Breast Reconstruction
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Breast Reconstruction
Breast Reconstruction is a surgical procedure or series of procedures that recreate the appearance, shape, and, in some cases, sensation of a breast after a mastectomy or lumpectomy, typically due to breast cancer.
This process helps restore a woman’s sense of self and confidence, offering various methods, including implants, autologous tissue transfer, or a combination of both, to achieve the desired result.
Reconstruction can be immediate or delayed, depending on individual circumstances, and often includes the recreation of the nipple and areola to complete the breast’s natural appearance. Dr. Sahar is a breast reconstruction expert known internationally for both his clinical and academic work in the area. He has over a decade of focused experience in breast reconstruction in both academic and private settings, managing lumpectomy, mastectomy, radiation breast injury and revision breast reconstructions.
Dr. Sahar conducted the first prospective randomized clinical trials study on using different acellular dermal matrices in implant based breast reconstruction after mastectomy. His work in showing safety of fat graft in breast reconstruction won “Best of the Best” award from the American Society of Plastic Surgeons (ASPS) and “Best Experimental Paper” award from Plastic and Reconstructive Surgery Journal, the highest Impact Factor Plastic Surgery Journal in the world. He has been an invited guest on ASPS’s Breast Reconstruction Roundtable with his patient showcased in the “Patients of Courage” series at the 2023 ASPS meeting.
Breast Reconstruction is a surgical procedure or series of procedures performed to recreate a breast’s shape, appearance, and, in some cases, sensation after a mastectomy or lumpectomy, typically due to breast cancer. There are a variety of ways to perform breast reconstruction, with the majority performed with implants. There are pros and cons for each procedure. Below are examples of breast reconstruction options: Implant Based Reconstruction:
- Tissue expander based breast reconstruction (two stages)
- Direct to Implant breast reconstruction (1 stage)
Autologous Breast Reconstruction:
Fat Graft Breast Reconstruction – Great option for lumpectomy defects, asymmetry and treatment of irradiated breast prior to or after implant reconstruction
Flap Reconstruction, Pedicled: – Latissimus Dorsi Flap – a workhorse for pedicled flap breast reconstruction. TRAM flap is another commonly used flap – Goldilocks Breast Reconstruction – This technique utilizes de-epithelialized inferior breast skin flaps as local autologous dermal cutaneous flaps to reconstruct a breast mound after skin-sparing mastectomy
Flap Reconstruction, Free – Free flaps involved removing skin and fat from one region of the body and transferring them to the chest for breast reconstruction using microvascular surgery. Examples include: – DIEP Flap Breast Reconstruction – The deep inferior epigastric perforator (DIEP) flap is based on lower abdominal skin and fat for breast reconstruction. – PAP Flap Breast Reconstruction – The Profunda Artery Perforator (PAP) flap utilizes skin and fat from the posterior thigh skin and fat for breast reconstruction – TUG Flap Breast Reconstruction – The transverse upper gracilis (TUG) flap utilizes branch of the medial circumflex artery and its venae for using the inner upper thigh skin and fat for breast reconstruction
Nipple and Areola Reconstruction: After reconstructing the breast mound, we often perform nipple and areola reconstruction to complete the natural look, sometimes using tattooing.
Indications:
Women typically consider breast reconstruction after undergoing a mastectomy or lumpectomy. Surgeons can perform it immediately after breast cancer surgery or delay it, depending on individual circumstances and preferences.
Procedure:
There are several methods of breast reconstruction:
Implant-Based Reconstruction:
- Tissue Expanders: The surgeon inserts a tissue expander during the initial surgery, gradually fills it with saline to stretch the skin and chest muscle, and later replaces it with a permanent implant.
- Direct-to-Implant: In some cases, a permanent implant can be placed immediately without the use of a tissue expander.
Autologous Tissue-Based Reconstruction:
- Flap Surgery: In this approach, tissue is taken from other parts of the body (e.g., abdomen, back, or thighs) and used to recreate the breast. Common techniques include the DIEP flap, TRAM flap, and latissimus dorsi flap.
- Nipple and Areola Reconstruction: After reconstructing the breast mound, our surgeons often perform nipple and areola reconstruction to complete the breast’s natural appearance. This may involve tattooing.
Combination of Implants and Autologous Tissue:
In some cases, we use a combination of implant-based reconstruction and autologous tissue reconstruction to achieve the desired outcome.
Timing:
You can choose to have breast reconstruction immediately (at the same time as the mastectomy) or delay it to a later date. This decision often depends on individual factors, such as the need for radiation therapy and personal preferences.
Results:
The goal of breast reconstruction is to create a breast that closely resembles the natural breast in terms of size, shape, and symmetry. This can significantly improve a woman’s self-esteem and quality of life after breast cancer surgery.
Risks and Considerations:
As with any surgical procedure, there are risks, including infection, scarring, changes in nipple sensation, and potential complications related to anesthesia. The extent of scarring and recovery time may vary depending on the chosen reconstruction method.
Consultation:
It’s crucial for women considering breast reconstruction to consult with a board-certified plastic surgeon experienced in breast reconstruction. The surgeon will assess the patient’s unique situation, discuss available options, and create a personalized treatment plan. The decision about reconstruction is highly individual and should consider the patient’s goals, medical history, and the recommendations of the medical team.
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Opening Hours & Locations
- Mon – Fri: 8:00 AM to 5:00 PM
- 416 N Bedford Dr #400b Beverly Hills, CA 90210
- Santa Monica - Saint John's Hospital
- Burbank - Disney Family Cancer Center
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