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Breast Reconstruction In Newport Beach, Orange County

BREAST RECONSTRUCTION INTRODUCTION

Breast reconstruction is achieved through several plastic surgical techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy, injury or birth defect. The following information has been prepared to familiarize you with facts about the surgical procedures known as breast reconstruction. You are requested to read this information thoroughly and to discuss any questions which might arise with your surgeon before proceeding with any type of breast reconstruction procedure. You are also requested to keep this form as a reference in the post-operative period. Breast reconstruction offers women the opportunity to feel whole again after mastectomy, injury (e.g. due to burn scars) or a birth defect. Most techniques involve several procedures which can

 begin as early as the time of mastectomy. The reconstruction begins with an attempt to restore shape, size, and appearance of the breast. There are several techniques by which this can be accomplished. Reconstructive options include expansion of the remaining tissues on the chest and placing an implant, or by using your own tissues, often taken from the abdomen or back. In addition to restoring the breast mound, there are also techniques to reconstruct the nipple and areola, including local skin rearrangements, skin grafts, and tattoos. In some cases, the remaining breast will need to be lifted, augmented, or reduced in order to improve symmetry. Please note, not all patients are candidates for every technique. Your surgeon will review the methods of reconstruction you are a candidate for in detail with you during your consultation. 

Although reconstructions have improved with modern implants and techniques, a reconstructed breast will never have the same look, feel, and sensation as the breast it replaced. In addition to being prepared for the emotional adjustment involved in breast reconstruction, patients must have realistic expectations about outcomes. 

It is important to understand that no person is perfectly symmetrical from one side to the other, even before a major surgical procedure like mastectomy. Every attempt will be made during surgery to minimize your side-to-side dissimilarities, but such differences are natural and always persist to some degree, even after the most successful operations. The greatest chance for approaching symmetry comes when the same operations are performed on each breast at the same times. This is often not the case for a variety of reasons, most commonly, a one sided mastectomy. Even when reconstructions are being performed on both sides, other factors like one sided radiation treatment can greatly alter the way each side heals and lead to asymmetries.

Before & After Breast Reconstruction in Orange County Plastic Surgery Clinic

Before
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After
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PATIENT 1001

23 year old who was born premature, lung collapsed, tube inserted into chest and caused a right breast deformity as she grew up and developed. Before and after a right lateral mastopexy and a left reduction.

Before
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After
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PATIENT 1007

32 year old female, after a left mastectomy and after reconstruction using tissue expanders, a silicone implant and a nipple areolar reconstruction

BREAST RECONSTRUCTION PREOPERATION PREPARATION

You may visit your surgeon as many times as you wish to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you have understood the procedure to be performed, that this material has been explained to you, that you have read and understand these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for surgical soap that is used before surgery, as well as pain pills, antibiotics and instructions for their use. Certain laboratory tests will also be required about two weeks prior to surgery. If you are over the age of 50 or have had any cardiac problems, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or laboratory (e.g. Kaiser Hospital, etc.)

All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation. 

As with all other elective procedures, the patient should avoid ibuprofen (Advil®), all Aspirin® products and excessive quantities of vitamin E (the small amount contained in most multi-vitamin preparations is not harmful) for at least two weeks before surgery, as these inhibit the clotting mechanism and increase your chances of unnecessary operative bleeding.

Patients will be given a prescription for Hibiclens® soap. It will be necessary to scrub the surgical site for ten minutes the evening prior to surgery and for one final time on the morning of surgery before leaving for the surgical suite. Scrubbing the skin with Hibiclens® these two times will decrease the number of bacteria on your skin and lessen the possibility of developing a surgical infection. 

Your anesthesiologist may call you the night before surgery to discuss the anesthetic care plan with you. Additionally, you may be scheduled for a pre-operative anesthesia consult. If you are not able to talk with the anesthesiologist before your surgery date, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the hospital or surgery center prior to your procedure. As discussed in the general information sheets, it is imperative that the patient makes prior arrangements for transportation to and from the hospital or surgery center. If you are going home the day of surgery, you must have a responsible adult stay with you for the first 24 hours after the operation.

BREAST RECONSTRUCTION OPERATION

Breast reconstruction procedures can be performed in an inpatient or outpatient setting. In most cases, a general anesthetic or deep sedative, along with local anesthetics, are employed to insure your comfort and safety. The initial procedures for breast reconstruction may be performed at the same time as your mastectomy or in a delayed fashion. Immediate reconstruction offers the psychological and aesthetic advantage of waking from the mastectomy procedure with less of a deformity. Major disadvantages include the longer surgery and recovery times, and the possibility of unexpected radiation therapy becoming necessary and compromising the reconstructed tissue. Depending on the risk factors known pre-operatively or determined intraoperatively, your procedure for breast reconstruction may be delayed. The two broad categories of breast reconstruction are implant based reconstruction

 and autologous reconstruction, where your own tissues are used to reconstruct the breast mound. Most often, implant reconstruction proceeds with the initial placement of a tissue expander to enlarge the tissues on the chest wall slowly over the period of a few months until a permanent saline or silicone implant can be inserted in a secondary procedure. In some cases, it is possible to place a small permanent implant in the first procedure. Acellular Dermal Matrix, derived from human or animal tissue may be used during implant based reconstructions. Use of this product can facilitate placement of a permanent implant at the time of mastectomy. It can also be used with tissue expander placement to speed the expansion process and improve the aesthetic outcome of the reconstruction. Some studies indicate these potential advantages may come at the cost of a slightly higher complication rate. You should tell your surgeon if you are opposed to the use of this product. 

