By Dr. Paul Pierce

 

Breast cancer is one of the most common cancers affecting women. Approximately 1 in 8 women will be diagnosed with breast cancer during their lifetime. With such high numbers of patients, options for treating breast cancer are constantly evolving. The most common approach, however, remains surgical removal. As a plastic surgeon, my job is to reconstruct the breast or breasts after cancer excision has been performed by the breast surgeon.

The Two Most Common Options for Breast Reconstruction

Breast reconstruction for post-mastectomy patients has evolved significantly since its origins in the 1800s. Today, the two most common approaches for breast reconstruction after mastectomy consist of implant-based and autologous options.

How Breast Implant Reconstruction is Performed

Implant-based breast reconstruction involves the placement of a permanent implant to provide a breast mound. Modern implants can be filled with silicone or saline. This process usually involves at least 2 operations along with 2 smaller office procedures to complete the reconstruction.

In order to perform implant-based breast reconstruction, a tissue expander is inserted into the breast pocket at the same time as the breast surgeon performs a mastectomy. This allows the tissue expander to be inflated in the office over the next few months until the skin is stretched to the appropriate size. This gradual expansion of the breast helps reduce discomfort while ensuring patient safety and satisfaction.

Once the pocket is of sufficient size, the tissue expander is removed, and a permanent implant is placed. Under certain circumstances, a permanent implant can be placed at the same time as the mastectomy. The benefits of this technique include a shorter operation, quicker recovery, and no additional incisions apart from the breast. This technique does, however, bring about the potential for certain drawbacks, including the need for a foreign device with the risk of implant infection, implant malposition, implant rupture, and capsular contracture.

Breast Reconstruction Using the Patient’s Own Natural Tissue

Another common form of breast reconstruction is the autologous technique. This reconstructive technique uses the patient’s own tissue to rebuild and shape the breast following cancer removal. The most common site for collecting tissue to be used for autologous reconstruction is the abdomen. The second most common site is the back.

The autologous technique is often used when patients either require radiation to the operative site, have experienced a failed implant reconstruction, or do not desire a foreign object in their body. This option also involves at least 2 operations along with 2 smaller office procedures to complete the process.

The initial operation is the same as implant-based breast reconstruction and involves the placement of a tissue expander into the breast pocket at the same time as the breast surgeon performs a mastectomy. Once the breast skin is stretched, a second operation is performed to move skin and subcutaneous tissue from the abdomen to the breast. This process involves identifying and protecting the vessels at the site of tissue collection and connecting them to vessels in the breast to keep the tissue alive.

Special training and dedication are required to perform this type of reconstruction, but the results can be phenomenal. Using a patient’s own tissue allows for a softer, more natural appearing breast without the need or risk of associated with implants. The drawback of this technique is the need for a longer second surgery and an additional surgical site required to provide adequate tissue for reconstruction.

Determining Your Best Option for Breast Reconstruction

Prior to choosing the right option for your breast reconstruction, it is important to speak with your surgeon to go over your desired outcome as well as any possible concerns you might have. Part of my role as a plastic surgeon is to instill confidence in my patients and help guide them through every step of their reconstruction.

 

Dr. Paul Pierce, MD, is a board-certified plastic surgeon who focuses on cosmetic and reconstructive surgery of the face, breast, and body.

Dr. Pierce understands that each patient has unique desires and goals when considering surgery. He makes it his mission to educate patients about their options and works with each patient to achieve the best possible results.

With a wealth of knowledge, passion for perfection, and a steady hand, Dr. Paul Pierce is driven to provide the highest quality of care for his patients. He is dedicated to staying current on the latest techniques and procedures available in the field of plastic surgery.

Dr. Paul Pierce was an award-winning plastic surgeon in Dallas, and he joined the Vanguard Plastic Surgery team in 2021. He is accepting new patients at the Vanguard Skin Specialists’ Northgate office in Colorado Springs and the Pueblo office.