Rafi Bidros, MD, FACS

920 Frostwood Drive Suite 690, Houston, TX 77024

MyBodyMD
Rafi Bidros, MD, FACS

920 Frostwood Drive Suite 690
Houston, TX 77024

Breast Reconstruction - Post-Mastectomy Surgery - Reconstructive Mammaplasty - Houston, TX*

31 Procedures ( View All )

Overview

Over the past several years, significant advances have been made in the treatment of breast cancer. Thankfully, more and more patients are surviving this terrible disease, but are left with wounds that serve as painful reminders.

"Everyone has the right to be made whole again and at the least, learn about their options for breast reconstruction"   For those newly diagnosed with breast cancer, many have the option of immediate reconstruction and should consult with board-certified plastic surgeon.   Dr. Rafi Bidros is considered by many as one of the top Breast Reconstruction surgeons in Houston.   

Dr. Bidros has trained with some of the pioneers of Breast reconstruction and the DIEP flap.  He was one of the first plastic surgeons in Houston to perform the stacked DIEP flap.

Regardless of having had cancer recently or years ago, a lumpectomy or mastectomy, radiation or without, you have options. Dr. Bidros offers many different options for breast reconstruction to help every patient get their best results. The techniques used at My Body MD Plastic Surgery include DIEP flap reconstruction, Hybrid Reconstruction, Total Envelope Fat Grafting, Anatamic Implants, Oncoplastic Reconstruction, Nipple Reconstruction, 3D Areola Reconstruction, and the lymphatic bypass  and VLNT for reduction of Lymphedema. 

Breast reconstruction surgery may be a good option for you if you have realistic goals for restoring your breast/body image. Breast reconstruction typically involves several procedures performed in stages, and can either begin at the time of mastectomy or be delayed until a later date.

Surgical Technique

Types of Mastectomy

The particular form of mastectomy is a major factor in determining the type and aesthetic result of the reconstructed breast. Therefore, the design of the mastectomy needs to be carefully tailored to the individual patient and the type of breast reconstruction the patient will have. The types of mastectomy include:

  • Traditional
  • Skin-sparing
  • Nipple/areola-sparing
  • Breast lift/reduction pattern

Lumpectomy & Reconstruction

Patients who choose breast conserving surgery and undergo radiation therapy often have noticeable deformities after the swelling subsides. The most common concerns are indentation of the breast, breast asymmetry, loss of firmness, and changes in skin pigmentation. Correction of such deformities is possible using different reconstruction techniques. Patients should consult with a plastic surgeon prior to lumpectomy to discuss their reconstruction options.

Types of Breast Reconstruction

While plastic surgeons continue to develop many new and advanced reconstruction techniques – making these procedures more popular than ever – nearly 70% of women eligible for breast reconstruction are not told about all of their options. One of the first decisions a patient must make with their plastic surgeon is what type of breast reconstruction they will undergo. Reconstruction is performed on either an immediate or delayed basis and generally falls into two categories, implant reconstruction or reconstruction using a patient’s own tissue, which are often referred to as flap procedures. Factors to consider when choosing the right reconstructive option are type of mastectomy, cancer treatments, and patient’s body type.

  • Immediate Reconstruction: This type of reconstruction begins at the time of the mastectomy and has become the standard of care for most patients.
    • Advantages: Immediate post-mastectomy reconstruction offers the psychological and aesthetic advantage of waking from the mastectomy procedure with a lesser deformity and reconstruction well underway.
    • Disadvantages: Many women find the primary drawback of immediate reconstruction to be the longer surgery and recovery times. Also, subsequent radiation treatment can compromise the reconstructed tissue.
  • Delayed Reconstruction: In some patients, there may be signs of advanced disease, or radiation may be required as part of the treatment plan before any surgery is performed. If this is the case, a patient may want to delay reconstruction until after all treatments have been completed.
    • Advantages: Many women feel that delaying reconstruction gives them time to focus on treatments and research the type of reconstruction that best suits their needs.
    • Disadvantages: Some patients find that being without a breast for an extended or unknown period of time can be emotionally difficult.
  • Hybrid Breast Reconstruction - Use of both autologous reconstruction and breast implant with fat grafting.
  • Lymphatic Bypass Procedure - reconnect lymphatic channels to decrease lymphadema.
  • Breast Lift after Mastectomy Reconstruction, Nipple Sparing Mastectomy Reconstruction.
  • DIEP flap surgery - A.K.A. tummy tuck flap.  It involves the use of tissue from other areas of the lower abdomen while giving the patient a tummy tuck.
  • Perforator Flaps - Use of other excess skin and fat from other parts of the  body (example: excess skin from Tummy, inner thighs, buttock and back)
  • Lumpectomy Reconstruction aka "Partial Breast Reconstruction"  is designed for patients with a larger breast to reconstruct the lumpectomy defect while reducing or lifting the breast for a better shape.

