The results after breast reconstruction can vary dramatically. The proper choice of breast reconstruction and the surgeon’s attention to detail will make a significant impact on the overall look and feel of a new breast.
How can you recognize a good breast reconstruction? Photographs are a basic way to describe the aesthetic appearance. However, the critical items of feel, touch and patient comfort simply cannot be seen on one or two pre or postoperative photographs. The long-term complication rates of different types of reconstruction also differ significantly.
So what makes for a truly great, or “aesthetic,” breast reconstruction?
For a truly aesthetic breast reconstruction, ALL of the following factors are very important:
- Type of breast reconstruction (own tissue vs. expander/implant)
- A surgeon’s experience and attention to detail during the breast reconstruction first stage (“the reconstruction part”)
- A surgeon’s time spent in attention to detail and during the second procedure, or “touch-up” stage. This is the time when the breast “reconstruction” procedure is transformed into an “aesthetic” procedure by a meticulous surgeon.
Type of breast reconstruction (own tissue vs. expander/implant)
Studies in medial literature have repeatedly shown that breast reconstructions performed using a patient’s own tissue results in a reconstruction which will look better and feel better in the long run than breast reconstructions performed with tissue expanders and implants. Breast reconstruction from a patient’s own tissue will appear more natural and tend to gain and lose weight with that patient.
Long term rates of complication using a patient’s own tissue also tend to be significantly lower than with the expanders and implants. This is especially true with patients who have undergone radiation in the treatment of the breast cancer. The patient’s own tissue brings in blood supply, nutrients and oxygen which contribute to and support, not only the breast reconstruction itself, but also the surrounding tissues. In contrast, reconstruction or an implant will cause the body to form a capsule, or shell of connective tissue, around the implant in all cases. The reconstruction may remain soft but has the propensity to form a contracture, or hardening of the shell over time. This risk of contracture and hardening is present throughout the life of the patient.
A surgeon’s experience and attention to detail during the first stage
The surgeon’s experience and attention to detail in determining the choice of reconstruction and the way it is performed during the first operation is important. Again, use of a patient’s own tissue will overall have a higher chance of having a natural-appearing result than that with tissue expanders and implants, especially in the face of radiation.
In a flap reconstruction procedure, tissue is taken from areas where the patient has excess. This is usually the patient’s abdomen, which provides the added benefit of removing the skin and fat normally removed during an abdominoplasty, or “tummy tuck.” This skin and fat can be shaped into a breast mound which will look and feel much like a natural breast.
The type of flap and experience of the surgeon are also quite important. A procedure which is muscle-sparing, such as a DIEP flap, will result in a reconstructed breast with the same appearance as that of different procedures such as TRAM flaps, but with the added benefit that no muscle is taken from the abdomen. This will result not only in a beautiful reconstructed breast, but also in a much-improved abdomen with less of the negative effects, weakness, pain and recovery time of having muscle taken.
The choice of a surgeon for this is critical as only several dozen surgeons in the nation perform the DIEP flap procedure routinely. You should make sure that your surgeon has an excellent safety record, with a common success rate being 97-99%.
The surgeon’s ability to perform this procedure successfully is not enough, however. The surgeon must take the time to properly inset the flap to allow for a second “touch-up” procedure to transform the breast into a beautiful aesthetic result. A surgeon who relies on speed or cost as their only indicators of success may not be the one who takes the time to pay attention to the significant details required for an optimal result.
A surgeon’s attention to detail during the second stage
This is the most critical portion for the achievement of a successful and aesthetic outcome. It is really during the second-stage procedure that the reconstruction is taken and turned from a “reconstructive operation” into an “aesthetic operation.” The breast mound is tightened up, lifted and shaped into a result which can very closely mimic the result achieved in a breast lift or mastopexy. Often at this point, the nipple is reconstructed and all excess skin from the abdomen or other area is removed. The result falls into a healing and scar pattern line which can be almost identical to that seen after an aesthetic mastopexy, or “breast lift.” The donor site, usually the abdomen, is also touched up. Any scar irregularities can be addressed and the hips liposuctioned down.
As in a tummy tuck, a meticulous surgeon usually has already plicated, or “tightened,” the fascia of the abdomen during the first procedure, but this can be performed at the second-stage procedure as well. This allows shaping not only of the hips but also adds a more hourglass-like appearance to a patient’s waist.
This second-stage procedure typically is performed as an outpatient procedure, although some patients opt for a brief overnight stay.
Again, time spent at this stage in attention-to-detail by the surgeon is critical. It is typically very difficult to achieve a superior aesthetic result with simply a one or two hour touch-up. Time and energy invested by the surgeon can result in a beautiful aesthetic outcome that will last a lifetime.
Overall, there is often much hype about the different types of breast reconstruction. A thoughtful choice of both procedure and surgeon are both essential for a superior result.
