Breast Reconstruction in Boston


Named Among the Best Plastic Surgeons in Boston

Helena O. Taylor MD, PHD, FACS & Stephen R. Sullivan MD, MPH, FACS

Breast Reconstruction is performed after treatment for breast cancer.

With 1 in 8 women in the United States having a diagnosis of breast cancer, breast reconstruction is one of the most common operations performed by plastic surgeons. Although most women will have breast conservation therapy, some will require mastectomy (removal of the breast) or elect to have mastectomy because of a genetic susceptibility with high risk for breast cancer such as a BRCA gene mutation. In addition to removing the breast, some women will also have removal of the nipple and areola, while others may be a candidate for nipple sparing mastectomy, which means that the breast tissue is removed while the skin, nipple and areola remain.

Some women will elect to have breast reconstruction following mastectomy. Boston Mass plastic and reconstructive surgeons Dr. Taylor and Dr. Sullivan have published their experience with breast reconstruction and are able to work together as a team to provide reconstruction tailored to each woman's needs. The timing of reconstruction can be immediately after removing the cancer or delayed to allow a safe recovery from the first procedure. Dr. Taylor and Dr. Sullivan provide support and education until the timing for breast reconstruction is right for you.

Types of Breast Reconstruction

The type of breast reconstruction varies: direct-to-breast implant, tissue expander followed by breast implant in a second stage, or using of a woman's own tissue from elsewhere on her body. The type and timing of breast reconstruction are carefully discussed with each woman, so we can understand and support your wishes and needs.

When a woman's own tissue is used, common locations are the tummy tissue and back tissue. The tummy tissue can be known as a transverse rectus abdominis myocutaneous flap (TRAM flap). This operation is very similar to a tummy tuck, and involves moving skin, fat and and a small area of muscle from the abdomen to make a new breast.

A TRAM flap allows breast reconstruction as well as simultaneous tummy tuck. A related form of tummy tissue reconstruction is the deep inferior epigastric peforator flap (DIEP flap), which moves only skin and fat while preserving the abdominal muscles. Back tissue, known as a latissimus dorsi myocutaneous flap, moves skin, fat and muscle from the back to make a new breast and is usually combined with a breast implant.

Breast reconstruction performed in the past can also be revised using the methods discussed above as well as fat grafting to correct smaller contour deformities. Dr. Taylor and Dr. Sullivan will spend time with you to carefully select an approach for your breast reconstruction, with careful consideration of your overall health and recovery.

Delayed Breast Reconstruction

With Breast Implant

Breast Reconstruction Boston

Dr. Sullivan and Dr. Isik have conducted research and published information on breast reconstruction (Plastic and Reconstructive Surgery. 2008;122(1):1493-1498), including information on the timing of implant based breast reconstruction. This patient underwent delayed reconstruction with a tissue expander followed by a breast implant. Preoperatively (left) after mastectomy and radiation for breast cancer. Postoperatively (right) after tissue expansion and exchange for a permanent breast implant and before nipple and areola reconstruction.

With DIEP flap

Breast Reconstruction Boston

Dr. Sullivan and Dr. Isik have conducted research and published information on breast reconstruction (Plastic and Reconstructive Surgery. 2008;122(1):1493-1498), including information on the timing of using a woman's own tissue, known as autologous tissue breast reconstruction. This patient underwent delayed breast reconstruction with tissue from the abdomen known as a deep inferior epigastric artery perforator flap (DIEP flap). Preoperatively (left) after mastectomy and radiation for breast cancer. Postoperatively (right) after DIEP flap and nipple and areola reconstruction.

Breast reconstruction methods

Breast reconstruction methods include placement of a breast implant versus use of a woman's own tissue from elsewhere on her body, or a combination of both.

Breast implants can be saline (salt water) or silicone gel. Silicone gel has been found to be a safe and more natural feeling breast implant reconstruction.

Dr. Taylor and Dr. Sullivan work with many companies including Mentor, Allergan, and Sientra to optimize your breast implant options. Additional options for silicone gel include a smooth versus a textured implant and a round versus a shaped implant.

Smooth breast implants are the most common form used in breast reconstruction Boston plastic surgeons Dr. Taylor and Dr. Sullivan recommend them as textured implants have been found with increasing frequency to be associated with breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL. BIA-ALCL is not breast cancer, it is a type of non-Hodgkin’s lymphoma. To decrease your risk, smooth breast implants are reccomended and often a Keller funnel is used to decrease exposure to bacteria and risk for infection. If you have a past history of a textured breast implant and have symptoms such as capsular contracture, painful scar or a fluid collection, please consider meeting with Dr. Taylor and Dr. Sullivan to learn more about breast implant removal and exchange.