Types of Reconstruction

  • Post-Mastectomy Expander/Implant: During this staged approach, a tissue expander (temporary device) is placed first to create a soft pocket that will eventually contain the permanent silicone or saline implant. At the time of expander placement, some surgeons may use an acellular dermal matrix to assist with reconstruction. Expansion will be started a few weeks post-op, after the patient has healed, as an in-office procedure. Once expansion is complete, the expander will be exchanged for the permanent implant during an outpatient procedure.
    • Hospital Stay (Mastectomy/Expander): 1 day; Recovery Time (Mastectomy/Expander): several weeks
    • Hospital Stay (Implant Exchange): outpatient; Recovery Time (Implant Exchange): 2-4 weeks
  • Direct-to-Implant: Post-mastectomy reconstruction with a direct-to-implant or “one-step” approach allows for a single stage reconstruction of the breast mound in select patients. The use of acellular dermal matrix during reconstruction has facilitated this technique. This approach allows for a permanent implant to be placed immediately following mastectomy, foregoing the need for a tissue expander. Although an expander may be avoided, some patients may still require a secondary procedure.
    • Hospital Stay: 1-2 days
      Recovery Time: several weeks
    • You are an ideal candidate for either of these procedures if you:
      • Have no available flap options.
      • Do not desire a flap operation.
      • Do not have compromised tissue at the mastectomy site.
      • Have no history of radiation to the breast or chest wall.
      • Are having prophylactic mastectomies.
      • Want bilateral reconstruction.
      • Are having immediate reconstruction after nipple-areola-sparing mastectomy.
      • Desire an operation on the opposite breast to help improve symmetry.
  • Options for Breast Implants
    • A saline breast implant is a sac (implant shell) made of silicone elastomer (rubber), which is surgically implanted under your chest tissues and/or muscle, and then filled with saline, a saltwater solution, through a valve. The amount of saline injected will affect the shape, firmness, and feel of the breast. Unlike saline breast implants, today’s silicone gel breast implants are pre-filled.
    • No-Touch Technique - Use of the Keller Funnel during silicone breast augmentation to decrease risk of infection, trauma to the breasts and smaller incision, which reduces the risk of capsular contracture. This will decrease downtime.
    • Natural Breast Augmentation - fat transfer using patients own fat to augment the breasts;

Types of Flap Reconstruction

 

  • Abdominal Free Flap: With the advances in microsurgery over the last decade, there are several new procedures available including deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric artery (SEIA) flap, and TRAM free flap. These microsurgical procedures can provide women with a very natural breast reconstruction when using abdominal tissue. Because these procedures do not use the actual abdominal muscle or only a portion of the abdominal muscle, they may allow for results with fewer donor site complications. Ultimately, the final choice of flap depends on the patient’s anatomy. These are lengthier procedures with potential for other complications. As such, these procedures should only be performed by plastic surgeons who perform microsurgery regularly and in institutions with experience in monitoring these flaps.
    • Hospital Stay: 3-5 days
      Recovery Time: several weeks to several months
    • You are an ideal candidate if you:
      • Desire reconstruction using your own tissue and want to minimize muscle loss in the abdomen.
      • Have had prior abdominal wall surgery that cut the abdominal wall muscle in the upper abdomen and desire using your own tissue.
      • Do not want or are not a candidate for implant reconstruction.
      • Have enough lower abdominal wall tissue to create one or both breasts.
      • Have previously had chest wall radiation.
      • Have had failed implant reconstruction.
      • Are having immediate reconstruction at the time of skin-sparing mastectomy.
      • Are having delayed reconstruction following prior mastectomy.
  •   
  • LD Flap: The latissimus dorsi flap is most commonly combined with a tissue expander or implant to give the surgeon an additional 17 options and more control over the aesthetic appearance of the reconstructed breast. At the time of breast reconstruction, the muscle flap, with or without attached skin, is elevated off of the back and brought around to the front of the chest wall. This flap provides a source of soft tissue that can help create a more natural-looking breast shape compared to an implant alone. Depending on the patient, the scar from the LD flap donor site on the back can be placed diagonally or horizontally. This scar can often be concealed under a bra strap.
    • Hospital Stay: 1-3 days
      Recovery Time: several weeks
    • You are an ideal candidate if you:
      • Are thin with small breast volume.
      • Have excess back tissue.
      • Have had previous radiation and are having an implant reconstruction.
      • Are not a candidate for other autogenous procedures involving your own tissue.
      • Are having a partial breast reconstruction to correct a lumpectomy defect.
      • Have thin skin that requires extra coverage for an implant.
      • Desire a more natural appearance than that of an implant alone.
      • Are having immediate or delayed reconstruction.
  • GAP Flap: Another flap choice is the gluteal artery perforator (GAP) free flap using skin and fat from the buttocks. This flap can be harvested from one buttock, with a well-hidden scar, or from both buttocks for bilateral breast reconstruction. A significant disadvantage of this type of reconstruction is that it is technically more difficult to perform. Also, the tissue from the buttock is somewhat harder to shape into a breast.
    • Hospital Stay: 3-5 days
      Recovery Time: several weeks
    • You are an ideal candidate if you:
      • Desire reconstruction using own tissue.
      • Do not have sufficient abdominal tissue to create a breast mound.
      • Have a slender body shape.
      • Have had previous surgery of the abdomen.
      • Have had failure of a previous abdominal flap.
      • Have had failure of a previous implant.
  • Inner Thigh Free Flap: This procedure uses skin, fat, and muscle from the inner portion of the upper thigh to reconstruct the breast. The scar can be made sideways just under the groin crease (known as the transverse upper gracilis or TUG flap) or longitudinally along the inner thigh. Unlike loss of other muscles (like the rectus abdominus), loss of the gracilis muscle does not result in any noticeable functional impairment. The tissue is dissected from the inner thigh and transplanted to the chest where it is reattached microsurgically. The resulting thigh scar is generally well hidden.
    • Hospital Stay: 3-5 days
      Recovery Time: several weeks
    • You are an ideal candidate if you:
      • Have small to medium sized breasts.
      • Want to avoid an abdominal scar.
      • Do not have enough abdominal tissue for a TRAM flap or an abdominal free flap breast reconstruction.
      • Have had previous abdominoplasty (tummy tuck surgery).
      • Have had multiple previous abdominal surgeries.
  • No-Touch Technique - Use of the Keller Funnel during silicone breast augmentation to decrease risk of infection, trauma to the breasts and smaller incision, which reduces the risk of capsular contracture.. This will decrease downtime.
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Breast Reconstruction FAQs

