If you have recently been diagnosed with breast cancer, you may wish to include breast reconstruction as part of your treatment. Reconstruction is typically a multi-surgery process that aims to restore or revise the breasts according to the patient’s goals. Health insurance companies are usually required to cover the cost of these procedures and related treatments.
Based on my experience with Fairfax and Northern Virginia patients, breast reconstruction is one of the most positive aspects of cancer treatment. While breast cancer can take many things from you—your health, your comfort, your peace of mind—breast reconstruction lets you focus on and shape your own “after” picture: how you will look and how you will feel about your appearance. There is room in the process to restore your breasts as closely as possible to where you started, or to change them to bigger or smaller or whatever suits your ideal.
As a plastic surgeon specializing in cosmetic and reconstructive procedures, I will coordinate your treatment with your cancer surgeon. At all times, you will be at the center of decisions, and I will make great efforts to ensure that you understand your options and receive an outcome that matches your goals. Your body and results will truly be your own.
Factors That Affect Your Experience with Breast Reconstruction
Fairfax and Northern Virginia breast reconstruction patients can choose from a variety of approaches to restoring and reshaping their appearance. I will advise you about the advantages of each and which is most likely to give you the look and feel you want, whether your ideal is small, big, perky, voluptuous, or subtle.
Breast Tissue vs. Implants
Using your own breast tissue offers the most natural outcome. If your cancer surgery does not leave enough tissue in the area of your breast, or if you choose to undergo mastectomy as your treatment of choice, I can use tissue from other sites, such as your lower abdomen and upper back, to rebuild the breast-. Note that healing from this procedure can take longer, as it is a longer surgery and you need to heal your new breasts as well as the site I took the tissue from.
Breast implants offer a more expedient surgery and recovery. In these procedures, I almost always recommend silicone over saline implants because of the more natural feel, movement, and appearance they offer. I am happy to share information about the safety of these types of implants, as they have been strenuously tested and investigated The most important factor however is your peace of mind – so if saline is the only choice you feel comfortable with, that’s what we will use.
Lumpectomy vs. Mastectomy
In a lumpectomy, your cancer surgeon will remove only a portion of the breast. In a mastectomy, the surgeon removes the breast completely. My website offers a more detailed discussion. In brief:
- Women who have a lumpectomy retain some breast tissue. As a result, I can reshape the existing tissue to a smooth mound and then customize its size and appearance to their needs. In order to adequately treat breast cancer with a lumpectomy, the remaining breast must be radiated.
- After a mastectomy, all breast tissue is removed. For reconstruction, Fairfax and Northern Virginia breast reconstruction patients can choose to receive implants or use their own tissue to replace the breast tissue removed. The other important difference is that mastectomy patients will only require radiation based on their tumor type. It is not automatically required like it is for a lumpectomy.
Breast Reconstruction for One or Both Breasts
Patients with a diagnosis of cancer in one breast may choose to have surgery on both breasts. In some cases, the surgery is to revise the other breast for better symmetry. In other cases, it is to reconstruct both breasts following a double mastectomy. Fairfax and Northern Virginia patients sometimes choose to remove the healthy breast as a preventative measure. I typically advise the women in my care that this does not ultimately decrease their risk of dying from breast cancer, but that it has advantages nonetheless Learn more.
Chemotherapy and Radiation
Chemotherapy and radiation can change the schedule I recommend for your surgeries, as well as the surgery itself. Chemotherapy compromises your immune system, so I don’t do surgery while you are actively on chemo. If something comes up that requires immediate surgical attention, I will coordinate with your oncologist to arrange a brief break from your medications. We will always work together to balance risk and benefit in these situations. If your chemotherapy is complete before your surgery, then we just need to schedule around radiation.
Radiation can begin as soon as you recover from the mastectomy/lumpectomy. Usually, I will need to wait until six months after radiation is finished to begin breast reconstruction. The waiting period is to that your tissues can recover enough from the radiation damage to heal from any surgery you have. Fairfax and Northern Virginia patients are sometimes uncertain when or whether they will receive chemotherapy/radiation. In these cases, I can advise about treatment and scheduling options that offer more flexibility.
