Joseph M. Brown M.D, F.A.C.S
PLASTIC SURGEON IN TAMPA
Dr. Brown has a true passion for breast reconstruction. His mother’s battle with breast cancer gives him insight to the physical and emotional strain this puts on patients and drives him to provide the most personalized, state-of-the-art care possible for his patients.
What should I know about breast reconstruction?
First, this is optional. When you are thrown onto the “cancer train,” there are a multitude of lab tests, imaging studies, questionnaires, and doctor’s offices you are told to do, receive, or go to, which creates an overwhelming sense of lack of control. While a lot of what is happening is beyond your control, this part is not. You decide when/how/if your breasts will be reconstructed. While it is not considered “cosmetic” by insurance companies, it is optional.
Second, breast reconstruction is a journey both in recovery and emotion. Regardless of which road you choose, there is no “one stop shop” option (for most patients) for surgical treatment. Most options require 2-3 operations over about 4-8 months to get to your final result. Dr. Brown takes the time to explain each process to his patients and his patients’ families so you never feel lost or alone while going through the phases.
For many patients, there is a fog that comes over them when they hear their diagnosis, and reality doesn’t set in until their visit with their plastic surgeon. This is likely due to the fact that the conversation shifts from “I need to treat my cancer” to “how is this going to affect my day to day?” With Dr. Brown, you can take comfort in the fact that he is aware of this and will take time to listen, answer questions, and offer comfort in the fact that if you want to do it, you CAN do it.
Third, you do not necessarily have to undergo breast reconstruction at the same time as your mastectomy. There is always an option to undergo delayed reconstruction, which may actually be safer for some patients. This means that if you do not choose to undergo breast reconstruction at the same time as your mastectomy, you have not lost your chance to ever have it.
What types of breast reconstruction are there?
There are two main types of breast reconstruction.
The most modern method for autologous reconstruction (using your own tissue) is the DIEP (deep inferior epigastric perforator) flap or muscle sparing TRAM (transverse rectus abdominis musculocutaneous) flap. With these operations, skin and fat from the lower abdomen are taken with their supplying artery and vein and brought up to the chest. The blood vessels are sewn to recipient vessels so that tissue can live there, and the tissue is shaped in the form of a breast.
Dr. Brown was trained at an institution where this was performed regularly at a high-volume center.
“Device based Reconstruction”
Device based reconstruction means an implant will ultimately be used to reconstruct the breast. There are multiple ways to effect this.
Staged Tissue Expander to Permanent Implant
With this operation, a specialized temporary implant called a tissue expander is placed at the same time as the mastectomy. It will be inflated over time to help create the “pocket” that a permanent implant will ultimately be placed into at a later operation. For most patients, this expander is placed underneath the pectoralis major muscle. The reason for doing this is to help increase the soft tissue thickness over the final implant and recruit the muscle as a part of the overall “shell” around the implant which helps it to prevent soft tissue thinning and visibility of the final implant.
The patient will then undergo expansion in the office, where saline will be injected into a fill-port. During this process, Dr. Brown and the patient will decide on a final volume that looks well proportioned. Once the patient/doctor team are happy, a second operation will be scheduled about two months later. At that time, the tissue expander will be replaced with a softer, natural feeling implant. Using state of the art techniques, Dr. Brown will fine tune and tailor the final shape of the breast. He will also typically perform liposuction on the abdomen to harvest fat, which will be injected into the upper part of the breast to help create a smooth/natural contour.
Direct to Implant
Some patients are candidates for “direct to implant” reconstruction. In select instances, patients may undergo placement of the final, permanent implant at the same time as the mastectomy. To do this, patients typically must desire smaller breasts than they currently have, be at their ideal body weight, and be ok with the thought of potentially requiring a revision surgery.
What about the nipple?
Some patients are candidates for “nipple sparing mastectomy.” To be a candidate, patients are typically smaller/moderately sized, relatively symmetric, have good skin elasticity, and minimal to no ptosis (droopiness). When the nipple can be spared, the incision of the mastectomy is typically placed along the crease underneath the breast. Sparing the nipple is done purely for the final visual result of the reconstructed breast. The nipple will not maintain its ability to lactate or be stimulated. There are techniques being employed by some surgeons in attempt to preserve the nerves providing sensation, but this is not standard at this time.
For patients who are not nipple sparing mastectomy candidates, there are three options.
Do nothing – Some patients are ok without having nipples and are finished after their last operation on the breast mound.
Tattoo only – Some patients do not want a projecting nipple to stand up on their breast mound, but are distracted by the “lack of nipple” when they look in the mirror. These patients are great candidates for nipple/areola tattoo. Special techniques are utilized to create an illusion of a 3-D nipple and areola with tattoo only. These look fantastic when done correctly and avoid the risks of a procedure. But when a hand is run across the breast, it will feel completely smooth.
Reconstruction with tattoo – Patients who desire to have a projecting nipple choose to undergo reconstruction with a tattoo. Using geometric patterns, Dr. Brown will create a standing nipple with your own living skin. Once this is healed, the nipple and areola will then be tattooed for its final appearance.
Breast Reconstruction Recovery
There is a recovery process with each operation and each process is different. Fortunately, the difficulties are “front loaded,” in that the first surgery and recovery are the worst, but each subsequent process is dramatically easier on your body and your emotional well-being. Dr. Brown will take the time to explain each of these to you during your consultation.
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We are located at Tampa Aesthetic & Plastic Surgery, 17523 N Dale Mabry Hwy Lutz, FL 33548.