Breast reconstruction is a rewarding procedure for women who have had a mastectomy. This surgery restores a natural appearance to the breast or breasts, so much so that most women can even wear a swimsuit after they have healed.
Minneapolis-based Dr. Tim Schaefer specializes in reconstructive surgeries and has experience with a number of state-of-the-art techniques for breast reconstruction. As a result, he can offer options to achieve your goals for outcome and recovery.
Your Initial Consultation
Breast reconstruction surgery is an extremely personal procedure, and Dr. Schaefer is sensitive to the fact that patients have endured strenuous circumstances.
Therefore, he will spend time with you to fully explain the process and answer all of your questions. During your consultation, he will perform a thorough medical analysis and devise a surgical plan based on your specific anatomy and goals. When appropriate, he will consult with your medical oncologist, surgical oncologist, and radiation oncologist.
Every aspect of your surgery will be customized depending on your specific needs, and Dr. Schaefer and his professional staff will make sure you are fully prepared for the procedure and know exactly what to expect.
Dr. Schaefer will also advise whether your reconstruction can be started immediately after the removal of the tumor. This is possible in most cases, but not all.
What to expect from Breast Reconstruction Surgery
Breast reconstruction surgery usually requires more than one procedure and may involve overnight stays at a hospital. Most of the early stages are performed with general anesthesia. Again, each reconstruction is unique to the patient, so Dr. Schaefer will explain your surgical plan and why he recommends it in your case. Many times, you will have choices regarding how your reconstruction is done, and Dr. Schaefer will point these out during your consultation.
Some breast reconstruction surgeries require breast implants, while other techniques do not use implants.
With all methods mentioned below, Dr. Schaefer may recommend a subsequent fat grafting procedure to further reshape the breasts. This involves liposuction to remove fat from the abdomen or thighs. The fat is then processed and injected into the reconstructed breast to fill indentations and misshapen areas. While this may mean a third surgery, Dr. Schaefer emphasizes to breast reconstruction patients that the safest process with the best aesthetics often requires treatment in stages.
Implant-Based Breast Reconstruction
The most common form of breast reconstruction, implant-based breast reconstruction, is typically a two-step process that begins with a temporary tissue expander placed under the pectoral muscle for four to six months. This expander stretches the skin and tissue so that there is enough coverage for a breast implant. In some cases, the implant may be placed over the pectoral muscle (prepectoral placement) rather than under the muscle (submuscular placement). Certain patients may be candidates for “direct-to-implant” reconstruction when the tissue expander stage is not done.
TRAM Flap Breast Reconstruction
TRAM (“transverse rectus abdominus myocutaneous”) flap reconstruction means that the breast tissue is created by taking skin, fat, and muscle from the abdomen. In the original approach which is infrequently done today, the tissue is tunneled from the abdomen to the chest underneath the skin. In this way, the tissue remains attached to its blood supply.
Dr. Schaefer usually performs the muscle-sparing free TRAM breast reconstruction. This means that he uses only a small portion of the abdominal muscle, which allows for a faster recovery and less of a risk of losing abdominal muscle strength. This is an advanced technique that requires microsurgery to reattach the blood supply to the abdominal tissue once it is moved to the chest. The breast is shaped out of the available tissue. The abdomen may need to be re-enforced with mesh, and the skin is closed with a scar that goes across the lower abdomen and around the belly-button. This has the side benefit of flattening the abdomen and has a similar appearance to a tummy-tuck scar.
DIEP and SIEA Flap Breast Reconstruction
The DIEP (Deep inferior epigastric perforator) flap and SIEA (Superficial inferior epigastric artery) flap breast reconstruction are advanced techniques. These techniques are similar to the muscle-sparing free TRAM flap breast reconstruction. Not every patient has the proper anatomy for these flaps, but if it is determined that an abdominally-based breast reconstruction is right for you, they will be considered. The microvascular anatomy that Dr. Schaefer finds at the time of surgery will determine exactly how your procedure is done with an effort to minimize damage to your abdominal muscle.
The DIEP flap involves harvesting the exact same blood vessels that are used in the muscle-sparing free TRAM flap, but Dr. Schaefer dissects through the muscle and takes only the blood vessels, and no muscle. This is possible in some, but not all patients, depending on their anatomy.
The SIEA flap involves harvesting vessels that run above the muscle and supply blood to the skin and fat. In this ideal situation, no incision in the muscle layer is needed and no muscle is harvested. Only approximately 10% of patients, however, have large enough vessels in this location to allow this procedure.
