Restoring your breast to a natural-look after mastectomy surgery (breast removal) for cancer or other diseases is commonly begun and completed immediately following mastectomy. A patient is able to awaken from surgery with a new breast mound in place.
Alternatively, breast reconstruction may begin years after mastectomy. New York plastic surgeon, Dr. Steinbrech works to make your breasts as symmetric and natural-looking as possible. Creative techniques, such as fat transfer or grafting, may be used to give your silhouette a natural and symmetrical look. Many insurance companies cover reconstruction following breast cancer surgery and legislation is currently before Congress to make coverage mandatory.
Dr. Douglas Steinbrech is a Plastic Surgeon certified by the American Board of Plastic Surgeons. Dr. Steinbrech specializes in Minimally Invasive Aesthetics. He is located in Manhattan at 60 East 56th Street, Suite 301, New York, NY 10022. To schedule your appointment call: (212) 750-0070.
Consultation with Dr. Steinbrech for Breast Reconstruction
Dr. Steinbrech understands the emotional complexities of patients who have faced the challenge of breast cancer and subsequent treatments which include a mastectomy. The longing to return your body to its feminine fullness and your desire to regain your sense of wholeness you felt before your mastectomy and your very personal identity associated with femininity are common feelings. Dr. Steinbrech understands some patients may need time to come to terms emotionally with their new breasts and the importance of restoring feelings of control over your body and life.
At the initial consultation appointment Dr. Steinbrech will review your medical history. He will perform a brief physical examination and explain the surgical techniques available to restore the fullness of your breasts. Computer imagery assists in your visualization of your potential results. Before/After photos of past patients will help you make your personal aesthetic decision. Understanding the patient’s body type is essential to choosing the right plastic reconstructive surgery.
If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.
Deciding which type of reconstruction option is best for you represents a big decision for patients. The time involved in the procedures ranges from one hour for an implant alone to five to eight hours for a DIEP Flap or an SIEA Flap. Dr. Steinbrech will help you make your best decision.
During the consultation appointment, Dr. Steinbrech will explain all the surgical choices available. You and Dr. Steinbrech will decide upon the best procedure and your unique surgical plan will be created which takes into consideration your best outcome and recovery time that fits your needs.
Breast Reconstruction Surgery Explained
There are two main categories of breast reconstruction surgery: flap surgery and breast implant surgery. Breast reconstruction has not been proven to affect the recurrence of cancer or other diseases, chemotherapy or radiation treatment.
Flap surgery is a microsurgical technique that uses transplant material from the patient’s own body to create new breasts. In some cases, your nipple may be spared in the mastectomy and can be used with your implant. Flaps are more complicated surgeries and take longer for recovery than an implant.
TRAM surgery uses a muscle in your lower abdomen between your waist and your pubic bone, known as the transverse rectus abdominis. A flap of this skin, fat, and all or part of the underlying rectus abdominus muscle are used to reconstruct the breast in a TRAM flap procedure. TRAM flaps are the most commonly performed type of flap reconstruction. TRAM flaps cut through muscle, while other types of flap reconstruction avoid this and are therefore considered to be “gentler” operations.
The DIEP and SIEA flap procedures both use microsurgery to take material from the abdomen and use it for the breast cancer reconstruction. The difference between DIEP and SIEA flap surgery relates to how blood vessels within the patient’s body are used. The SGAP flap surgery utilizes tissue from the upper buttock and hip area taking tissue from both buttocks to ensure symmetry.
The latissimus dorsi flap surgery takes an oval flap of skin, fat, muscle, and blood vessels with the blood vessels (artery and vein) of the flap left attached to their original blood supply in your back. Because the flap contains a significant amount of muscle, a latissimus dorsi flap is considered a muscle-transfer type of flap.
Some women have weak muscles in their abdomen meaning surgeons must use material from elsewhere. Flap procedures can include transplants from the shoulders, buttocks or other physical body areas. With microsurgical techniques patients’ soreness during recovery is reduced and recovery period is decreased.
DIEP/SIEA Procedure for Breast Reconstruction
The deep inferior epigastric artery perforator (DIEP) is a flap procedure used for women who do not have enough material to create one or both breasts. Skin and tissue but no muscle is taken from the abdomen to create the new breast. Women generally have additional skin and fat along the lower portion of their abdomen.
One benefit of this process is that patients can contour their mid-section, similar to the effects of a tummy tuck. In a second operation the breasts can be sculpted to be more natural-looking and attractive.
A “staged” DIEP flap is a good option for women who might need post-mastectomy radiation therapy. Dr. Steinbrech will place a tissue expander at the time of mastectomy. When treatment is complete, typically a few months later, the flap reconstruction can begin. Patients appreciate an improved abdominal contour.
Patients who are unable to have a DIEP/SIEA because of a prior abdominal surgery or because there is not sufficient abdominal tissue may instead turn to SGAP. The superior gluteal artery perforator (SGAP) flap uses tissue from the top of the buttocks to create breast tissue. Patients without adequate skin and tissue in their abdomens, or who have had previous abdominal surgeries that may have interfered with blood vessels that the DIEP flap requires are candidates for the SGAP flap.
