Breast Reconstruction

Breast Reconstruction in San Francisco, CA

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What is Breast Reconstruction?

Breast reconstruction by our board-certified plastic and reconstructive surgeon, Dr. Charles K. Lee, can rebuild the breasts after a mastectomy. New techniques in reconstructive microsurgery make it possible to rebuild the breast from tissues from the abdomen, thighs, or buttock. Dr. Lee offers both implant based breast reconstruction (tissue expanders and silicone gel implants) and autologous tissue reconstruction, such as the DIEP, SIEA, and TUG flaps.  Dr. Lee has successfully performed hundreds of breast surgeries throughout his career, which includes his unique microsurgical breast reconstruction techniques and treatment for arm lymphedema with supermicrosurgery LVA and Lymph Node Transplant. He works with a team of microsurgeons from UCSF Plastic Surgery to optimize patient care. If you would like to schedule an appointment, contact one of our patient coordinators today to begin the process.

Dr. Lee's Surgical Techniques

Breast reconstruction is an extremely personalized surgery. Each patient will have an in-depth consultation with Dr. Lee to determine their surgical plan based on their concerns, needs, and suitable options. If you are thinking about reconstructive surgery, it is crucial that you have realistic expectations. While Dr. Lee aims to give you a natural appearance, your reconstructed breast(s) may not have the same sensations, look, or feel as your original breast(s). You should get clearance from your oncology team to undergo surgery and tell Dr. Lee regarding any other medical conditions that could affect your recovery.

Autologous Tissue Flaps

There are several techniques available today for breast reconstruction. There are also many factors that Dr. Lee considers when deciding on the technique that will produce your best results. A few of these factors include cancer diagnosis, when the reconstruction is performed, whether you will use natural tissue or implants, and if nipple-sparing or nipple reconstruction is a part of the process. In order to recreate the breast, there must be enough tissue to adequately cover the breast mound. Flap methods accomplish this by using your own muscle, fat, and skin to create, cover, and build the breast. The most common flap techniques are:

  • DIEP and SIEA Flap
    Similar to a TRAM Flap, the DIEP Flap takes skin, fat, and blood vessels from the lower abdominal area, but it does not take the muscle. The DIEP (deep inferior epigastric perforator) flap transfers fat and skin from the abdomen to build the new breast then uses microsurgery to attach the transferred blood vessels to the chest wall.  the SIEA Flap takes only skin and fat from the abdomen without touching the muscle.  Dr. Lee will determine which abdominal skin flap is best based upon blood flow and anatomy.
  • TRAM Flap
    This technique takes skin, fat, and muscle from your stomach to rebuild the breast. The tissue used to build the new breast can be detached from the stomach or the tissue may stay connected to the donor location, maintaining the original blood supply.
  • Latissimus Dorsi Flap
    This method uses muscle, fat, and skin from your back. During this technique, tissue is moved from the back to the breast(s) through a surgically created path so it stays attached to the donor location, which keeps the original blood supply in place.
  • TUG flap   This is tissue from the inner thigh that can be shaped and formed to recreate the breast tissue.  Patients who do not have enough abdominal skin are usually good candidates for this flap.
  • PAP Flap
    Another flap is the profunda artery perforator (PAP). This method takes fat, muscle, and skin tissue from your inner thigh to reconstruct your breast(s).
  • Composite-Stacked Flap and APEX Flap
    Also known as a composite stacked flap, this technique takes flaps from several areas on your body for breast reconstruction.  The APEX technique connects additional perforator vessels within the flap to optimize blood flow.  Dr. Lee is facile with all of the latest, cutting edge techniques.

An autologous flap breast reconstruction may take 3-4  hours per flap under general anesthesia. This type of surgery can also necessitate an inpatient stay of 3 – 7 days. We ask that your activity level remain low, especially keeping their upper arms still with the elbows at your side as to not disturb the blood vessels reconnected in the chest area. It will take about four weeks for all surgical sites to heal.

Tissue Expansion method

At the time of our mastectomy, your options to rebuild your breasts may require the tissue expansion method, which is a two-stage breast reconstruction option. The tissue expander will be placed within the breast and gradually filled with saline (via injection) over several months (4 – 6) to stretch the area and make room for a breast implant or a tissue flap.

