Breast Reconstruction

Direct-To-Implant Breast Reconstruction

Immediate reconstruction with breast implants is generally an outpatient procedure. Once the mastectomy is performed, a pocket is developed by elevating the pectoralis muscle. Alloderm, which is an acellular human dermis is prepared and placed similar to a hammock to help support the implant and create a well-defined pocket. The implant is then prepared and placed into the pectoralis muscle-Alloderm pocket and the skin is then closed in layers.

Although some patients are eligible to receive their breast reconstruction surgery directly following their mastectomy, the majority of patients will require the two-stage reconstruction process. The two-stage reconstruction procedure involves placing a tissue expander beneath the pectoral muscle.

The implant-based reconstruction procedure is similar to a breast augmentation. Dr. Esmailian uses silicone or saline implants to replace the breast tissue that was excised during the mastectomy. He starts with an incision, followed by creating a pocket beneath the pectoral muscle in the chest. Once this pocket is made, he can insert the agreed-upon implant that will be used. While this can sometimes be done directly following a mastectomy, most patients require Dr. Esmailian to use a tissue expander before the implant may be inserted.

Breast Reconstruction Surgery With Tissue Expander

After a mastectomy, the remaining tissue is often inadequate to hold a breast implant. When this occurs, Dr. Esmailian will use a tissue expander to gradually create a pocket big enough for an implant. The balloon-like expander is placed under the pectoral muscle. Over the next 2-3 months, Dr. Esmailian will periodically inject a saline solution into the expander to gradually make it larger. This allows the skin to stretch over time with minimal discomfort. Once a sufficient pocket has been created, a second surgery removes the tissue expander. Once this is done, a permanent saline or silicone implant is inserted into the pocket made by the expander, and the procedure is carried out just like a breast augmentation. Breast reconstruction not only requires precision technique and expert surgical knowledge, but also sensitivity and care that cannot be compared to any other procedure. To get a glimpse of the different implant options available for your breast reconstruction surgery view our types of breast implants page. Dr. Esmailian is a caring expert who will ensure the process is comfortable at every step.

If a patient needs radiation therapy, Dr. Esmailian waits until these treatments are complete before placing the breast implants in a breast reconstruction procedure. Once the radiation therapy is complete, a waiting period of 6 months is required before the implant surgery can be performed. If radiation therapy is not needed, then once the expansion has been completed, there is a 3 month waiting period before the implant surgery is performed. The second stage of reconstruction is performed as an outpatient surgery.

Autologous Flap Reconstruction Procedures

Autologous flap reconstruction procedures involve using the patient's own tissue to create a new breast mound, offering a natural look and feel compared to implants. In these procedures, tissue from areas such as the lower abdomen is harvested along with its blood vessels to ensure viability. Various types of flaps are used, including the TRAM flap (transverse rectus abdominis myocutaneous flap) and perforator flaps like the DIEP flap (deep inferior epigastric perforator flap). A free flap is detached from the original location and then reattached at the chest, requiring meticulous microsurgery to connect the blood vessels. Contouring the breast mound to achieve the desired shape and adding an areola are essential final steps in this complex reconstruction process.

Nipple Reconstruction

Nipple reconstruction is a surgical procedure to recreate the nipple and areola on a reconstructed breast, typically performed several months after the initial breast reconstruction. This process can involve using local tissue flaps to form the nipple, followed by tattooing to achieve the natural color and appearance of the areola. Alternatively, medical tattooing alone can be used for a less invasive approach. The goal is to achieve a realistic look, enhancing the aesthetic outcome and helping patients feel more complete and confident in their post-reconstruction appearance.