Breast Reconstruction

Breast Reconstruction Newport Beach

Breast Reconstruction surgery is performed to reconstruct a breast that has been lost to mastectomy or in other cases, to correct a congenital abnormality or a deformity in the chest. Other times, if an accident or injury has left one or both breasts damaged or deformed, the breast can be  reconstructed to restore a more natural appearance  or to restore balance to the breasts. Whatever the cause, a breast restoration is vital to maintaining a woman’s self-esteem and to help reinforce a positive body image.

Overview of Breast Reconstruction
There are several approaches to breast reconstruction and the use of each depends on the type of mastectomy that you and your surgeon decide upon. If you elect to have a nipple-preserving mastectomy, or if you choose not to have nipple reconstruction, the reconstruction process can be completed in a single procedure, often immediately after a mastectomy. In other cases, as with delayed breast reconstruction, the first stage occurs sometime after the mastectomy procedure.

Stages of Breast Reconstruction 

Stage 1:  The new breast mound is formed either by using tissue expanders and implants or with autologous (your own) tissues.
Stage 2:  A new nipple is created along with any cosmetic revisions to the new breast.
Stage 3:  The nipple and areola are tattooed (optional).

Dr. Goshtasby utilizes a variety of techniques to reconstruct breast tissue with the intent of creating a natural appearance and feel.  Each of these techniques has benefits and drawbacks and Dr. Gostasby will help you evaluate which will be the most beneficial for your situation.

Tissue Expander with Implants
Breast reconstruction using a tissue expander with implant is a two-stage procedure that begins with the insertion of insertion of a temporary tissue expander (an empty saline breast implant) that is filled with saline solution and gradually stretches the chest muscle and skin, creating a pocket that will accommodate a permanent breast implant.

Often performed immediately following a mastectomy, Dr. Goshtasby places an empty tissue expander behind the pectoral muscle and then places a small amount of saline solution in the implant.  Over the next six to eight weeks, more saline solution is added to the expander to increase its volume, stretching the muscle, tissues and skin. Once the desired volume has been reached, the new breast is allowed to rest for several weeks before the expander is removed and a permanent implant is inserted.

Autologous Tissue Breast Reconstruction
Using autologous tissues (donor tissue that is taken from another part of the body) to reconstruct the breast contour, this method is often combined with the use of tissue expanders to create a pocket for the donor tissues.

There are two main techniques used in the autologous tissue transfer method, and each has its advantages and disadvantages:

  • TRAM Flap technique
  • Latissimus Dorsi Flap technique.

TRAM Flap Technique
The most commonly used for breast reconstruction is the Transverse Rectus Abdominus Musculocutaneous (TRAM) flap technique.  In the TRAM flap procedure, Dr. Goshtasby will use skin and fat, along with portions of the rectus abdominus, the muscle that extends along the center of the abdomen on either side of the navel and stretches from the pubic area to the central ribs and sternum.  During the procedure, the lower section of the muscle is divided and loosened from its original location, creating a muscle flap.  The lower, loosened section is folded and moved upward into the breast area by tunneling underneath the skin. The upper portion of the flap, called the pedicle, remains partially attached to its original location to preserve the attachment of the blood vessels, allowing blood flow to the reconstructive tissues in the breast.

A similar procedure, called a Free TRAM Flap procedure may also be used for women who have larger breasts.  In a Free TRAM Flap procedure, donor sections of the TRAM muscle are removed and the vessels are detached and reattached to vessels at the breast site.

After the donor tissues, fat and skin are placed and sculpted to form the breast mound, the incisions are closed.

Latissimus Dorsi Flap
Often referred to as an “LD” procedure, the Latissimus Dorsi Flap procedure is one of the most commonly performed procedures and has been an accepted method for breast reconstruction for decades. The procedure often includes the use of tissue expanders to create a pocket for an implant, creating a more natural appearance of the reconstructed breast.  For women with smaller breasts, this procedure can be utilized without an implant, using only natural tissue to reconstruct the breast mound.

During the procedure, Dr. Goshtasby will relocate the latissimus dorsi flap, a flat, broad, triangular-shaped muscle on the back that connects to the bones of the spine, shoulder and arms. This muscle is gently detached from its natural location on the back and transplanted on the front of the chest wall.  The main vessels are left intact to ensure proper blood supply to the flap. The LD flap provides enough native soft tissue to allow for complete coverage of an implant if one is to be used.

After the donor tissues, fat and skin are placed and sculpted to form the breast mound, the incisions are closed.

Breast reconstruction is performed under general anesthesia and lasts for two to three hours with a one to three  day stay post-operative stay in the hospital. The initial recovery time is two to three weeks and any secondary procedures follow in about three months.

Overall, there are no major long-term physical limitations and normal activities can be resumed as recovery permits.

About three months after the initial procedure, it may be necessary to perform one or more secondary procedures to:

  • Exchange expander implants
  • Improve breast symmetry
  • Reconstruct the areola around the nipple

Secondary procedures are usually performed as outpatient surgery and the recovery period is much shorter.  If you are undergoing chemotherapy, any secondary procedures must wait until chemotherapy is completed.

Many women opt to have the color of the skin around the nipple and areola restored to help create the appearance of a completely reconstructed breast.  Patients who wish to have this third and final stage completed at a later date are encouraged to do so.

Because Breast Reconstruction is a highly-personal and individualized process, Dr. Goshtasby will consult with you personally several times prior to surgery to answer your questions and concerns about your treatment plan.