Breast reconstruction is not as simple as putting in a replacement for the former breast. There are factors to take into consideration such as:

  • Are you having a skin, nipple, and/or muscle-sparring mastectomy?
  • Will you have enough skin to cover a breast implant?
  • Will one type of reconstruction lead to more infection than another?
  • How much room is available for rebuilding the breasts?
  • How will the surgery impact blood flow to the breasts?

Of course, there are many factors that go into your personalized treatment. We want you to be prepared for some of the situations you may come across in preparing for surgery.

Direct to Implant

Direct-to-implant breast reconstruction is performed when all of the conditions are right for the breast to be reconstructed with a saline or silicone implant. Dr. Lee will want to make sure that a direct-to-implant breast reconstruction is a safe option for you. He may also discuss having an alternative plan if your situation changes after your mastectomy.

Your Recovery

Surgical breast reconstruction is performed in various steps. During some phases (such as the flap creation, inserting an expander, or implant placement), general anesthesia may be used. Some patients will require an overnight stay — this is dependent on the current treatment phase. When the last step has been completed in the breast reconstruction process, you will wear a supportive bra and you will be given medication by Dr. Lee to help control discomfort, bleeding, and swelling. In time, the reconstructed breast(s) will look normal so you can feel more comfortable. Ongoing checks with mammograms and breast exams are important and highly recommended for your ongoing health.

Surgery for Lymphedema

If you have had a mastectomy and the lymph nodes in the area were also removed in the process, you may be living with a debilitating disorder called lymphedema. This is a disorder of the lymphatic system that presents itself as painful swelling in the area where nodes were removed.

As far as treatment goes, lymphedema treatment after mastectomy may consist of lymphatic massage or wearing compression garments to limit swelling. These are only helpful to relieve symptoms not heal the problem. Dr. Lee performs two types of microsurgeries for lymphedema.  Lymphaticovenous anastomosis (LVA) and vascularized lymph node transplantation (LNT). 

Having surgery for lymphedema can:

  • Prevent excessive swelling
  • Reduce symptoms and body circumference where lymphedema exists
  • Decrease pain
  • Lessen the risk of infection
  • Limit the need to wear compression garments

Frequently Asked Questions

Which breast reconstructive technique should I choose?
There is no single reconstructive technique that is right for everyone. The best method for you will depend on your health, needs, goals, and current body. In your consultation, Dr. Lee will go over your choices, including both implants and flaps, so you understand the benefits and challenges before you decide on your treatment plan. Whether you decide on a flap or implants, Dr. Lee will do his best to give you natural-looking results.

Where are lymph nodes taken from if I have lymphedema?
This will depend on your body. Dr. Lee has his choice of several accessible areas where lymph nodes may be harvested. He will select the best lymph nodes that are still connected to a blood vessel that can be easily transplanted into the arm. He may choose a donor site from the hip bone area (groin flap), the armpit (subaxillary flap), or the neck area (transverse cervical flap). Dr. Lee will use his microsurgical skills to evaluate and select the areas that will best work for your lymph node transfer as needed to remedy the effects of lymphedema.

Should I have reconstruction with my mastectomy or wait?
This is called having a delayed or immediate breast reconstruction. The timing of your breast reconstruction is based on many factors. Some patients choose to get their breast(s) reconstructed right away with their mastectomy (immediate breast reconstruction). There are women who prefer to wait a while between their mastectomy and breast reconstruction. Even if it is a decade later, there are also women who change their minds about having additional surgery and want to be considered for breast reconstruction, also known as delayed breast reconstruction. Even if you want to have an immediate or delayed breast reconstruction, Dr. Lee suggests you schedule a consultation following a diagnosis of breast cancer. This will give you more choices. If you want to have reconstruction at the same time as your mastectomy, Dr. Lee can work with your oncologist to plan a combination surgery.

For Your Form & Function

Although the breast reconstruction process can be lengthy, it is probably one of the most worthwhile surgical processes for our San Francisco, CA patients at L Plastic Surgery. Our reconstructive breast services may help decrease the emotional and physical impact of breast cancer treatment while also allowing you to restore your self-confidence and figure. If you have been diagnosed with breast cancer, have had an injury to the chest, or were born with a defect that affects the appearance of your breasts, we encourage you to call our San Francisco, CA office. Please schedule your consultation with Dr. Lee.

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