Mastectomies are life-saving surgeries designed to remove breast cancer. While effective, these surgeries often leave women feeling incomplete. Houston plastic surgeon Dr. Leo Lapuerta is a breast reconstruction specialist who works with cancer patients in the greater Houston, Pearland, and Katy, Texas, areas to help them regain their self-confidence following a mastectomy.
His goal is to surgically rebuild the breasts to restore their original appearance by creating a natural shape and contour, while at the same time ensuring they are symmetrical. Dr. Lapuerta will work with the cancer surgeon toward a mutual goal to achieve the best surgical outcome.
When a breast cancer patient undergoes a mastectomy, a surgeon will remove the woman’s entire breast tissue to eradicate cancer or prevent its further spread. This can involve removal of one or both breasts, depending on the treatment plan.
Mastectomy surgeries can be an effective treatment for patients with breast cancer as well as a preventative treatment for those at-risk of developing it. A concern that many patients face with this surgery, however, is the end-result from removing breast tissue — a flat chest without the appearance of breasts.
Breast reconstruction surgery after a mastectomy is a procedure that involves rebuilding and reshaping the breasts. Surgeons can provide a patient with the option to reconstruct their breasts with implants or with tissue from other parts of her body.
To understand your options and determine if breast reconstruction surgery after a mastectomy is right for you, schedule a consultation with Dr. Lapuerta.
There are several steps and considerations patients should plan for when exploring breast reconstruction surgery.
To start, patients should come to their first consultation regarding breast reconstruction after cancer prepared to discuss where they are in the treatment process and which cancer surgeon provided treatment. Our office will require patients to provide any necessary pathology reports.
Additionally, patients should consider that the reconstruction process may take place in multiple steps if the breast tissue needs to be stretched to make room for implants. This discovery phase will help guide the reconstruction process so patients end up with a new breast that is the size, shape, and look they want.
Dr. Lapuerta tailors the reconstruction technique according to each patient’s physical health, aesthetic goals, and personal preferences. His ultimate goal is to ensure the patient is healthy and happy with their final breast results. Many factors play into the approach that he takes with each breast reconstruction surgery.
There are two primary categories of breast reconstruction techniques:
Procedures that involve using a breast implant and procedures that are autologous, which use the patient’s own body’s tissue to reconstruct and recreate the breast.
Breast reconstruction using silicone or saline implants is a common approach that generally starts with the use of a tissue expander to help form a suitable pocket for an implant. The surgeon may insert an expander after the mastectomy procedure or during the same operative session. Over the course of several months, the expander will slowly be enlarged using a sterile solution injected through a port residing under the skin. Then, during the scheduled reconstruction surgery, the surgeon will remove the expanders and replace them with silicone or saline implants.
If there is limited tissue inside the breast, or limited skin on the outside, the surgeon may recommend using tissue from another part of the patient’s body such as the buttocks, thigh, or abdomen to supplement. This is an autologous approach to breast reconstruction. The TRAM flap (Transverse Rectus Abdominus Myocutaneous), the DIEP flap, and SIEA flap techniques involve taking skin and fat from the abdomen and relocating it to the breast. The latissimus dorsi flap is another common method using tissue from the patient’s back.
Additionally, nipple and areola restoration techniques are often required as part of a breast reconstruction process if the surgeon performing the mastectomy cannot save the nipple and areola. The loss of one’s nipple and areola can be as unnerving as the removal of the breast itself. However, reconstruction techniques have advanced greatly, allowing plastic surgeons the opportunity to recreate these areas of the breast to give a natural, aesthetically appealing appearance. In a separate procedure, the surgeon creates the nipple using existing breast skin or from the abdominal or latissimus flap. Using a tattoo technique, the surgeon recreates the areola with a skin graft taken from the thigh, abdomen, or back.
Before undergoing the actual procedure, the patient will first meet with Dr. Lapuerta to discuss breast reconstruction surgery options. Once they have decided on a treatment plan, the patient attends a pre-operative appointment to further discuss expectations and preparations, before scheduling the surgery.
On the day of the procedure, Dr. Lapuerta will perform the breast reconstruction surgery under general anesthesia at an accredited surgical facility. Preparation for the procedure can take roughly two hours, while the procedure itself may take up to six hours, depending on which technique the surgeon uses.
After surgery, some patients may be required to stay in the hospital to be monitored for complications. Patients who have had reconstruction using a flap technique will usually be required to stay in the hospital for two to five days.
Once Dr. Lapuerta clears the patient to go home, he will provide follow-up instructions and require the patient to attend several post-op appointments. During these appointments, he will assess the patient’s healing, update the treatment plan if necessary, and address any questions and concerns. Patients are sometimes recommended to wear a support bra that encourages healing and reduces swelling.
The recovery process can be somewhat lengthy, but many view it as the final step in their cancer journey and, thus, very rewarding.
It is important for patients to have realistic expectations of their “after.” While the surgeon will do his best to reconstruct and reshape the patient’s breasts, they may not look or feel exactly how they once did in their natural state. Most women are thankful to have had the opportunity to restore their breasts and are satisfied with their results.
Recovery itself will include immediate swelling, bruising, and soreness following surgery, It can take at least two months until the patient can comfortably return to normal activities. They may also experience limited mobility and restricted movements until they fully heal. The surgeon will likely prescribe pain medications to help ease the pain.
The Women’s Health and Cancer Rights Act of 1997 has made it possible for many women to undergo breast reconstruction surgery without the burden of a heavy financial cost. The act states that insurance companies and managed care organizations are required to pay for breast reconstruction for women who have had a mastectomy. It supports all phases of the cancer treatment and reconstruction process. Dr. Lapuerta’s insurance and billing office will work with the provider to understand exactly what the coverage will be.
For those interested in learning more about breast reconstruction surgery options, schedule a consultation with Dr.Lapuerta. Having performed more than 20,000 surgical procedures, Dr. Lapuerta has over two decades of professional experience. He will discuss your health, concerns, and goals to help you decide if undergoing breast reconstruction surgery after cancer is an option for you.