Aesthetic and Reconstructive Surgery

433 N. Camden Drive | Suite 1170 | Beverly Hills, CA 90210 | 310-274-2763

18372 Clark Street, Suite 204 | Tarzana, CA 91356 | 818-343-3345

Procedures

American Society of Plastic Surgeons
Board Certified - American Board of Plastic Surgery
 

Procedures

Breast Reconstruction

After mastectomy, the goal of breast reconstruction is to replace the resulting chest wall deficit with a soft, natural looking breast silhouette, which in turn can dramatically improve a woman's appearance, self-image and outlook on life.

Breast reconstruction can be performed at the same time as the mastectomy (Immediate Reconstruction), or at a later time, after healing of the mastectomy and completion of other necessary combined treatments (Delayed Reconstruction).

The main advantage of immediate reconstruction is that women do not have to face a flat chest wall, since the first stage of breast reconstruction is already initiated. Occasionally, it is advantageous to complete the adjuvant treatments such as chemotherapy or radiation prior to delayed reconstruction, as this may produce a finer, longer lasting aesthetic reconstructive outcome.

It is essential to recognize that breast reconstruction is an elaborate, multi-staged surgical treatment with an artistic touch, and requires long-term commitment.

Choices in Breast Reconstruction

Breast Reconstruction is a critical decision-making process that encompasses the patient, her overall medical condition, her breast shape and size, her lifestyle, as well as her goals and objective from the reconstruction.

Breast Reconstruction can be accomplished by the use of the patient's own tissue via various types of tissue flaps, and/or by the use of an expander/implant technique. A tissue flap is a section of skin, fat and muscle, which is relocated from a different area of the body, such as: the abdomen with a TRAM flap or the back with a Latissimus muscle flap. These flaps can be augmented with implants if necessary. Alternative flaps can be offered on an occasional basis when donor sites for the more common flaps are not suitable.

The breast expander/implant technique utilizes a fluid-filled device that is surgically placed under the remainder of the chest wall tissue after mastectomy to gradually recreate a new breast silhouette. The expander is serially enlarged until the desired breast volume and location is achieved. The expander is then replaced with a rubber-shelled implant filled with either saline or gel.

After the completion of the initial stage of the breast reconstruction, the contralateral "opposite" breast is addressed to reestablish breast symmetry by reducing or augmenting its size and/or lifting its position (mastopexy). At the same time or on a separate stage, the nipple-areola complex of the mastectomy side is recreated from the local tissue.

Choices in autologous "own" tissue reconstruction:

Transverse Rectus Abdominus Myocutaneous Flap Reconstruction

Many options are available when discussing autologous tissue reconstruction, but by far the most common flap used following mastectomy (across the board) is the Transverse Rectus Abdominus Myocutaneous flap reconstruction TRAM. This flap can be utilized either as a pedicle TRAM, or as a free flap with the modifications of free TRAM flap, free muscle sparing TRAM flap and the more refined Deep Inferior Epigastric Perforator DIEP flap, which preserves the integrity of the rectus abdominus muscle and abdominal wall. Free flap reconstruction is a technically demanding surgical procedure that requires a team with extensive expertise to safely and proficiently perform, and monitor the flap after surgery.

Who is a candidate for the procedure?

Breast reconstructive surgery with autologous tissue may be a good option for women when they:

  1. Are in good medical condition
  2. Desire to have their own tissue used for reconstruction
  3. Do not desire to have an implant

How can you prepare for your surgery?

  1. Avoid medications that may complicate surgery or recovery such as herbal supplements, aspirin, non-steroidal anti-inflammatory medication (Motrin, Advil, etc).
  2. Arrange for transportation and care at home after surgery. <
  3. Stop smoking.

How long does the surgery take?

  1. The surgery takes 4-8 hours.
  2. It is (usually) performed under general anesthesia.
  3. It is (usually) performed as an impatient procedure.

What can you expect after Surgery?

  1. Bed-rest the first day.
  2. Minimal ambulation increased gradually.
  3. Average hospital stay is about 3-6 days.
  4. You can expect to be comfortable after the fist two weeks.

When can you resume your normal activities?

  1. Driving may be resumed in 3-4 weeks.
  2. Non-contact sports in 4-6 weeks.

Latissimus Dorsi Muscle Reconstruction

The use of the Latissimus Dorsi Muscle Flap from the back is another suitable option for patients desiring breast reconstruction with or without an implant depending on the patient's breast size and her desires regarding the simultaneous use of an implant. It is considered a good viable option for breast reconstruction. It could be performed as an immediate reconstruction or as a delayed procedure.

Who is a candidate for the procedure?

Breast reconstruction with an Latissimus Dorsi muscle with or without an implant technique may be a good option for women when they

  1. Desire a faster recovery time.
  2. Desire a shorter hospital stay.
  3. Are comfortable with the use of implants (in the case of combined use of an implant).

How can you prepare for your surgery?

  1. Avoid medications that may complicate surgery or recovery such as herbal supplements, aspirin, non-steroidal anti-inflammatory medication (Motrin, Advil, etc).
  2. Arrange for transportation and care at home after surgery.
  3. Stop smoking.

How long does the surgery take?

  1. The surgery takes 3-4 hours.
  2. It is usually performed under general anesthesia.
  3. It is usually performed as an overnight stay procedure; occasionally, patients may require an additional 1-2 days of hospital stay. The decision is usually individualized, based of the medical condition of the patient.

What can you expect after Surgery?

  1. Bed-rest the first day with minimal short walks.
  2. The discomfort lasts 1-4 days then gradually decreases.
  3. You can expect to be very comfortable within 2-3 weeks.

When can you resume your normal activities?

  1. Driving may be resumed in 2 weeks.
  2. Non-contact sports in 3 weeks.

Expander/Implant Reconstruction

The expander is traditionally placed under the Pectoralis Major Muscle either as an immediate or delayed procedure. It is usually followed by serial expansion as an out-patient office procedures until the desired size is reached. A second stage outpatient procedure is then followed where the expander is exchanged with an implant, either saline or silicone gel-filled rubber shell. The nipple areola complex reconstruction is done with local tissue rearrangement either at the second stage or as a separate procedure.

Who is a candidate for the procedure?

Breast reconstruction with an expander/implant technique be a good option for women when they:

  1. Desire a faster recovery time.
  2. Desire a shorter hospital stay.
  3. Are comfortable with the idea of implants.

How can you prepare for your surgery?

  1. Avoid medications that may complicate surgery or recovery such as herbal supplements, aspirin, non-steroidal anti-inflammatory medication (Motrin, Advil, etc).
  2. Arrange for transportation and care at home after surgery.
  3. Stop smoking.

How long does the surgery take?

  1. The surgery takes 2-3 hours.
  2. It is usually performed under general anesthesia.
  3. It is usually performed as an overnight stay procedure.

What can you expect after Surgery?

  1. Bed-rest the first day with minimal short walks.
  2. The discomfort lasts 1-4 days then gradually decreases.
  3. You can expect to be very comfortable within 2-3 weeks.

When can you resume your normal activities?

  1. Driving may be resumed in 2 weeks.
  2. Non-contact sports in 3 weeks.
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