Breast Reconstruction

Breast reconstruction is a procedure that rebuilds a patient’s breasts, most often after a mastectomy. Patients can choose a breast reconstruction immediately following a mastectomy or after time spent recovering.

An Introduction to Breast Reconstruction

The decision of whether to undergo breast reconstruction often comes during a difficult time in a woman’s life. Unfortunately, breast cancer is the most common form of cancer among women. One in eight women will face this burden in their lifetime.[1] Mastectomies are a very effective treatment for breast cancer, but they sometimes leave women yearning for their pre-cancer form. After a mastectomy, women can suffer from decreased self-esteem, lower quality of life scores, and may experience insecurity about body image. Breast reconstruction is a proven remedy to increase self-esteem and quality of life after a mastectomy.[2]

Breast reconstruction can also be performed as a corrective surgery under some circumstances such as complications with breast augmentation, after a lumpectomy, and other reasons. 

During this taxing time, having a compassionate and understanding plastic surgeon becomes an essential part of the process. A patient should emphatically trust their reconstruction surgeon. Dr. Korman won numerous awards and published papers in peer-reviewed scientific journals during his 20+ years of teaching plastic surgery at Stanford Medical School. Dozens of patients give Dr. Korman five star reviews for his dedication to every patient’s needs by providing exemplary service.

Dr. Korman maintains three offices in Northern California. Schedule a free consultation if you want to learn more about breast reconstructive surgery.

  • For Mountain View, call (650) 254-1200
  • For San Jose, call (408) 831-6229
  • For Carmel-by-the-Sea, call (831) 656-9331

What is Breast Reconstruction?

Some patients might be self-conscious about their appearance after a mastectomy. Other patients may worry about having two surgical procedures done in quick succession. Patients should feel empowered to choose when to undertake breast reconstruction. Breasts can be rebuilt immediately following a mastectomy, or even as part of a single procedure. Reconstruction of the breast can also be done at a later date if the patient decides on that course of action. Different circumstances and concerns may require different solutions.

There are two primary types of procedures used to reconstruct a patient’s breast after a mastectomy: implant reconstruction and flap reconstruction. Flap reconstruction may also be called autologous reconstruction. The style of breast reconstruction that best suits an individual patient will vary. A consultation with a plastic surgeon will help determine which technique will best help you achieve your aims.

  • Breast Reconstruction with Implants – First an expander is placed. Then, an implant of saline or silicone is placed to recreate the shape of the breast.
  • Flap Reconstruction – Flap or autologous reconstruction is when tissue from other parts of the body is used to restore the breast.

Before & After Photos

Breast Reconstruction Before & After Patient #2374
Breast Reconstruction Before & After Patient #2374

What are the Benefits of Breast Reconstruction

  • Increased self-esteem
  • Improved body image
  • Higher quality of life

BREAST-Q is a survey tool specifically developed to measure a patient’s overall satisfaction with breast reconstruction post-mastectomy. Since implementation, BREAST-Q surveys conducted by plastic surgeons and researchers consistently find statistically significant improvements in psychological well-being, sexual enjoyment, and satisfaction with the appearance of their breast post-reconstruction.[3][4]

Is Breast Reconstruction Right for Me?

Patients who undergo a mastectomy should ask themselves a few questions to decide whether breast reconstruction is the best choice for them. The first question for patients considering reconstructive breast surgery:how important is rebuilding the breast? Would they be content with a prosthetic breast they put on and take off? Or would that adversely affect their overall self-image? Are they comfortable with having another surgery immediately following the mastectomy? The best time to determine if, and when, to have breast reconstruction is after a conversation with both the mastectomy surgeon and a plastic surgeon board-certified from the American Board of Plastic Surgery.

Personal Consultation

When patients need breast reconstruction, credentials matter. As the Clinical Professor of Surgery specializing in Plastic and Reconstructive Surgery at Stanford Medical School, Dr. Korman possesses a stellar reputation. Patients fly into the Bay Area from out of town for Dr. Korman’s world-class service. The medical directory Castle Connolly and San Jose Magazine have both rated Dr. Korman as a “Top Doc”. The Consumer Research Awards bestowed the esteemed “Compassionate Doctor Award” on Dr. Korman in 2011. For more information, schedule a consultation with Dr. Korman at his main office by calling (650) 254-1200. 

The Breast Reconstruction Procedure

There are several aspects to understand about breast reconstruction. The first is whether the patient, in consultation with her surgeon and plastic surgeon, decides to have implant reconstruction or flap reconstruction. The second is when will the breast reconstruction procedure occur. These questions inform which incisions the mastectomy surgeon might use.

When breast reconstruction is not planned along with the mastectomy, horizontal incisions are popular. Horizontal incisions make it so the skin can be reattached in a clean line. 

