Help with Choosing Method for Breast Reconstruction, Lift and Implants?

I need to make up my mind regarding breast reconstruction, with breast implants and breast lift. I have gone to different plastic surgeons. I am 50 years old and weigh 104 lbs. I have no fat in my stomach.

I had a mastectomy in January followed by radiation. I would like to have reconstruction on one side and a definite lift on the other. One doctor says do the one step latissimus dorsi with implants on both sides; the other says do a deip flap muscle sparing. Who is right?

Doctor Answers 13

Breast Reconstruciton

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No body is right or wrong. It all depends on what you want from the surgery and what you are willing to go thru. One is a shorter recovery and the other is a very big surgery with prolonged hospital stay. The diep flap is complicated and will take anywhere from 6-10 hours depending on who is doing it. The other the lat flap will be faster and shorter recovery. The lat is somewhat a compromise of a surgery given the history of radiation.

You just have to decide what you are willing to go thru and how much surgery you are willing to under go.

Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

After radiation and mastectomy, plan for a flap

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Hi Connecticut, I agree with others in that after mastectomy with irradiation, you require some kind of "flap". A flap refers to any piece of tissue moved from one area of your body to another. The basic list of donor sites are abdomen (TRAM, DIEP), back (latissimus), upper thigh (TUG), and butt (SGAP). If you are thin, you may not have enough fat in any one area to make up for a whole breast, and you will have to go for a flap + an implant. Of all of the flaps listed above, the one that is different significantly is the latissimus, which is very very reliable (it won't die), but always needs to be combined with an implant. I'm sorry I can't help further without evaluating you, you can feel free to send all of us a photo if you desire!

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 16 reviews

Breast reconstruction in irradiated breast

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All options are available to you

1. implant only-limits are that you will only be able to place a small implant

2. Tissue expander, then implant- would make it possible to get a larger implant but the use of implants has higher risks of wound problems and capsular contractures in irradiated tissues.

3. Latissimus with implant-Very good option for this situation. At your weight you may not have enough skin and fat from the belly to recreate the breast

4. DEIP/TRAM, etc- although this is also a good option you may still need an implant.

What you do to the other side depends on what you have to do to match the reconstructed side, implant, lift, reduction or nothing

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

Some radiated breasts can be reconstructed with implant alone.

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1) At 104 pounds, I doubt that you have enough excess abdominal tissue for a DIEP flap. So, without examining you, I would say the latissimus flap sounds better.

2) If there are no radiation changes in your skin, we sometimes do breast reconstruction in radiated patients just with an implant under the chest muscles, without any flaps. We have had good results in selected patients, and of course it is much less invasive surgery.

3) On the other side, you need a breast lift with or without an implant.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Best type of breast reconstruction

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There really is no one best type of breast reconstruction - the approach needs to be individualized to the patient. A DIEP (Deep Inferior Epigastric Perforator) flap can be an elegant option to reconstruction with minimal morbidity to the abdominal wall and a very natural looking result. If you do not have any fat on your abdominal wall, however, the size of the reconstructed breast may be limited. A one-stage latissimus with implants will allow for a larger reconstructed breast.

Given that you have had radiation therapy, both surgeons are correct in wanting to use some kind of flap in your reconstruction; implants by themselves would not have nearly as good a result.

Ultimately, your choice of operation will depend on your choice of surgeon. If you cannot make up your mind, a third opinion from someone who has the opportunity to talk with you and examine you may be useful.

Best of luck. Hope this helps.

Help with choosing method for breast reconstruction, lift, and implants?

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Hello!  Thank you for your question.  After radiation, you have an increased rate of complications including wound problems, infections, thinning of the tissue, and decreased vascularity to the skin/tissue of the area.  The best method to reconstruct a breast following radiation therapy is with a flap.  The flap, which is skin, fat, and sometimes muscle, will serve to bring in healthy, well-vascularized tissue to the chest/breast area that will significantly ameliorate the radiation issues compounding the problem.  Microsurgical perforator flaps (such as the DIEP flap and SGAP/IGAP flap) are the newest and most-innovative procedures in breast reconstruction today.  As these are muscle-sparing flaps, the pain, morbidity, and complications such as those above, of these procedures are much less.  They are highly-complex procedures that few plastic surgeons performed and consult with one who is well-versed, trained, and skilled in these procedures if you are interested.  

