Breast Reconstruction Indianapolis
A variety of hereditary, benign and cancerous conditions can affect the breast. These conditions or their therapy can result in breast asymmetry or complete loss of one or both breasts. Absence of the breasts can be associated with psychological distress and altered body image in some women.
Fortunately, breast contour and volume can be restored by a number of reconstructive techniques, with a recognized positive impact on self-image. These techniques include implants with tissue expansion, use of the patients own tissues to rebuild a breast (flap surgery) or a combination of these techniques. The choice of which techniques to use for breast reconstruction in Indianapolis may be complex. Factors weighing into this decision include the patients body build, size of the opposite breast, other treatments to be used (such as radiation or chemotherapy), other medical conditions, lifestyle considerations, the surgeon’s judgement, and patient preferences.
When you are ready to discuss your reconstructive options in person, request a complimentary consultation at Wagner and Associates Plastic Surgery in Indianapolis. We understand the unique needs of reconstructive patients and are here to help you make the decisions that are right for you.
Breast Reconstruction Timing
Breast reconstruction may be performed immediately (at time of the mastectomy) or delayed until after all cancer therapy has been completed. Immediate reconstruction has advantages of prompt physical and psycological rehabilitation of the cancer patient and economizes on the recovery process and costs. Delayed reconstruction is usually favored when extensive postoperative chemotherapy or irradiation is planned, to avoid complications that might delay these therapies or detract from the reconstructive outcome.
Implants and Tissue Expanders
Silicone gel or saline inflatable breast implants can be used to reconstruct a breast mound. Adequate tissue coverage must be present. When the tissue envelope is good enough, the implant is usually placed beneath the pectoralis major muscle at the time of the mastectomy. If the pocket is too tight or not enough skin is left to cover an implant, the skin is usually closed over tissue expander. A tissue expander is a temporary, inflatable balloon type device that is gradually inflated over several weeks to stretch the skin to permit placement of an implant. Some expanders can serve as both expander and permanent implant. The expander is gradually filled with saline through an integrated or separate tube to stretch the skin enough to accept an implant beneath the chest muscle. Typically, the permanent breast implant is placed at a second surgery.
Breast reconstructiion with implants has the advantage that there are no additional scars, the surgery is short and recovery is quick. Limitations of breast implants for reconstruction are the need for 2 or more operations, potential for implant failure, capsular scarring around the implant, a higher likelihood of need for revisional surgeries, limited breast size can be achieved, and somewhat unnatural feel. Implants are not the best choice for breast reconstruction in irradiated breasts, as scarring or other complications are more likely.
Breast Reconstruction with tissue flaps uses the patients own tissue with or without an implant to build a new breast. Common sites for tissue to be taken include the back (latissimus dorsi flap) or the abdomen (TRAM, DIEP flaps) and tunneled to the front of the chest wall to form the reconstructed breast. The transported tissue forms a flap that can be used to cover a breast implant, or it may provide enough bulk to form the breast mound without an implant. In selected cases, any of these tissues or others may be microsurgically transplanted to create a new breast mound. The advantages of tissue flaps are provision of better coverage to the chest (even over an implant), single stage operation, better tolerance of radiation, more tissue allows a larger breast to be reconstructed, and a generally somewhat more natural texture to breast. Disadvantages are longer operation and recovery, potential for donor site scars and weakness (especially with variations of the TRAM flap), and higher cost.
Breast reconstruction surgery usually requires more than one operation for most patients. The first operation creates a breast mound. After several months of healing the breast shape will settle and the nipple, and areola are restored in a second stage minor operation. Scars at the breast, nipple, and donor site will fade substantially with time, but do not disappear entirely. Breast reconstruction is sometimes combined with alteration of the opposite breast to achieve a symmetric overall appearance.
Board certified plastic surgeon Dr. Jeffrey Wagner and the entire team at Wagner and Associates Plastic Surgery are committed to helping you with the important decisions you face. Request a complimentary consultation online at Wagner and Associates Plastic Surgery or call 317-621-2520 today to schedule an appointment.