage)
- Latissimus Flap with Implant Breast Reconstruction (2-stage)
- Transverse Upper Gracilis (TUG) Flap Breast Reconstruction