Breast Cancer and Beyond

Mobile Breast Reconstruction after Cancer at The Park & Rebowe Clinic for Plastic Surgery //

Facing a breast cancer diagnosis is an unexpected and emotionally challenging journey. The multitude of decisions to be made within a short time frame can be overwhelming, and the vast amount of information from various sources can leave many women feeling vulnerable.

At The Park & Rebowe Clinic for Plastic Surgery where you'll find the expertise of Dr. Park and Dr. Rebowe, we provide an overview of your available options and collaborate with the National Breast Cancer Foundation to ensure our patients have access to the best resources available. In this challenging context, our Mobile, AL plastic surgeons aim to offer hope and support to women facing these difficult choices. Our goal is to guide each woman through their journey to recovery, helping to restore what cancer has taken from them. We aspire to provide hope that, once all treatment is complete, every woman can regain her confidence and feel like herself again.

Restoring Beauty and Hope

What is Breast Reconstruction? //

Studies have shown that most breast cancers can be treated with breast conservation: removal of the breast lump (lumpectomy) and postoperative radiation treatment. But 30 percent of women with breast cancer require removal of the breast (mastectomy), which results in a significant chest wall deformity and psychological damage.

It is important that women considering mastectomy or a large lumpectomy have a preoperative consultation with Dr. Park or Dr. Rebowe. Clearly, the primary goal in the management of breast cancer is cure of the disease, but treatment should consider the cosmetic outcome if the patient so wishes, as there are important psychological benefits to Breast Reconstruction after Cancer for many. Dr. Park and Dr. Rebowe have extensive interest and experience in the full breadth of breast reconstruction options and are happy to provide advice and assist in decision making during this difficult time.

The Timing of Breast Reconstruction

The Timing of Breast Reconstruction may be immediately after mastectomy or secondarily, once the wounds have healed and the chest wall swelling has resolved (typically 3 months after mastectomy or 6 months after radiation). With immediate reconstruction, the chest tissues are soft and pliable and easier to reshape and stretch, but Dr. Park and Dr. Rebowe feel that reconstruction should be delayed if there is any chance that additional tumor removal or radiation may be needed, especially with expander/implant reconstruction. Immediate Breast Reconstruction after Cancer in Mobile does not interfere with any plans for chemotherapy. Patients should be aware that intraoperative findings may alter the plans or lead to postponing reconstruction and erring on the side of safety, as reconstruction can be performed later and the result is better when the reconstruction is not radiated.

Reconstructive Goals

Reconstructive goals are to create a breast mound shape, size, and position to match the opposite breast without the need for an external prosthesis. Nipple reconstruction may be necessary at a later date after the breast mound has settled into position.

Navigating Reconstruction Options

Reconstructive Options //

There are two general Reconstructive Options: using local tissue and a breast implant versus using autologous tissue from another area of the body. This decision is based upon patient preference, contralateral breast shape, medical condition, surgical history, radiation history and body characteristics.

If the reconstruction cannot achieve symmetry with the opposite breast, surgery on the opposite side may be necessary, either reduction mammoplasty, augmentation mammoplasty, or lifting the opposite breast (mastopexy). These procedures are covered by most insurance plans and Park & Rebowe Clinic for Plastic Surgery can assist in determining your benefits. Certain patients, especially those with genetic risk (BRCA), lobular carcinoma, or strong family history may receive the recommendation of removal of the opposite breast with reconstruction (prophylactic mastectomy). In these cases, this new variable must be accounted for and an experienced breast reconstruction surgeon such as Dr. Park is very helpful.

Mobile Breast Reconstruction model wearing hat

Breast Reconstruction after Cancer with an Implant

After a mastectomy, tissues are usually deficient and in these cases, reconstruction must be done in stages. First, a tissue expander is placed under the muscles of the chest wall (pectoralis major and serratus anterior) and/or a biological mesh and the skin is closed. The muscle and skin are then closed over this empty silicone walled balloon. This straightforward operation takes one to one and half hours per side and should not prolong the hospitalization or recuperation of a mastectomy.

The expander is then inflated through the skin and into a valve every few weeks in clinic (approximately five minutes and only mildly uncomfortable) to stretch the muscle and skin beyond the desired size. The valves can be felt through the skin if the remaining soft tissue is thin but usually a magnet is necessary to identify the metal back wall of the valve. In the second operation, the expander is removed, the permanent breast implant is placed, the reconstructed breast can be revised, and the opposite breast can be modified. This second operation will usually take one to two hours in an outpatient setting. The permanent implant options and variables are the same as those for breast augmentation: either silicone gel or saline in a silicone shell.

