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Breast Reconstruction


Breast Reconstruction

Breast cancer is unfortunately a diagnosis that more and more women are forced to face.  This can be a scary and emotionally draining time for a woman and the people in her life.  Although lifesaving, the surgery to remove the cancer can sometimes be disfiguring.  The perception of femininity is often times tied to a feminine form, and breast cancer survivors can be left with altered senses of femininity, sexuality, and sensuality.  Additionally, the asymmetry which accompanies breast cancer surgery can be challenging when it comes to wearing bras, fitting in clothing, and being physically active.

As a result, Dr. Waltzman believes it is imperative that all women undergoing breast cancer surgery be educated about their options regarding breast reconstruction.  Dr. Waltzman works with a team of highly trained Surgical Oncologists and Breast Surgeons in Long Beach, CA.  Together, they formulate an individualized plan for each patient in order to optimize oncologic safety while providing the best aesthetic results.

Is breast reconstruction right for me?

Having breast reconstruction is a personal decision.  Every woman is different, and everyone has different reasons for the decisions they make surrounding breast reconstruction.  There are no “correct” answers.

In general terms, you are a good candidate for breast reconstruction if:

  • You are healthy enough to undergo general anesthesia and live a moderately active lifestyle that will enable you to recover from the surgeries required to perform breast reconstruction.
  • You are emotionally prepared for the fact that sometimes in surgery there can be setbacks. While everything goes right the majority of the time, there are always risks to surgery.  It is important you have a support structure that will allow you to handle these potential setbacks.
  • You have realistic expectations and goals for your breast reconstruction.
  • You understand that breast reconstruction is a process, and not typically complete in one procedure.

What to expect during your consultation

Dr. Waltzman will take a detailed medical history and perform a physical exam that will focus on specific measurements of your chest and breasts.  While it is not required, it is a good idea to bring a friend or family member with you on the day of your initial consultation.   This person can take notes for you and write down potential questions.  Dr. Waltzman will discuss your specific goals for reconstruction and present the available options.  The typical initial consultation is about 60-90 minutes.  We know that patients have a lot of questions and so we make sure that we have plenty of time to make sure we can address all of them.  Additional consultations are common, which serve as additional opportunities to ask questions or go over the reconstructive plan.

Immediate vs. delayed reconstruction

Immediate reconstruction means that the reconstruction is performed on the same day as the mastectomy.  Delayed reconstruction means that the reconstruction is performed at some point in the future.  A delayed reconstruction can take place several weeks to several years after the initial mastectomy.  There are a variety of reasons why your surgeon might decide that a delayed reconstruction is a better option.  This is discussed on a case by case basis.  Delayed reconstruction can also be performed for a patient who did not have access to reconstruction at the time of mastectomy.

Implant vs. autologous tissue reconstruction

The majority of the breast reconstructions performed in the United States are with a tissue expander and implant.  At the time of mastectomy a tissue expander is placed in the chest.  Over the coming weeks the expander is slowly filled with fluid that will gradually stretch the skin and provide a shape to the reconstructed breast.  Filling the expander is a simple process that is performed on a weekly basis in Dr. Waltzman’s office.  After reaching the desired volume, a second surgery is performed where the expander is removed and a much softer permanent implant is placed.  The same scars are used from the first operation.

The other main category of breast reconstruction is to use the patient’s own tissue (autologous) to reconstruct the breast.  The most common donor sites are the abdomen and the back.  This type of reconstruction by definition requires placing an incision on another part of the body with a resulting scar.  This type of reconstruction has the advantage of natural skin and fat being used to reconstruct the breast, providing a very natural feel. The surgery time is often longer when compared to an implant based reconstruction.

Not every women is a candidate for implant based and autologous reconstruction. Depending on a variety of factors, including your body type and the type of therapies needed to treat your cancer, you might not be a suitable candidate for all types of reconstruction.

Stages of breast reconstruction.

Breast reconstruction should be thought of as a process.  As a result, it is important that you find a surgeon that is a good fit for you.  You will be seeing this surgeon for multiple office visits and likely several surgeries.

Occasionally complete breast reconstruction can be accomplished in one stage at the time of mastectomy. However, the norm after a total mastectomy is for several “stages” of reconstruction.  Some of the typical stages involve: tissue expander placement, removal of the expander and placement of an implant, nipple reconstruction, and possible revisions in the future.

Dr. Waltzman works with most major insurance carriers in the area.  Contact our office to schedule a consultation if you, or someone you know, are considering breast reconstruction surgery in the Long Beach, CA area.