Immediate Breast Reconstruction

With DIEP flap

Breast Reconstruction Boston

Dr. Sullivan and Dr. Isik have conducted research and published information on breast reconstruction (Plastic and Reconstructive Surgery. 2008;122(1):1493-1498), including information on the timing of using a woman's own tissue, known as autologous tissue breast reconstruction. This patient underwent immediate breast reconstruction with tissue from the abdomen known as a deep inferior epigastric artery perforator flap (DIEP flap). Preoperatively (left) before mastectomy and radiation for breast cancer. The blue marks on the abdomen indicate the location of perforating blood vessels from the the deep inferior epigastric artery. Dr. Sullivan and colleagues have conducted research and published information on the size and location of these vessels as they relate to body mass index (Journal of Reconstructive Microsurgery. 2009;25(4):237-241). Postoperatively (right) after DIEP flap and nipple and areola reconstruction as well as radiation therapy.

With Breast Implant

Breast Reconstruction Boston

Dr. Sullivan and Dr. Isik have conducted research and published information on breast reconstruction (Plastic and Reconstructive Surgery. 2008;122(1):1493-1498), including information on the timing of implant based breast reconstruction. This patient underwent immediate left breast reconstruction with a tissue expander followed by a breast implant. Preoperatively (left) before mastectomy for breast cancer. Postoperatively (right) after immediate tissue expansion and exchange for a permanent breast implant and soon after nipple and areola reconstruction.

Recovery following Reconstruction

Following mastectomy for breast cancer or prophylactic mastectomy because of increased risk for breast cancer or BRCA gene mutation, you may be a candidate for immediate breast implant placement (silicone gel or saline) or you may have a tissue expander placed with the goal of creating room for a final breast implant placed at a later time.

Working closely with Dr. Taylor and Dr. Sullivan, as well as the breast team, you may consider immediate breast reconstruction at the time of the mastectomy, as shown in the above image published by Dr. Sullivan.

The preoperative photograph (above, left) demonstrates a woman before undergoing left mastectomy and immediate placement of a tissue expander followed by second stage breast implant reconstruction, shown 1 year postoperatively (above, right) at the time of nipple construction and areola tattooing. Some of our Boston breast reconstruction patients can avoid the need for a tissue expander and proceed straight to an immediate breast implant, often with simultaneous internal dermal sling. Nipple sparing mastectomy and immediate breast implant placement is also an increasingly common practice offered by Dr. Taylor and Dr. Sullivan.

BREAST SURGERY (Breast Reduction, Breast Lift or Mastopexy) AFTERCARE INSTRUCTIONS

Preoperatively, In the week before your operation:

  • Consider eating pineapple, it may help reduce bruising
  • Consider supplementing with Arnica montana, it may help reduce bruising
  • Complete household chores and prepare meals for the first few days of postoperative recovery
  • Follow preoperative instructions with eating, drinking, and medications. Please have nothing to eat or drink after midnight the night prior to surgery, except for a sip of water with your medications

Postoperatively,

  • You will need someone to take you home, and ideally stay with you for the first 24-48 hours, as you may feel drowsy. You may require help the first few times you get out of bed.
  • It is important to get out of bed and walk (with assistance) every few hours after your breast operation to decrease the chance of postoperative problems such as blood clots.
  • Practice 15-20 deep breaths every hour to keep your lungs open.

Please take your medications as directed by Dr. Taylor or Dr. Sullivan to manage discomfort or symptoms.

You are likely to be given:

  •  Acetaminophen (Tylenol) 1000 mg every 8 hours, space doses 4 hours after Ibuprofen so one or the other is taken every 4 hours
  • Ibuprofen (Motrin) 800 mg or Colecoxib (Celebrex) 200 mg every 8 hours, space doses 4 hours after Acetaminophen so one or the other is taken every 4 hours
  • Gabapentin 300 mg every 8 hours for 7 days. If you have dizziness, double vision, or significant sleep disturbances, consider stopping the Gabapentin.

You may also be given:

  • Vitamin C 500 mg daily for 50 days
  • Oxycodone 5 mg – 1-2 tablets every 6 hours as needed for pain, though many patients may not need it
  • Colace 100 mg twice daily to prevent constipation, it is important to have a bowel movement each day. Prune juice may also be helpful.
  • Zofran 8 mg every 8 hours if needed for nausea
  • Scopolamine patch may be placed on the neck on the day of surgery and can stay for 3 days to prevent nausea

Eat a light diet for 2-3 days and avoid spicy food. Some suggestions to ease abdominal discomfort or indigestion after surgery:

