Beverly Hills Breast Reconstruction
Board Certified Breast Surgeon in Los Angeles
In Beverly Hills, breast reconstruction after breast cancer surgery has changed significantly in the last several years. Women have more options to have the natural looking breasts they desire and deserve. Dr. David Sayah has performed extensive research in the field of breast reconstruction, and, in response to federal law changes, breast reconstruction following cancer treatment is now a right and not a privilege. As a result, all insurance companies must cover breast reconstruction.
What Type of Reconstruction Is Right?
Options for breast reconstruction naturally are dictated by the type of deformity that occurs following a surgery for breast cancer. For patients who had a minor area of their breast removed and did not under therapy with radiation, a breast implant can be an excellent option. If the opposite normal breast is too large, another option is to make the larger breast smaller via a breast reduction surgery.
Radiation therapy makes matters a bit more complicated; breast implants have a much higher chance of becoming hard if you have undergone radiation therapy. In such cases, better options include a breast lift on the opposite breast, or if the deformity on the affected breast is large, Dr. Sayah can reconstruct your breast with your own tissue.
Another issue to consider in breast reconstruction is timing. While most women prefer to have their breast reconstructed simultaneous to their lumpectomy or mastectomy, other women wait to have their breast reconstructed at a later stage. Thorough team discussions with your oncologist, breast cancer surgeon, as well as Dr. Sayah are very helpful in making such decisions.
Issuing Your Own Tissue
There are several options when it comes to using your own tissue for breast reconstruction. These include your latissimus dorsi muscle (on your back) or your tummy tissue, which would be obtained from a tummy tuck (TRAM or DIEP flap). In the second case, Dr. Sayah would perform a tummy tuck on you, using the excess skin and fat that was removed to reconstruct your own breast. This type of surgery under the microscope is the most cutting-edge approach to breast reconstruction.
In those who have had the entire breast taken out to prevent the spread of cancer, reconstructive options would include breast implants or using theirown tissue as described above. Dr. Sayah also strives to help you better understand your choice of techniques. Because of the complexity and importance of this topic, and you are encouraged to request a consultation with Dr. Sayah so your particular case and preferences can be discussed in detail.
What to Expect During the Procedure
During your consultation and pre-surgical visits, Dr. Sayah reviews which surgical option is your best solution. If you have chosen breast implant reconstruction, they are typically inserted through the already existing scar from your prior surgery. In some cases, a tissue expander may need to be inserted first in order to stretch your breast skin over time until your desired breast size is reached. A saline or silicone breast implant is then exchanged for the temporary tissue expander. To accomplish symmetry, a breast lift on the opposite normal breast may be performed with minimal scar techniques. For those choosing to have their breast reconstructed with their own tissue, skin, and fat can be derived from your buttocks, tummy, thighs, or back area. Each “donor site” has its own benefits and disadvantages.
Most commonly, back or tummy tissue is used. When using tissue from the back, the muscle and its overlying skin and fat are carefully separated from the back and rotated to the chest to reconstruct the affected breast. When using tissue from your tummy, the excess skin and fat removed during a tummy tuck are rotated to the chest to reconstruct the breast.
Modern techniques such as the DIEP Flap avoid the weakness of the tummy muscle and have lower abdominal wall complication rates. Based on the timing and reconstruction technique you have chosen, your procedure is performed in an ambulatory surgery center or at a hospital. While breast implant reconstructions are performed as outpatient surgery, allowing you to go home shortly after your procedure, more involved tissue reconstructions (TRAM, DIEP) will require hospitalization for a few days.
Frequently Asked Questions
What Is Breast Reconstruction?
Reconstructive breast surgery restores a natural appearance to the breast following a lumpectomy, or rebuilds the breast following a single or double mastectomy. Reconstruction is typically covered by insurance, and is often included as part of a comprehensive approach toward cancer treatment.
Am I a Candidate?
Candidates for breast reconstruction have lost part or all of a breast or both breasts, typically due to cancer treatment. Candidacy may depend on whether future treatments, like chemotherapy or radiation, are still required following a lumpectomy or mastectomy; some women may need to wait until their other treatments are completed before pursuing reconstructive surgery. The best candidates will be in good health mentally and physically, and have realistic expectations about their results.
Will Insurance Cover Breast Reconstruction?
If your insurance company covered your mastectomy, then they are required by federal law to cover your reconstructive surgery as well. This includes not only reconstruction on the affected breast, but also any procedures that are necessary on the opposite breast to create symmetry.
Should I Choose Breast Reconstruction Right Away, or Should I Wait?
This is a personal choice for every woman, and there isn’t one right answer that works for every patient. Some patients prefer to undergo the initial stages of reconstruction at the same time as a mastectomy. Others prefer to wait for personal reasons, or delay reconstruction for medical reasons until after other necessary treatments are completed.
What Options Do I Have for Reconstruction?
Dr. Sayah offers a number of choices for reconstructive surgery. The easiest and most popular option for breast reconstruction is to use breast implants. Form-stable cohesive silicone gel implants (nicknamed gummy bear implants) offer a beautiful choice for reconstruction, delivering results that look and feel very natural. Flap reconstruction is another option offered by Dr. Sayah. During flap reconstruction, tissue is taken from either the back of the shoulder or the abdomen to reshape the breast. This may be combined with implants, or performed on its own.
What Should I Expect During My Procedure?
Each breast reconstruction will vary depending on the level of correction needed, as well as the preferred surgical approach. Reconstructive surgery typically takes more than one appointment, even if the first surgery occurs at the same time as your mastectomy. It’s also common to include additional procedures on the opposite breast to ensure symmetry, like breast reduction or a breast lift. Breast implants may be used on both sides as well. For implant-based reconstruction, adjustable sizers are placed at first to gradually stretch the skin until the desired size is reached. At that time, the sizers are replaced with permanent implants. For patients undergoing flap reconstruction, Dr. Sayah first removes tissue from a donor area, and then uses that foundation to reshape the breast. In some cases, this may be combined with implants as well. Tissue is also used to form a new nipple, which is then tattooed (along with an areola) for natural pigmentation.
What Should I Expect During Recovery?
It’s normal to feel sore and uncomfortable after a breast reconstruction, especially if tissue was taken from a donor area. The skin may feel tight after reconstruction initially, until your body stretches to accommodate your new contours. Cold compresses can be beneficial to reduce swelling and help you feel more comfortable. Over-the-counter medication helps patients feel more comfortable, although Dr. Sayah can recommend something stronger if needed. The majority of patients are able to return to work within a few weeks.
When Will I See Results?
You’ll see a difference in your breasts right away after surgery. However, since reconstruction is a very complex surgery, you may not see your final results for several months, depending on the treatment plan that Dr. Sayah recommends.
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