ECAPS Center for Breast Reconstruction
The ECAPS Center for Breast Reconstruction was established in September 2011 by Drs. Cerio and Loghmanee to serve the women of New Jersey, New York, and surrounding areas. Its primary goal is to facilitate a woman’s desire to regain her sense of wholeness by offering all forms of available methods for breast reconstruction. Every woman is different, with varied lifestyles, goals, and preferences. Breast Reconstruction at the ECAPS Center is specifically tailored to the individual, as one method of reconstruction does not fit all.
Breast reconstruction is the rebuilding of a breast using prosthetic material or one’s own tissue, usually in women, most commonly following a mastectomy or lumpectomy. The surgery often involves several procedures performed in stages, consisting of a mastectomy/lumpectomy, breast reconstruction and recreating the nipple/areola.
There are several reconstruction techniques that can restore a breast to near normal shape, size, and appearance. The following are the five types of procedures we use for this surgery.
For many decades this was the only option for breast reconstruction, and is still commonly used today because the surgery time is shorter and recovery time is faster. Results can be excellent, depending on the quality of the breast tissue, and especially if doing both sides simultaneously. The downside is that the results are less natural than using one’s own tissue, and may be fraught with delayed complications with the implants, especially if radiation therapy has been used. Using this method, an implant is placed under the pectoral chest muscle and is slowly filled with saline over a period of months to allow the surrounding tissue to gently expand. Once the desired size is achieved, the implant (which is usually a temporary tissue expander) is replaced with a permanent implant.
Latissimus dorsi flap plus Tissue Expander and Implants
In this technique the surgeon moves the latissimus dorsi muscle (and a small portion of fat and skin) from the back to the site of the mastectomy. Then, a tissue expander is placed under this muscle and tissue. The expander is filled with increasing amounts of saline over a period of weeks in order to allow the skin and surrounding tissues to slowly expand to the desired size. Once this step is complete, the expander is replaced with a permanent implant. In most cases, little to no compromise of strength or motion occurs from the movement of the latissimus dorsi muscle to its new location.
Pedicled TRAM Flap
The pedicled tram is a more complicated procedure than implants alone, or Latissimus plus implants and tissue expander. The basic steps in the pedicled TRAM (Transverse Rectus Abdominis Myocutaneous) flap procedure is the use of portions of skin and fat from the lower abdomen, which remains connected to a portion of the abdominal muscle and its blood supply. The flap of tissue is then transferred under the upper abdominal skin to the mastectomy site to create a new breast. Some weakness occurs from the loss of this abdominal muscle, but over time the other muscles compensate and long-term effects are usually minimal. One may also develop a bulge(weakness of the abdominal wall) or a hernia after transfer of the abdominal tissue, which may require a secondary operation for hernia repair.
Free TRAM Flap
A “free” TRAM flap is similar to the pedicled TRAM, but in this case less abdominal muscle is used to recreate a natural appearing breast. The blood supply to the abdominal skin and muscle is temporarily cut and microsurgically reattached to blood vessels in the chest, closer to the breast. This allows for better shaping of the abdominal tissues and more accurate placement, so that the of new breast is more natural appearing and less firm when compared with the above described “pedicled TRAM.” There is less of a chance to develop an abdominal wall hernia and/or weakness when using the “Free TRAM” versus the “pedicled TRAM.”
The DIEP procedure is the most advanced breast reconstruction technique. For a DIEP (Deep Inferior Epigastric Perforator) flap, the same lower abdominal incision is made, and tissue from the area is used to create a natural appearing breast, as described above. However, in this method the abdominal muscles are left fully intact, which helps maintain one’s normal abdominal anatomy and reduces abdominal wall hernias and weakness. This is a technically challenging procedure that not every patient is a candidate for, however if a good candidate, it may be the best form of reconstruction available.
Am I a good candidate for breast reconstruction?
One or more of the following may indicate you are a good candidate for breast reconstruction;
- You are in relatively good physical condition
- You have undergone, or are planning to undergo, a mastectomy
- You are bothered by a breast abnormality, a defect, or asymmetry, which makes you feel less feminine
- You have breasts that are damaged or missing due to a birth defect, injury, mastectomy or lumpectomy
Dr. Loghmanee or Dr. Cerio will conduct an examination and discuss with you your expected outcome and determine how your desires and goals can best be achieved. It is important to note that the look and feel of a reconstructed breast will never be identical to that of a natural breast. You must come prepared to discuss your full medical history, including any medical conditions, previous surgeries or treatments, history of breast cancer and treatment, drug allergies, current medications, and use of alcohol, tobacco or illegal substances.
Cancer Treatment: It is important to discuss with your oncologist whether this procedure is right for you. Ongoing cancer treatments can affect your ability to withstand the multiple procedures necessary for reconstruction.
Age: Breast reconstruction surgery can be performed at any age but in general, for the best outcome for any breast procedure it is recommended that you wait until breast development has stopped.
Pregnancy: It is also important to inform Dr. Loghmanee or Dr. Cerio if you are considering having children in the future. Pregnancy can cause body changes which could affect the long-term results of your surgery. Consideration will be given to your specific situation to choose the best procedure for your specific goals and lifestyle.
Surgery and Recovery
Breast reconstruction using only implants is an outpatient surgery, performed under general anesthesia, or local anesthesia with sedation. After a few hours recovery, and possibly a one night stay in the hospital, you will be ready to go home. Your breasts will be wrapped in gauze dressings or a surgical bra, and you may have drain tubes to prevent the accumulation of fluid. You will be given detailed information from Dr. Loghmanee or Dr. Cerio detailing normal symptoms, signs of complications and instructions for recovery.
Breast reconstruction using one’s own tissue usually requires admission to the hospital for 3-5 days depending on the type of tissue used.
After implant reconstruction one usually is able to walk immediately following surgery and will be up and about within the first 24 hours of surgery. Your breasts will be sore and tender to the touch for the first few days, and you must not lift, bend, pull or push anything and not engage in any strenuous activity for at least two weeks. More specifically, you will not be allowed to lift anything greater than 5 pounds for atleast 4-6 weeks and usually will stay out of work for 2-4 weeks depending on type of operation. Drain tubes are usually removed after 5-10 days and dressings will be removed within several days and you may be required to wear a supportive garment for comfort and to minimize swelling. Over time some breast sensation will return and scarring will improve, but will never fade completely. You should be able to resume your normal activities after 6-8 weeks. Dr. Loghmanee or Dr. Cerio will recommend follow up visits to closely evaluate your healing process. It is important to follow your doctor’s orders for the best outcome.
Recovery after a flap procedure using you body’s own tissues has a more involved recovery process that will be discussed in detail during your consultation.