  • Drink water or warm liquids
  • Prune juice to prevent constipation

WOUND CARE

  • If you had breast reconstruction following breast cancer, you may or may not have drains. The drainage bulbs connected to the end of the drains should be compressed at all times to keep suction. It is normal for red fluid and blood clots to form in the drains. Please record time and amounts of drainage over a 24-hour period – we will provide a form. Usually the drains will be removed when the drainage is 30cc or less in a 24-hour period. All patients heal differently and according to many factors. On average, drains remain for one to two weeks.
  • You may shower or sponge bath the day after the operation with assistance and wash your skin as you normally would with soap and water. Avoid soaking the incision, although It will not hurt to get a splash water from the shower on the wounds. Gently pat dry after washing.
  • You may wear a camisole, postoperative bra provided at the hospital, or no bra after surgery. Dr. Taylor or Dr. Sullivan will advise you when you may wear an underwire bra - usually a minimum of 6 weeks after surgery.
  • Most wounds will be closed with absorbable sutures that are buried and skin glue. The skin glue forms a barrier to water. Please do not remove the glue, it will fall off on its own after a few weeks. Do not apply any lotions, potions, ointments, creams or solutions (e.g. no hydrogen peroxide or alcohol) as they can be harmful to the fragile healing tissue.
  • Do not smoke or expose yourself to smoke, smokers or nicotine as wound healing will be compromised.
  • Infection is very uncommon, but please call Dr. Taylor or Dr. Sullivan at any sign of infection which would be signaled by fever, increased pain, spreading redness or significant swelling.

ACTIVITY

  • For the first few days following breast surgery, avoid raising your blood pressure or heart rate as it can cause bleeding. We recommend gentle range of motion exercises with your arms 3 to 5 times per day starting the day of the operation.
  • Please do not drive until turning the steering wheel can be done safely and without pain (usually 5 to 7 days). Do not drive while taking pain medications such as oxycodone.
  • Do not lift anything heavier than 10-20 lbs, run, lift weights, or perform strenuous exercise for 7-10 days. Do not perform chest muscle exercises or strenuous bouncing exercises for 6 weeks.
  • Massage to the breast and areas of liposuction can help increase circulation and soften firm areas under the skin. Please wait at least 3 to 4 weeks after surgery to start massage to avoid increased swelling.

GENERAL OUTCOMES

  • Moderate swelling of your breasts is to be expected. Following breast reduction or breast lift, the breasts may initially appear quite high and perky, and will settle into a natural appearance over several weeks. Please be patient.
  • If you elected to have simultaneous liposuction, swelling and bruising is to be expected. Please be patient, the swelling and feeling of tightness will gradually subside over the following months. Bruising may last for a few weeks and will move down your body due to gravity.
  • It is not uncommon for wounds to develop along the incision under the breast. These typically appear 2 to 3 weeks after the operation at the junction of the vertical incision and inframammary fold. The wounds are often red with patches of yellow and white – this is not an infection, which is usually associated with fever and spreading redness. These wounds can be treated with soap and water wash and a gauze dressing; and they will heal on their own in a few days to weeks.
  • The incisions often appear lumpy and bumpy. This is normal and the incisions will flatten over a few weeks.
  • Following breast reduction or breast lift, the nipples can be inverted rather than projecting outward. This is normal and the nipples will usually project again within a few days to weeks.
  • The areola can appear asymmetric or irregularly shaped. This is normal and is due to the dissolving suture - similar to the way a draw string works on a garbage bag. Please be patient, the irregular shape and asymmetry will resolve over a few weeks.
  • Sensations like numbness, shooting pain, and burning are common during the healing process, may last several weeks, and gradually disappear. If the nipples are sensitive, it is best to desensitize them with gentle touch.
  • Scars take one full year to mature. You may notice that they become red, raised and firm for several weeks to months before becoming soft, flat and pale. Avoid Vitamin E as it can irritate the scar. Mederma has no proven benefit and is likely not worth the expense. All incisions will be sensitive to sunlight during the healing phase. Direct sun contact or tanning booths are to be avoided. Silicone cream or skin moisturizer with sunscreen and gentle massage may be helpful.
  • Please call our office (617-492-0620) if you have:
    o Continuous bleeding (a small amount bleeding from the incision is expected) o Significantly more swelling on one side when compared to the other
  • Worsening pain
  • Fever, spreading redness or irritation of the skin
  • Shortness of breath

It is important to be seen by Dr. Taylor or Dr. Sullivan after your operation. They will see you in follow-up appointments at regular intervals, typically 1 week, 2-4 weeks, 3 months, 6 months, and 1 year or as often as needed post-op. Call to schedule your appointments at Taylor & Sullivan Plastic Surgery office at (617) 492- 0620 between the hours of 8:30 – 5:00 or visit our webpage at www.massplasticsurgeons.com. We are always available for postoperative concerns or emergencies and can be reached through our paging service 24 hours per day at (617) 492-0620.

Download our Breast Lift and Breast Reduction Postoperative Instructions Here.

Call Today 617.492.0620

To schedule a private consultation with Dr. Taylor or Dr. Sullivan, please call the office or request an appointment using our form. We welcome your visit and your questions.

300 Mount Auburn St. Ste 304, Cambridge, MA 02138

Taylor & Sullivan Plastic Surgery Boston
American Society of Plastic Surgeons American Board of Plastic Surgery Fellow American College of Surgeons America Association of Plastic Surgeons Sigill Massachusetts

617.492.0620

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300 Mount Auburn St. Ste 304, Cambridge