There are many options to breast reconstruction including implant-based and flap-based procedures.  The complication rate with implants following radiation is reported as high as 60-70% in some studies.  Flap reconstruction is usually recommended, but there are several centers who perform implants following radiation with great success and results.  I typically prefer flaps, such as the DIEP flap.  Other flaps are the conventional TRAM, latissimus flap, SGAP/IGAP, and, TUG.

You are a candidate for other procedures, if you are willing to continue with your journey for a reconstructed breast.  Flaps such as those above, including others, are available, and I would recommend flap reconstruction for you, in my opinion.  There is nor correct answer for which is the right one for only you can truly decide which one you choose to proceed with given your goals and expectations.  The decision to continue with this will be your decision and what you are willing to go through.  There are risks and benefits with everything that we do in Surgery - discuss the various options with a board certified plastic surgeon who will educate you on all of the options and help you to decided if breast reconstruction or which procedure will be best for you.  Hope that this helps and best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Best method of breast reconstruction

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Implants should never be used alone in a radiated breast unless it is combined with another flap for coverage. To get more volume in a radiated field you need to use your own tissue. A TRAM flap is just one tool used in breast reconstruction. It sacrifices your stomach muscle but provides fat on a leash to your breast.. Another is a DIEP flap which also uses your belly tissue but does not sacrifice your stomach muscles. It essentially uses the same tissue that would be discarded in a tummy tuck but relocates the tissue to create a breast. A third option is the Latisimus flap (back muscle); its best use is along with an implant. These "autologous" tissue (your own tissue) can be used in any breast reconstruction. Women prefer it because it is their own tissue. It is also an excellent option for someone who has had radiation. You should consult with a plastic surgeon who offers all three of these methods as well as the implants, so that you have the best choice of options

Breast Reconstruction Choices

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Deciding upon the best breast implant technique is best for you requires a consultation and discussion with a board certified plastic surgeon.  This meeting will be provide you with a thorough evaluation and discussion fo the all breast reconstruction optionsoptions, and advise you which might be best for you.

There are some general notions to consider.  Implant expander technique have a relatively high complication rate.  Including infection, malposition of the implant, capsular contracture, firmness, cold breast mound.

Autologous tissue breast reconstruction techniques make a warm, soft, more natural breast using your own body tissues.  These include older techniques such as a TRAM flap, as well as state of the art procedures call perforator flaps such as DIEP flaps, PAP flaps and S-GAP flaps.  

For more information of these and other breast reconstruction techniques see our  website.

Fredrick A. Valauri, MD
New York Plastic Surgeon

Choosing plastic surgeon?

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Reconstruction surgery is sometimes very complicated so please make sure you choose a surgeon who is experienced in this area.

During your consultation with a board certified plastic surgeon, ask to see before and after photos of actual patients who have undergone cosmetic surgery. The surgeon may provide you with a list of patients you may speak to as a reference for the doctor. To enhance your education regarding the surgeon, you may be introduced to some post-op patients as well during your visit with the surgeon. 

Professional doctors will ensure realistic expectations and take the time to address your concerns. They will provide you with honest advice and encourage you to do your homework, talk to other patients, and make an informed choice. One of the most important factors in choosing a plastic surgeon is your personal comfort level with the doctor. You should feel comfortable asking questions about your cosmetic surgery procedure so that you can make an educated final decision on whether you would like to proceed with surgery.

There are a number of advantages in choosing a qualified and highly experienced plastic surgeon to perform your cosmetic surgery. If there are any complications during surgery, an experienced plastic surgeon will be more adept at handling the situation. In addition, a plastic surgeon that has performed many cosmetic surgeries will have had more time to perfect his or her technique and results.

Reputable plastic surgeons should have privileges to perform cosmetic surgery procedures in the operating room at an accredited hospital, not just in the surgery center in their office. They work with a highly skilled team including, board certified anesthesiologists, nurses, and technicians to enhance patient comfort and to provide a peace of mind to the patient’s and their families.

I hope this helps.

Breast reconstruction

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There are many options ofr recontstruction folowing radiation. Yes, an LD and implant is one, and a TRAM, DIEP, etc.  are others. In order to know what is right for you, you would need an exam.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.