This procedure uses the same microsurgery techniques, but it utilizes tissue from the upper buttock and hip area. SGAP is less common because most women prefer to remove tissue from the abdomen and because SGAP takes material from both buttocks to ensure symmetry.
Latissimus Dorsi Flap
Your latissimus dorsi muscle is located in your back, just below your shoulder and behind your armpit. An oval flap of skin, fat, muscle, and blood vessels from your upper back is used to reconstruct the breast. This flap is moved under your skin around to your chest to rebuild your breast. The blood vessels (artery and vein) of the flap are left attached to their original blood supply in your back. Because the flap contains a significant amount of muscle, a latissimus dorsi flap is considered a muscle-transfer type of flap.
The latissimus dorsi flap may be a good option for women with small- to medium/small-sized breasts because there’s usually not much fat on this part of the back. In most cases, a breast implant has to be placed under the flap to achieve the desired shape, size, and projection. A latissimus dorsi flap procedure leaves a scar on your back, but most surgeons try to place the incision so the scar is covered by your bra strap.
Breast Implants for Breast Reconstruction
Breast implants are preferable to flap surgery for some women because implants offer more options in size enhancement which can be important for women who have large breasts but have only had one breast removed. An implant may be required so both breasts are symmetrically sized. This procedure requires two separate operations with a process which is different from that of a flap surgery.
Women who have undergone a mastectomy may lose some of the skin and tissue that would typically work with an implant to form a complete, natural-looking breast. Dr. Steinbrech rebuilds this skin and tissue, including the use of a “breast expander”. In general, breast implant surgery may provide a quicker recovery than flap surgery.
A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline. This is a good option for women who do not require radiation therapy for their breast cancer treatment. The Food & Drug Administration (FDA) has approved the use of silicone gel breast implants since 2006. The alternative saline-filled implant, a silicone shell filled with salt water, is also available if you choose.
Breast Reconstruction Surgery Recovery
The recovery time for flap reconstruction is four to six weeks to resume most normal activities. You will be sore for about a week or two and then begin to improve every day.
This type of operation will require you to stay in the hospital for three or four days. This is shorter than most centers’ hospitalizations for these procedures. You will be able to eat the next day after surgery, and you will be able to get out of bed and walk with assistance on the second day after surgery. While at home you will be able to do all activities of daily living. Heavy or strenuous activity should be avoided until follow-up with your surgeon. You will also have three to four surgical drains depending on whether one or two breasts are reconstructed. In most circumstances, these drains will remain in for one to two weeks. If they are highly productive they will stay in longer.
Frequently Asked Questions
Who are the best candidates for breast reconstruction?
Women whose cancer seems to have been eradicated with mastectomy are the best candidates for breast reconstruction. Those with health problems such as obesity and high blood pressure and those who smoke are advised to wait. Others prefer to postpone surgery as they come to terms with having cancer, consider the extent of the procedure, or explore alternatives.
What will I look like post-surgery?
Dr. Steinbrech will do everything possible to make your breasts look and feel as natural as possible. Often you will require a final surgery after your DIEP flap in order to make your breasts as symmetric and natural-looking as possible. Creative techniques, such as fat transfer or grafting, may be used to give your silhouette a more natural appearance.
Are there risks associate with breast reconstruction?
All surgical procedures have potential risks including bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia. Breast reconstruction risk includes infection around the implant, if an implant is used, and capsular contracture, when the scar around the implant tightens, causing the breast to feel hard. Treatment for capsular contracture varies from “scoring” the scar tissue to removing or replacing the implant.
Dr. Douglas Steinbrech is a Plastic Surgeon certified by the American Board of Plastic Surgeons (AMBS). He specializes in minimally invasive aesthetics and incorporates this philosophy into all of his surgical and non-surgical techniques. He has been selected as one of America’s Top Plastic Surgeons by the Consumers’ Research Council of America. The ABPS is one of 24 medical specialty boards that make up the American Board of Medical Specialties (ABMS). Through ABMS, the boards work together to establish common standards for physicians to achieve and maintain board certification. The boards were founded by their respective specialties to protect the public by assessing and certifying doctors who meet specific educational, training and professional requirements.
Dr. Steinbrech underwent eight years of surgical training at New York University in General Surgery and Plastic and Reconstructive surgery. He was trained in Plastic and Reconstructive Surgery at the prestigious NYU Institute of Plastic and Reconstructive Surgery. This included training at Manhattan Eye, Ear and Throat Hospital by recognized plastic surgery mentors including McCarthy, Aston, Baker, Tabbal, and Pittman.
Dr. Steinbrech approaches each patient’s unique decision and condition with compassion and insight. He helps guide his patients with his experience and skill. He believes in the importance of returning to society. He is involved in several philanthropic organizations including Smile Train, The National Foundation for Facial Reconstruction, Rx: Art, and The Lenox Hill House.
To schedule an appointment with our plastic surgery office in New York City, please contact us at:
Dr. Douglas Steinbrech, M.D. F.A.C.S.
60 E 56th Street, Suite 301
New York, NY 10022
P: (212) 750-0070
F: (212) 504-2812
Monday to Friday 8:30 AM to 5PM