Rarely the expansion stage can be skipped with a skin sparing mastectomy or nipple sparing mastectomy and the use of biological mesh. The primary advantages of implant reconstruction are shorter operations with less morbidity and scarring. The primary disadvantage is that the result is usually less natural unless the other breast is augmented, has certain characteristics, or is also reconstructed. Also, the delay to final reconstruction, the increased number of office visits, and the dependence on a man-made, mechanical implant subject to failure and complications, including capsular contracture, rupture, and leak, must be considered. Radiation therapy is a relative contraindication to implant Breast Reconstruction after Cancer but successful breast reconstructions in this situation are possible.

Mobile Breast Reconstruction model with blonde hair

Breast Reconstruction With Flap / Autologous Tissue

Breast reconstruction flaps create a breast by moving tissue from another part of one’s own body (autologous). The advantages are increased durability to radiation, more natural shape and feel, and the ability to add tissue where tissue is missing. In suitable patients, Dr. Park prefers flap reconstruction.

Blood supply is critical for flap reconstruction and is impaired in patients who are smokers, diabetic, obese, or suffer from vascular disease, collagen vascular disease, and autoimmune diseases. The most common source for breast reconstruction flaps is the abdomen. The primary advantage of using abdominal tissue is that it provides the most cosmetic and natural Breast Reconstruction after Cancer in women with the best skin and texture match to the breast. In addition, a modified version of an abdominoplasty or tummy tuck is performed at the same time, but this should not drive the decision. The potential complications of implants are also usually avoided.

The skin and fat of the lower abdominal wall, normally discarded in a tummy tuck operation, are elevated and moved to the chest using either the rectus muscle as a pedicle or hinge with blood supply (Pedicled Transverse Rectus Abdominis Myocutaneous /TRAM flap), disconnecting the tissues blood supply to the muscle and skin and moving it to the chest (Free Transverse Rectus Abdominis Myocutaneous / Free TRAM flap), a free TRAM with limited muscle (Muscle sparing free TRAM), or moving the tissue based only on a blood vessel, skin, and fat (Deep Inferior Epigastric Perforator / DIEP flap). The last three options mentioned are much more complicated and time intensive, requiring division of vessels and reconnection to blood vessels in the chest or armpit using a microscope, similar to a transplant. Once completed, the amount of blood flow is greater than the pedicled TRAM, but there is a risk of thrombosis (clotting) of the anastamoses, creating the need for urgent reoperation and the risk of complete loss of the flap.

These procedures should only be performed by those experienced in their use and Dr. Park has learned the techniques of Dr. Bob Allen, the developer of the DIEP flap, performed each of these procedures when he developed the microsurgical Breast Reconstruction program at Wake Forest University Baptist Medical Center prior to moving to Mobile. Drs park and Rebowe perform Diep flap so remove this portion. The operation can take between two and a half to four hours for a pedicled TRAM and four to 12 hours for a free TRAM/DIEP and usually requires a three to five day hospital stay. There will be tubes to drain fluid and blood from the breast as well as the abdomen for one to two weeks. This operation does require a prolonged convalescence. The removal of abdominal skin will leave the belly tight and the patient will not be able to stand or lay straight for at least a week in order to minimize pain and prevent tension on the abdominal closure.

Additional Reading

It will take at least three weeks before resuming light activity and three months to resume strenuous levels of activity. There will be a scar across the length of the lower abdomen as well as on the breast. The abdominal wall may be weakened and prone to bulge, which can be prevented or corrected with mesh reinforcement. Skin transferred from the abdomen may develop some sensation, but it will be quite different from sensation prior to mastectomy. Transfusions may occasionally be necessary. If the lower abdominal wall is not available for reconstruction either because of one’s natural anatomy or previous operative procedures, then skin, fat, and muscle can be transferred from the back in what is called the pedicled latissimus dorsi myocutaneous flap. Skin and fat overlying the muscle are lifted up and transferred around to the chest wall. In most instances, a complementary breast tissue expander or implant is needed to achieve sufficient size and projection. This operation will leave a scar on the back. Dr. Park can design the scar with an orientation that permits easier concealment.

Reconstruction of the Nipple and Areola is completed several months after the final breast reconstruction, allowing the reconstructed breast to settle into its final shape and position before setting the location of the nipple reconstruction. The nipple can be reconstructed with skin flaps from the reconstructed breast and the areola (dark area) can be reconstructed with a skin graft or tattooing. If desired, this phase of reconstruction can be performed in the office awake. Otherwise, it will be done in the operating room. Skin grafts require some additional care, but usually only one treatment is necessary and activities are only limited for a week or so. Tattooing may require several rounds but each session has minimal downtime. Dr Park and Rebowe also bring in a renowned 3-D Nipple Tattoo artist, Mary Emily Davidson of Outliner Studios, to perform state of the art tattoo reconstructions on his patients. Patients are referred out. This service is not brought in.