Your Medical Team?

If you are diagnosed with breast cancer, your treatment plan should include a full team of medical professionals to provide optimum care. This team should include:

  • Primary Care Physician/Gynecologist
  • General Surgeon/Breast Surgeon
  • Plastic Surgeon
  • Oncologist
  • Radiologist/Radiation Oncologist
  • Breast Care Navigator

If all of these specialists are not involved in your care, find out why. Plastic surgeons are trained specifically in reconstructing tissue and are a vital part of the breast reconstruction team. 

Initial Consultation?

During your consultation, Dr. Bidros will:

  • Evaluate your general health status and any pre-existing health conditions or risk factors.
  • Examine your breasts and take measurements of their size and shape, skin quality, and placement of nipples and areolae.
  • Take photographs for your medical record.
  • Discuss your options and recommend a course of treatment.
  • Discuss likely outcomes of breast reconstruction and any risks or potential complications.

Patients are encouraged to ask Dr. Bidros questions, including:

  • Am I a good candidate for this procedure?
  • What surgical technique is recommended for me?
  • What are the risks and complications?
  • Where and how will you perform my procedure?
  • How long of a recovery period can I expect, and what kind of help will I need during my recovery?
  • What will be expected of me to get the best results?
  • How are complications handled?
  • What are my options if I am dissatisfied with the outcome?
  • Do you have before and after photos I can look at? What results are reasonable for me?

Genetic Testing?

Genetic mutations known as BRCA1 and BRCA2 harbor an increased risk for developing breast and ovarian cancer. For people that carry a BRCA gene mutation, the increased lifetime risk for developing breast cancer may be as high as 85%. A simple blood test is used to determine whether or not a patient is a carrier.

Risk factors:

  • Having another family member that has tested positive for a BRCA gene mutation
  • Having had early onset breast cancer (diagnosed before age 45)
  • A family history of early onset breast cancer
  • A family history of ovarian cancer
  • Being of Eastern European or Ashkenazi Jewish heritage

Should a patient carry one of the BRCA gene mutations, bilateral (both sides) prophylactic (preventative) mastectomies may be recommended. Patients who do not have a cancer diagnosis but are carriers can achieve a greater than 90% reduction in breast cancer risk by having prophylactic mastectomies. Patients choosing not to have preventative surgery may be screened through MRI, ultrasound, and mammography every 3-6 months.

Secondary Procedures?

Breast reconstruction is inherently staged. Patients almost always require more than one surgery to obtain the optimal outcome – even in those cases where reconstruction is performed immediately following mastectomy.

  • Surgery on the Opposite Breast: Achieving symmetry with the newly reconstructed breast may be done through a breast reduction, breast lift, or breast enlargement with an implant.
  • Implant Reconstruction Revisions: Common revisions to implant reconstruction include surgery to address contour abnormalities, rippling, or a buildup of scar tissue around the implant for those patients who have undergone radiation.
  • Flap Revisions: Flap reconstruction procedures frequently require a second surgery to achieve the final breast contour and create the nipple areola.
  • Nipple Areola Reconstruction: Creating the nipple areola is the final surgical component to breast reconstruction, involving the formation of a nipple mound.
  • Nipple Areola Tattooing: The finishing touch to breast reconstruction is having your nipple areola tattooed, which is a simple, fast procedure that can take as little as 15 minutes and is normally done in your plastic surgeon’s office.

*Individual results are not guaranteed and may vary from person to person. Images may contain models.

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