Nipple Reconstruction and Nipple Sparing Mastectomy
In a traditional mastectomy, the surgeon will remove the nipple and the areola. This gives us several options:
- Following the initial breast reconstruction procedure, I can recreate the nipple in a second, simple, and minimally uncomfortable painful surgery.
- You can use the services of a skilled tattoo artist to create the three-dimensional appearance of a nipple.
- Some women choose not to have nipple reconstruction. This eliminates the need for modesty in certain clothing styles.
In addition to the above, you may be a good candidate for nipple sparing mastectomy. The technique can preserve your original nipple and prevent a second procedure to recreate it.
What to Expect with Breast Reconstruction
Fairfax and Northern Virginia patients start with an initial consultation at my practice. I’ll perform an examination, talk with you about your options, and make recommendations based on your needs and preferences. Once we decide on a plan, my office will coordinate with you and your breast surgeon to determine the best schedule for your procedures. I will also see you for a second visit to help you prepare for your surgery and recovery.
On the day of your breast reconstruction procedure, I will meet you at the pre-operative area, go over the details of what to expect once again, and answer any questions you have. You’ll also get to know your anesthesiologist, who will administer general anesthesia so that you sleep through the experience.
As part of your recovery:
- You will wear a surgical bra to give additional support.
- I will prescribe pain medications and antibiotics for your comfort and safety.
- Some Fairfax and Northern Virginia patients will receive a pain pump to minimize discomfort further.
- Mastectomy patients will have skin drains to prevent fluid buildup.
I’ll see you within 2-4 days of your procedure to check on your progress and to respond to any needs you may have. Fairfax and Northern Virginia patients can expect their recovery from breast reconstruction with implants to take about four weeks. Harvesting natural tissue to recreate the breast requires a longer recovery since additional sites in the body must heal.
Breast Reconstruction with Implants
If you are receiving breast reconstruction with implants:
- I will size an implant based on the height, width, volume, and projection that fit your body’s dimensions and your desired outcome.
- During surgery, I will use disposable “sizer” implants to ensure that the option I’ve selected is best for your needs.
- I will place the implants using an acellular dermal matrix to prevent implants from moving out of position over time.
Procedures with a Tissue Expander
After lumpectomy/mastectomy, some of the Fairfax and Northern Virginia breast reconstruction patients benefit from the use of a tissue expander.
A tissue expander is an implant that can be adjusted in the office. I can use it to stretch available skin on the breast if a patient wants larger breasts, or if the cancer surgery left too little skin behind. In this case, after you have healed from the procedure in which I place the expander, you will return to my office about every week. I will add saline solution to expand the device slowly over time. When you have developed enough skin, I will conduct a follow-up procedure to replace the expander with a permanent breast implant (which feels nicer and is designed to last longer).
In another situation I can also deflate the tissue expander to decrease strain on skin that isn’t healing well. Without the expander, we would need to return to the operating room to change out a permanent implant for something smaller to decrease skin stress. Once the “de-stressed” skin has recovered, I can re-inflate the expander to the desired size. Like the above scenario, replacing it with a softer, more durable implant will require a trip back to the operating room.
In surgeries where the reconstruction goal is not to go larger, and the skin and tissue is healthy, I can place a permanent implant immediately, saving a step. Even though patients who undergo “direct to implant” reconstruction don’t have to return to the OR for a tissue expander exchange, they still usually need a brief touch-up surgery after the initial healing is done. Some women will heal differently on one side than the other and thus look asymmetric, some will decide they want to adjust the size of their implants, and some will have other adjustments that need to be made. Eliminating the tissue expander doesn’t mean eliminating all future surgery, but it is one step closer to the finish line. .
Breast reconstruction allows patients to restore their appearance in a way that suits their personal goals and needs. If you are interested in shaping your “after” picture, schedule a consultation with Dr. Jespersen at her office in Fairfax and Northern Virginia by calling (703) 992-7969 or completing our contact form.