Compassionate Guidance for Your Journey

Your Breast Cancer and Reconstruction Consultation //

At The Park & Rebowe Clinic for Plastic Surgery in Mobile, AL, we understand that a breast cancer diagnosis is a life-altering event that comes with numerous challenges. Our dedicated team, including renowned surgeons Dr. Park and Dr. Rebowe, is committed to providing compassionate and expert guidance throughout your breast cancer and reconstruction consultation.

During this essential consultation, we prioritize your well-being and healing journey. We will discuss your unique circumstances, answer your questions, and address your concerns. Our goal is to empower you with information about Breast Reconstruction after Cancer options, ensuring you make decisions that align with your physical and emotional needs. We partner with the National Breast Cancer Foundation to provide you with comprehensive resources and support. Our focus is not just on surgery but on helping you restore confidence, hope, and a sense of self after your breast cancer journey.

Empowering Beauty Through Adversity

Your Breast Reconstruction after Cancer Procedure //

The first stage of the process involves the temporary placement of a tissue expander into a breast pocket before the implant is introduced. This outpatient procedure typically lasts one to two hours. The expander is equipped with a port system through which small injections of saline are administered every two weeks. This gradual process continues until your breasts reach the size agreed upon in your treatment plan, creating space for the future implant.

In the second stage, the tissue expander is removed, and saline or silicone implants are inserted into the breast pocket. This outpatient surgery also takes one to two hours. Alternatively, patients may opt for Unilateral or Bilateral Direct-to-Implant Breast Reconstruction after Cancer. In this approach, breast implants are placed directly into the breasts during the mastectomy, bypassing the tissue expander stage. While this provides immediate breast shape and size restoration, it's important to note that the drawback is that your post-surgery breast size will match what you had before the procedure. If you desire an increase in breast size, using a tissue expander becomes a necessary step.

Celebrating Life

Breast Reconstruction Results //

Breast reconstruction is a transformative journey that culminates in remarkable results. At The Park & Rebowe Clinic for Plastic Surgery in Mobile, AL, our experienced surgeons craft each stage with precision and care to ensure that the outcome is both aesthetically pleasing and emotionally empowering. The results of breast reconstruction go beyond physical appearance.

They grant you a renewed sense of beauty, confidence, and self-assurance. Whether you choose an implant-based approach or autologous tissue reconstruction, our goal is to provide you with breasts that look and feel natural, harmonizing with your body. With Breast Reconstruction after Cancer Mobile patients often report improved quality of life and psychosocial well-being. It's not just about restoring what cancer has taken; it's about embracing a future with a complete sense of self and a newfound radiance. Your breast reconstruction results are a testament to your strength and resilience, enhancing your overall well-being.

The Courage to Heal

Breast Reconstruction Recovery and Aftercare //

Your breast reconstruction journey doesn't end with the surgery; it continues with the critical phases of recovery and aftercare. At The Park & Rebowe Clinic for Plastic Surgery in Mobile, AL, we are committed to supporting your well-being every step of the way.

Recovery after breast reconstruction may involve some discomfort and swelling, which is typically managed with medication. Your surgeon will provide you with detailed post-operative instructions, guiding you on the best practices for a smooth recovery. Our team will monitor your progress and address any questions or concerns you may have. Aftercare plays a pivotal role in maintaining the results of your breast reconstruction. Regular follow-up appointments are essential to ensure your satisfaction and comfort. We are here to nurture your healing journey, helping you regain your confidence and embrace the beauty of your new self.

Breast Reconstruction Frequently Asked Questions //

Is Breast Reconstruction right for me?

The decision of whether breast reconstruction is suitable for you is a highly personal one. It's important to understand that breast reconstruction is an optional procedure after mastectomy, and you're not obligated to decide on it immediately. While breast reconstruction offers various benefits, including improved body image and the ability to wear clothing comfortably without a prosthesis, it does add additional steps to the breast cancer treatment process. Most women tolerate these procedures well, but individuals with significant heart, lung, liver, kidney, or other major organ dysfunction may not be ideal candidates for Breast Reconstruction after Cancer. Common medical issues like high blood pressure, diabetes, and high cholesterol typically do not preclude breast reconstruction, but they should be managed appropriately around the time of the procedure. Ultimately, the decision is yours to make based on your unique circumstances and needs.

Exploring your Breast Reconstruction Options

How do I choose the best reconstruction approach for me?

The choice of method depends on factors like your medical history, body type, and personal preferences. Your surgeon will discuss these options with you during a consultation. They will help you make an informed decision based on your specific needs, ensuring that the chosen method aligns with your goals for Breast Reconstruction and overall well-being.

Breast Reconstruction after Cancer Conveniently Located to Serve Fairhope and Mobile, Alabama

Mobile Breast Reconstruction after Cancer at The Park & Rebowe Clinic for Plastic Surgery //

Breast Reconstruction Before & Afters