Breast reconstruction surgery is for women who have had a mastectomy, are planning to undergo mastectomy for breast cancer, or who plan on having a prophylactic mastectomy because they have a strong genetic risk for developing breast cancer. Breast reconstruction is also an appropriate topic for patients that have had breast conservation treatment with lumpectomy and radiation, but have a contour deformity or asymmetry as a result of the treatment. In either case, breast reconstruction reestablishes the symmetry and form following removal of the entire breast (mastectomy) or lumpectomy for breast cancer.
Breast reconstruction can be done weeks or decades after your mastectomy and is best thought of as a process. Unlike the mastectomy for removing the breast cancer, breast reconstruction involves three to four stages, at least two of which are operations that are spread out over the course of 6 months to a year.
Studies have shown that the experience and operative volume of the surgeon is paramount in achieving the optimal results with the lowest complications. Dr. Frank Isik is one of the few plastic surgeons in the Pacific Northwest with the clinical volume and vast experience to offer all methods of breast reconstruction.
Stage I: Creation of a Breast Mound
In the first operation, a breast mound is created using one of the methods for breast reconstruction. The breast mound can be created either by a tissue expander/implant or transferring your own tissues, which are called flaps. Breast mound creation is required prior to building a nipple and then giving it color by tattooing. There are 3 different surgical methods available for breast mound creation and there are reasons to choose one method over another. Not all women are good candidates for every method and Dr. Isik will make recommendations that are tailored to you based on your anatomy, medical history and whether you received radiation to your chest. The goal is to make your breast reconstruction safe, durable and an aesthetically pleasing life-long result.
To learn more about the different breast reconstruction methods available, download our breast reconstruction brochure or please follow the links below.
Stage II: Symmetry
Patients who had unilateral (one-sided) breast reconstruction are offered surgery on the opposite, unaffected breast to achieve symmetry and equalization. Surgical procedures on the opposite breast may include a reduction mammaplasty (reduction of the size of the breast), mastopexy (breast lift) or augmentation mammaplasty (enlargement of the breast), or a combination of these procedures. This step is optional but often enhances the final form and symmetry. This step is done as outpatient surgery meaning that you will leave the office and go home that day. This stage is done usually two months after Stage I. This stage is omitted for patients that have had bilateral (both-sides) mastectomy and bilateral breast reconstruction.
Stage III: Nipple Reconstruction and Tattooing
A nipple is reconstructed when the breast mound has “settled” and the other side has achieved optimal symmetry and form, usually a few months after the first stage. The preferred method of nipple reconstruction is to use the tissues already on the breast mound. No additional grafts or tissue is usually required elsewhere from your body. This is done in the office setting as a minor procedure under local anesthetic.
The reconstructed nipple is without color. The final step of the breast reconstruction process is to tattoo a color around the reconstructed nipple that matches your other nipple and this is done in the clinic a month or two after the nipple reconstruction. This completes the breast reconstructive process. The entire breast reconstruction process can take 6 months to a year to complete. The benefit is the final result, which is a natural and durable breast reconstruction that reestablishes symmetry and form without the need for wearing external breast prosthesis.
Timing Breast Reconstruction: Immediate vs. Delayed
As for the timing of breast reconstruction following mastectomy (removal of the breast involved with breast cancer), it is advisable to delay breast reconstruction until the breast cancer issues are completely known and resolved. Some types of breast cancer require additional treatment besides mastectomy, such as radiation treatment and chemotherapy; treatments that may complicate breast reconstruction and increase your risk of complications following breast reconstruction. You will not know whether you will need additional treatment until the pathologist has examined the breast tissue, which will not be available for a week after your mastectomy. This is the rationale for waiting several weeks after your mastectomy prior to proceeding with breast reconstruction.
Thus, a short delay in breast reconstruction is in your best interest: to have the best looking result with the least likelihood of developing a surgical complication and a poor looking result. Immediate reconstruction at the time of mastectomy has higher complication rates which often leads to poor aesthetic results in the long run. This is a well documented fact from studies done in other institutions as well as from a study done by Dr. Isik; delayed breast reconstruction looks and works better.
Alderman AK, Wilkins EG, Kim HM, Lowery JC. Plast Reconstr Surg. 2002 Jun;109(7):2265-74.
Sullivan SR, Fletcher DRD, Isom CD, Isik FF. True Incidence of All Complications Following Immediate & Delayed Breast Reconstruction. Plast Reconstr Surg 122(1): 19-28.