Breast Reconstruction in Fort Worth

Breast reconstruction includes surgical procedures that are performed to restore a breast’s natural appearance, shape, and size following a mastectomy (surgical removal of the breast). Breast reconstruction can also be performed for correction of changes due to partial removal of the breast (lumpectomy) and for congenital or developmental absence or abnormalities.

The decision to undergo breast reconstruction is a personal one. Many women choose to have breast cancer reconstruction after a mastectomy to restore their sense of femininity and intimacy with their partner, to attain symmetry in bras and clothing, and to enhance self-esteem and self-image following breast cancer. Women who have had breast cancer reconstruction will often later say that it brings a sense of closure to their cancer treatment and helps minimize the reminder of having had breast cancer.

Breast reconstruction surgery may take place immediately following a mastectomy or may be delayed. Advantages of immediate breast cancer reconstruction include fewer operations, improved cosmetic results, and less psychological distress. Delayed breast reconstruction may be completed anytime following a mastectomy and is appropriate for those women requiring radiation therapy as part of their cancer treatment. Additionally, those patients who are unsure about breast reconstruction can always undergo reconstruction at a later time. There are many medical and personal factors that also contribute to the timing of breast reconstruction. This will be discussed with your breast reconstruction surgeon, Dr. Steele, at the time of your consultation.

The number of operations needed for breast reconstruction varies for each individual and can range from one to four or five procedures depending on the reconstructive technique and a patient’s particular goals. Typically, these operations are spread out over several months and are tailored to the patient’s schedule. Generally, the first operation forms the breast mound and is the longest operation, usually requiring at least an overnight stay. A second operation is generally needed for refinement of the breast shape, placement of permanent breast implants, and reconstruction of the nipple. Fat grafting, using a patient’s own fat, may also be performed to improve the size, shape, and symmetry of the reconstructed breast(s). These secondary procedures are usually less invasive and can be performed as outpatient surgery. A final procedure may be necessary to tattoo the nipple and areola.

There are a variety of surgical procedures available to obtain symmetry of the breasts. These procedures may be completed during the reconstruction process and include: breast augmentation, breast lift, and breast reduction. Dr. Steele will discuss this with you during your consultation.

All medical insurance policies, including Medicare, must cover breast reconstruction surgery after mastectomy and procedures performed on the other breast for symmetry. The Women’s Health and Cancer Rights Act, passed in 1998, mandates that all insurance companies cover these procedures.

We recommend that you arrange for your spouse, a family member, or friend to accompany you to your initial consultation visit to provide support. During your consultation, our breast reconstruction surgeon, Dr. Steele, will spend time discussing reconstruction as well as procedure options that he recommends for you based on: your personal desires and needs, physical examination and your health history. He will also discuss your recovery time and what to expect following the surgery. You will be given an opportunity to discuss your insurance coverage and scheduling options with our patient care coordinator following your consultation.

There are three major categories of breast reconstructive procedures you can get in Fort Worth: alloplastic (breast implants), autologous (your own tissue), or a combination of the two. The use of permanent breast implants is typically preceded by the use of tissue expanders that gradually stretch the skin to make room for the implants. However, improved surgical techniques in combination with better implants/tissue substitutes has allowed permanent implant placement at the time of mastectomy to become a viable option for many women. Autologous tissue flaps involve transferring your own skin and fat to construct a breast mound. In some cases, an implant is necessary in addition to a tissue flap to increase the volume of the reconstructed breast.

Use of tissues expanders and implants are the most common procedures for breast reconstruction surgery. Tissue expanders can be placed at the time of mastectomy (immediate reconstruction) or in a delayed fashion. The expanders are similar to balloons and are gradually inflated with saline (salt water) over time until the patient’s desired volume is attained. Once the patient is satisfied with the volume, the tissue expander is replaced with saline or silicone gel implants. Patients frequently choose alloplastic reconstruction because of the shorter surgery and recovery times, as well as the avoidance of the surgical donor site required for harvest of a tissue flap. Many patients who undergo alloplastic reconstruction will benefit from grafting of their own fat to camouflage the implants and improve size, shape, and symmetry.

There are several advantages to using your own (autologous) tissue for breast reconstruction surgery: avoidance of a foreign body (implant), more natural look/feel, fewer complications in those patients requiring radiation therapy, and better symmetry with the remaining breast. The disadvantages include longer operative times, longer recovery, and the need for surgery on another part of the body to harvest the tissue.

The latissimus dorsi muscle is the largest muscle in the body and runs from the top of the armpit down the back. It is the muscle that gives a competitive swimmer that muscular “V” shape to their torso. This type of reconstruction can be used for immediate or delayed breast reconstruction and has excellent outcomes, even in the face of radiation therapy. The latissimus dorsi flap is typically combined with a tissue expander because most patients do not have enough volume (skin and fat) on their back to create a breast of sufficient volume. Once the tissue expander reaches the desired volume, a permanent implant can be placed. Occasionally, in overweight or obese patients, a latissimus flap is large enough and an implant is not necessary. This procedure takes about three to four hours in the operating room, and most patients go home the same day. Patients should expect four to six weeks of recovery time to return to normal activities.

Nipple and areola reconstruction is completed during the final stage of reconstruction and is typically preformed several months after the final shaping of the breast mound. The new nipple is shaped from tissue used to make the new breast. In some cases, a skin graft is needed. Dr. Steele is able to reconstruct the nipple and areola of an appropriate size, shape and projection. Nipple reconstruction can also be combined with fat grafting of the breast if necessary to optimize shape and symmetry. Nipple reconstruction is performed as an outpatient, same-day surgery and requires minimal recovery time. Following the nipple reconstruction, nipple/areola tattooing may be done to provide a natural color to the nipple and areola. A newer option that most of Dr. Steele’s patients choose is a 3D nipple/areola tattoo. The result is a stunningly realistic 3D appearance without the need to undergo any incisions or surgery.

Download these .PDFs to learn more:

Allergan Breast Implant Information

Sientra Breast Implant Information