When the breast reconstruction is planned along with the mastectomy, care is taken to preserve as much skin and, if possible, the nipple. This will depend on the patient’s circumstances. In general, the nipple can be saved during a mastectomy if:

  • The malignancy is not situated near the nipple
  • The position of the nipple doesn’t interfere with the incision 
  • The patient’s breasts are between A-cup and C-cup size

Planned breast reconstruction can inform the type of incisions used in mastectomies.

  • Horizontal incision – This is used for mastectomies where breast reconstruction is not planned.
  • Skin-sparing – An elliptical incision is made around the nipple and areola. This spares the most skin but removes the nipple.
  • Nipple-sparing – Several types of incisions spare as much of the skin and nipple-areolar complex as the circumstances allow. These incisions include inframammary incisions and radial incisions.

For breast reconstruction patients can select implant reconstruction or flap/autologous reconstruction. Implants consist of either saline or silicone. The FDA approves both saline and silicone implants for reconstructive purposes. Flap reconstruction, also called autologous reconstruction, uses fat tissues harvested from other parts of the body. Sometimes implants supplement autologous reconstruction.

A patient’s individual circumstances and desires inform which option to implement. Among patients that require additional radiation therapy, surgeons usually recommend autologous reconstruction.

Due to recent advances, new options in breast implants expand the range of choices for patients. Patients can now receive silicone implants as part of their reconstruction journey which offer a wide array of sizes and shapes. Breast restoration can now be more individualized and customized to a patient’s needs and wants.[5] Dr. Korman specializes in breast reconstruction that appears natural and is suited to each woman’s unique body type.

What to Expect After Breast Reconstructive Surgery

After the procedure, the new breasts are immediately bandaged. Patients may experience some swelling and bruising. Patients shouldn’t worry because swelling and bruises are normal for a few days following breast reconstruction. Make sure to follow the surgeon’s instructions on cleaning the area and bathing. Sometimes, the surgeon installs a tube to drain excess fluids, which aids the recovery process. Surgeons usually suggest taking 4-6 weeks off from strenuous physical activity and intense sexual encounters. Usually, patients can resume all normal activities after about 6-8 weeks. Follow the surgeon’s advice on when to return to wearing a bra. Some patients find it helpful to consult with other women who have gone through breast reconstruction. Find the support you need or lend your strength to others in your position.

What is the Cost of Breast Reconstruction in Mountain View, California?

California law requires that insurance cover procedures that restore and attain breast symmetry following a mastectomy.[6] If insurance doesn’t pay the full cost of restorative breast surgery, financing options can help manage the medical bills.

FAQ

When will discomfort subside after breast reconstruction?

Patients should expect to experience some discomfort and skin irritation for a few weeks up until 6 months after treatment. However, with mastectomies and breast reconstruction, every case is different. Some patients may never experience pain while others might experience complications for a longer period of time. Make sure to communicate any pain with the surgeon and clinicians.

Does breast reconstruction look natural?

Yes. A reconstructed breast might not precisely resemble pre-mastectomy breasts. However, Dr. Korman focuses on recreating natural-looking breasts. With Dr. Korman, patients have a partner for their breast reconstruction that understands the empowering feeling of natural looking breasts.

Is breast reconstruction considered an elective surgery?

While breast reconstruction is considered elective surgery, the Women’s Health and Cancer Rights Act of 1998 mandates that insurance cover breast reconstructive surgery.

Can breast reconstruction be done years after a mastectomy?

Yes, breast reconstruction can occur months or years after a mastectomy. However, breast reconstruction immediately after a mastectomy usually offers the best cosmetic results. 

References 

  1. Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., … Bray, F. (2014). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer, 136(5). doi: 10.1002/ijc.29210
  2. Somogyi RB, Ziolkowski N, Osman F, Ginty A, Brown M. Breast reconstruction: Updated overview for primary care physicians. College of Family Physicians of Canada. 2018;64(6):424‐432. PMID: 29898931
  3. Ng, Sally K., et al. Breast Reconstruction Post Mastectomy. Annals of Plastic Surgery, vol. 76, no. 6, 2016, pp. 640–644., doi:10.1097/sap.0000000000000242.
  4. Nelson, Jonas A., et al. The Functional Impact of Breast Reconstruction. Plastic and Reconstructive Surgery – Global Open, vol. 6, no. 3, 2018, doi:10.1097/gox.0000000000001640.
  5. Panchal, H., & Matros, E. (2017). Current Trends in Postmastectomy Breast Reconstruction. Plastic and reconstructive surgery, 140(5S Advances in Breast Reconstruction), 7S–13S. https://doi.org/10.1097/PRS.0000000000003941
  6. Bill Text. leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201120120SB255.