Once the appropriate flap is harvested, the tissue is moved to the chest wall, a breast is shaped, and the blood vessels are connected to blood vessels within the chest using a microscope, just like the muscle-sparing free TRAM flap.
The donor site is closed with an incision across the lower abdomen and around the belly-button, similar to a scar that would result from a tummy-tuck.
Latissimus Flap Breast Reconstruction
When tissue is used from the upper back to reconstruct the breast, it is called a latissimus flap breast reconstruction. The skin, fat, muscle, and blood vessels are tunneled through the axilla (armpit) to the chest.
Dr. Schaefer performs this technique with or without tissue expanders or implants, depending upon your needs, although an expander and/or implant are usually required with this method.
Oncoplastic Breast Reconstruction
Some patients with large breasts are candidates for this technique. After a lumpectomy by a surgical oncologist to remove the tumor, a modified breast reduction is performed on the side with cancer, and a standard breast reduction is performed on the opposite side to make the breasts smaller during the reconstruction. After healing, radiation may be necessary on the breast with the tumor.
Nipple Reconstruction and Tattoos
While Dr. Schaefer regularly performs tissue-based nipple reconstruction as part of a breast reconstruction, some patients opt for three-dimensional (3-D) tattooing of the nipple after breast reconstruction. We find that our patients are very pleased with the results of these tattoos, which look natural and real. Other patients opt for non-anatomic decorative tattoos by specialized tattoo artists.
Recovery from Breast Reconstruction
Using evidence-based methods, Dr. Schaefer and his highly professional medical team implement a process that leads to a faster recovery. You will typically require a hospital stay of at least one night, and drains will be placed under the breast skin to capture post-operative fluids. These are usually removed within one to two weeks. If the tissue has been removed from another part of the body for the breast reconstruction, drains will be placed in those areas as well.
Breast reconstruction recovery is highly individual. You can expect to be sore, swollen, and bruised after reconstruction, but this is common following any surgical procedure. We will provide you with pain medication to ease your discomfort, and you will have post-operative examinations so that Dr. Schaefer can monitor your progress.
The complete process of breast reconstruction can take 1-½ years, but you will see form develop after the first operation. Scarring will gradually improve over a period of months and will continue to evolve over years, looking less prominent with the passage of time.
Dr. Schaefer will recommend a time when you are cleared to return to work after your surgery. Physical activities should be limited for several weeks or months, however. Rest and sleep are important to the healing process, but it’s essential that you sleep on your back to avoid disturbing the healing tissue.
Can I Exercise After Breast Reconstruction Surgery?
Dr. Schaefer will monitor your healing and let you know when you are cleared to work out. Note that returning to workouts too early can cause serious setbacks, like muscle tears and internal bleeding. During the healing process, please check with our staff before engaging in any kind of strenuous physical activity. Typically, strenuous activity is restricted for 4 weeks. All patients are referred to physical therapy after breast reconstruction to ensure an optimal recovery.
Choosing a Breast Reconstruction Surgeon
Choosing the right surgeon for your breast reconstruction is of paramount importance. It is vital for your plastic surgeon to have the right qualifications and credentials, such as board certification and good standing with the various medical boards. The surgeon should also have extensive experience performing breast reconstructions.
You also want to be sure that your surgeon has professional, friendly, and caring support staff. These people will assist you while in the office and during your recovery, so it is essential to feel comfortable with the entire team.
Do your research to learn as much as possible about your surgeon. Then, arrive at your breast reconstruction consultation prepared with questions, concerns, and your ultimate goals written down.
Why Choose Dr. Schaefer as your Breast Reconstruction Surgeon
With his careful planning and problem-solving approach, Dr. Schaefer customizes his strategy so that your breast reconstruction is specifically designed for your body and goals. He has extensive reconstructive training with years of experience performing breast reconstructions.
Dr. Schaefer is known for his work in the Minneapolis community in helping women feel better and restore their self-confidence. He has been honored as a BEST DOCTOR and BEST DOCTOR FOR WOMEN by the Minnesota Monthly Magazine, as well as a TOP DOCTOR FOR PLASTIC SURGERY by the Minneapolis St. Paul Magazine.
Schedule Your Consultation Appointment Today
Dr. Schaefer is proud to perform a procedure that can dramatically improve a woman’s life after she has gone through cancer surgery. To learn more about breast reconstruction with Dr. Schaefer, please contact us today.
To schedule your consultation appointment at our Minneapolis office, please call 952-920-2600 or go to our contact page and fill out the necessary information to schedule your appointment. We look forward to seeing you soon.