The manufacturers of breast implants expect them to last a long time, but everything man-made does break or wear down eventually. The life span of all types of implants can be shortened by trauma or mechanical failures. Such a rupture may be clinically undetectable to you or your surgeon if you have silicone gel filled implants, but could be picked up during mammography or other specialized tests. Rupture or leakage of the older gel implants often led to gel migration or formation of lumps within your breast as a result of scar tissue developing around the free silicone, necessitating future breast biopsies and implant replacement. Today’s gel-filled implants contain a “cohesive” gel that stays intact even with shell rupture, will be less likely to migrate and easier to remove. However, rupture of a saline filled implant, will generally be obvious because the breast will resume its previous size and shape over a short period. Unfortunately, no one can predict in advance when an individual implant will fail. Replacing an implant will become necessary if a leak is detected. It is strongly suggested that you return to see your plastic surgeon at least once a year for a breast examination.


Autologous reconstruction harvests tissue, called a flap, from another part of your body to reconstruct the breast mound. In breast reconstruction this is most commonly from the abdomen, called a TRAM (transverse rectus abdominus myocutaneous) flap, or the back, called a latissimus flap. Other donor options include the buttocks or thigh. Flaps can be kept attached to their dominant blood supply and tunneled into position in the chest or they can be disconnected from their native blood supply and attached to other vessels in the chest via a microvascular anastamosis. The later involves more operative time and a higher risk of total loss of the flap but can afford more versatility in the donor location or configuration of the flap. When the flap is taken from the abdomen, it will often require repair of the abdominal wall with a synthetic mesh like material. In general, autologous reconstructions tend to produce a more natural looking breast mound that ages with the patient and may not require as many secondary operations as implant reconstructions. It does, however, involve more operative time, longer recovery, and subjects other areas of the body to the need to heal and risk of complication. 

In some cases, breast tissue is resected as a part of your reconstructive procedure. Any tissue resected during a breast reduction procedure will be examined by a pathologist and you will receive separate bills from the laboratory and the pathologist for these services.

Following the procedure, a light dressing will be applied and you will be sent to the recovery room where you will be kept until you are awake and ready for admission or discharge.

BREAST RECONSTRUCTION POST-OPERATIVE CARE

Depending on which operation you are undergoing, you may be admitted to the hospital to start recovering after surgery. Otherwise, after you have recovered to the point where you are awake and comfortable, you will be discharged home with a responsible adult. You are to leave the dressing dry and intact until your first post-operative visit to the office, which will generally be two to five days following the procedure. Drainage tubes may be needed during your procedure, in which case you should empty them before they get full and record how much comes out of each tube every day. This will help you surgeon decide when the tubes can be removed. During these initial days, you will be requested to take an antibiotic tablet once daily and to limit your physical activity to avoid lifting or straining. 

Following your first dressing change, you will be allowed to begin showering and to increase your activity as tolerated. Most patients find that within a week or two, they can function comfortably around the house and return to the office setting. Recovery may take a bit longer following initial muscle flap surgeries.

Usually, at least four to six weeks must pass before increased physical activity should be undertaken after a primary reconstructive procedure (flap or tissue expander placement). The best rule of thumb is to avoid any activities that cause you discomfort and to enjoy those that do not.

BREAST RECONSTRUCTION POSSIBLE COMPLICATIONS

Every activity in life, whether driving automobiles or having surgery is associated with risk. The following inherent risks must be understood and assumed by the patient if we are to proceed with this operation. Although most patients have a very satisfactory result, complications may occur following any surgical procedure. The patient must understand that asymmetry (differences in appearance from one side to the other) is perfectly natural and that some will persist following even the most successful procedure. Likewise, visible and occasionally unsightly scars are an expected outcome of such an operation. Possible complications include infections, bleeding, fluid collections, capsular contracture, implant rupture, vascular compromise of the flap, skin or tissue loss, which may delay healing, necessitate skin grafts or other subsequent surgical procedures. When autologous flaps are used for breast

 reconstruction, the donor site will be scarred and can incur complications. 

Aside from the healing complications listed above, these can include muscle weakness and hernia or bulge of the abdominal wall.

The need for additional procedures to enhance the aesthetic outcome or improve symmetry is very common following breast reconstruction. Any additional procedures or unexpected hospitalizations will result in additional expense. It is not possible to advise you of every conceivable complication. The foregoing was not intended to frighten or upset you, but to insure that your decision to have this operation is made with your awareness of the possible risks.

FEES

All fees will be discussed freely in advance by the office staff. Co-pays, deductibles, and other patient responsibilities vary with each insurance carrier and plan. Patients will be asked to pay their expected responsibility for surgical fees in advance. Any overpayment or underpayment will be refunded or billed after final adjustments are made by the insurance carrier. Financing may be arranged if desired. Your insurance company may cover a part of the fee but almost never the entire fee. Payment of all fees, however, is the patient's responsibility; all fees are due prior to surgery and the proceeds of the insurance check will go to you when the check arrives (minus a 6% billing fee if you chose to use our billing service). If requested, the office staff will assist you with forms, but recovery of any insurance benefits is between you and your insurance company. In compliance with suggestions adopted by the

 American Society of Plastic Surgeons®, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no more than two weeks before surgery. Additional fees are also required for laboratory tests, surgical facility fees, and the anesthesiologist. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict exactly how long a procedure will take to complete. 

It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.

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