Aesthetic breast surgery and breast reconstruction is a sub-specialization of Dr. Wanzel's. He completed additional training after his seven year residency in aesthetic and reconstructive breast surgery.
Breast reconstruction is performed on women who have lost one or both breasts to mastectomy, or who lack breasts due to congenital or developmental abnormalities. The goal of breast reconstruction is to create a breast and nipple that resemble the natural breast as closely as possible in shape, size and position.
Most breast reconstructions involve two or three procedures that occur over time. The initial operation involves the reconstruction of a new breast mound. This can either be performed immediately following breast removal (mastectomy) or can be done months to years later. In one or two more stages, a final shaping of the breast mound is accomplished, a reconstruction of the nipple and the areola is performed, and possibly surgery to enlarge, reduce or lift the natural breast to match the reconstructed breast is performed.
Types of Breast Reconstruction
In general, there are 2 ways to make a new breast.
The first is commonly referred to as "alloplastic" and involves the use of breast implants to create the new breast. This is often a two-stage endeavour whereby at the first operation a tissue expander is placed (it essentially acts to help stretch the skin to make room for the eventual permanent implant). The second stage replaces the tissue expander with a permanent implant.
The other method uses the patient's own tissues to make a new breast (it is commonly called "autogenous"). The most common place that we look to find extra skin and fat is the abdomen. We can use this tissue with its blood supply and shape it to make a new breast. The tissue either remains attached to the patient (eg. TRAM flap) or is detached and reattached to new arteries and veins in the chest (eg. DIEP flap).
alloplastic Breast Reconstruction
Implant/tissue expansion breast reconstruction involves inserting an implant in the chest after the skin has been stretched enough by an expander to contain it. At the first, the surgeon inserts a balloon expander beneath the skin and chest muscle where the reconstructed breast will be built. Then, during the next few weeks or months, a saline solution is injected through a tiny valve beneath the skin into the expander. As the expander fills with saline, it stretches the skin and creates a pocket for the implant. The expander is left in place for about 3 months so that the skin will remain stretched and is then replaced with a permanent implant made of silicone gel.
Autologous Breast Reconstruction
Autologous tissue breast reconstruction is used if there is not enough tissue left post-mastectomy to create a new breast using tissue expansion, there is significant skin damage from radiation, or a woman who may not want breast implants. During autologous tissue breast reconstruction, a breast is created using skin, fat and, sometimes, muscle from other parts of the body. The abdomen, back, buttocks or thighs are all donor sites. The donor tissue, which is called a "flap," is either surgically removed and reattached (free flap - eg. DIEP) to the chest, or left connected to its original blood supply and "tunneled" through the body to the chest (pedicle flap - eg. TRAM). There are a number of different flap techniques; which one is used depends on the individual patient. Factors taken into consideration include how much extra tissue is available for transfer; the width and flexibility of blood vessels; and how large the breast(s) needs to be.
after the Breast mound is reconstructed
The first goal of a breast reconstruction is to make the "breast mound". At subsequent operations, the mound may require some refinements to achieve the best possible shape.
Once we are satisfied with the new breast shape, we can discuss the creation of a new nipple and areola. This is often done with a combination of techniques that may include flaps, grafts and/or tattoo.
If it is a unilateral reconstruction (ie. one sided only), often times a subsequent operation is needed on the remaining breast to best achieve balance. This can either be a reduction, a lift, or an augmentation.