For many women, their breasts are a defining feature of their femininity. Hearing that you have breast cancer and that you require a lumpectomy or mastectomy can be difficult.

Joseph Michaels, MD, FACS, strives to alleviate some of the difficulty that women undergoing breast cancer treatment experience by providing surgical breast reconstruction in Bethesda and Fairfax. Breast reconstruction surgery is often an integral part of the healing process, restoring patients’ positive body image, emotional wellbeing and quality of life overall.

If you or a loved one is undergoing breast cancer treatment involving lumpectomy or mastectomy, contact Dr. Michaels for help with breast reconstruction. During your consultation, Dr. Michaels reviews your full medical history and listens to your goals for reconstruction, with both patience and compassion. He then recommends a course of action that is best suited to your unique needs. With breast reconstruction surgery, Dr. Michaels’ ultimate goal is to restore the appearance of your breasts while providing natural-looking results.

Candidates

Often, breast reconstruction can be performed at the same time as mastectomy, so you can awake from your procedure with a newly reconstructed breast.

Several factors influence which breast reconstruction approach is best for you, including the timing of your reconstruction in relation to your mastectomy as well as if you require adjuvant therapy such as radiation or chemotherapy. Dr. Michaels works closely with your oncologist and breast surgeon to establish a treatment protocol that is most beneficial to you.

Although some women are suitable candidates for breast reconstruction using breast implants alone, others do not have an adequate amount of tissue on the chest wall to support and cover the implants. In the latter case, Dr. Michaels uses either a flap technique or tissue expansion to generate enough tissue to cover and support the breast implant used in reconstruction.

Reconstruction Options

Tissue expansion

This reconstructive technique involves a multiple-step procedure that ultimately expands your own tissue, creating a sufficient amount of tissue to cover and support a permanent breast implant. Although tissue expansion is a lengthier process overall, it allows for an easier, quicker recovery period.

This approach involves inserting a temporary breast implant device called an “expander” into the mastectomy site that is then closed with dissolvable sutures. Dr. Michaels then uses an internal valve to fill the device gradually, over a period of four to six months. Eventually, the overlying skin tissue is expanded, so it can accommodate and cover a permanent breast implant. A second procedure to remove the implant, reshape the breast envelope and place a permanent implant is then performed.

Flap reconstruction

With any of the flap techniques, Dr. Michaels repositions your own skin, fat and muscle tissues to create a breast mound, cover the existing breast tissue or produce a sufficient amount of tissue to cover an implant. The two principal flap techniques involve either a TRAM flap or a latissimus dorsi flap.

TRAM flap

With this approach, Dr. Michaels reconstructs the breast using donor skin, fat and muscle tissue taken from the abdomen. Depending on unique factors such as your distinct body type, the breast reconstruction surgeon either leaves the TRAM flap attached to the original blood supply while tunneling upward through the chest wall or detaches the flap entirely, molding it into a breast mound.

Latissimus dorsi flap

With this approach, Dr. Michaels utilizes donor skin, fat and muscle tissue from the back, tunneling anteriorly under the tissue to the site of the mastectomy. With this technique, he keeps the tissue attached to the donor site, allowing the blood supply to remain intact. This flap is often placed over an implant to provide adequate volume to the reconstructed breast.

Procedure

Breast reconstruction is performed as an inpatient procedure under general anesthesia. The surgery can last several hours, depending on the technique used and the complexity of the procedure.

Once there is an adequate amount of tissue to cover and support a breast implant, Dr. Michaels can surgically place a saline or silicone implant. He may use a breast implant in place of or in addition to a flap. Dr. Michaels closes the incisions with stitches and dresses the treated area with bandages and an overlying surgical bra for additional support.

Whether the breast mound is reconstructed with a breast implant, a flap or both, Dr. Michaels reconstructs the nipple during a later procedure, once the new breast mound has adequately healed. This usually occurs about three months following your reconstruction procedure. In addition, an areola can be tattooed on the reconstructed breast mound to enhance the results. Also, breast augmentation or breast lift surgery may be needed on the opposing breast to produce a symmetrical look.

If you would like to learn more about breast reconstruction, click here or call (301) 468-5991 in Bethesda, MD or (703) 957-8610 in Fairfax, VA to schedule a consultation.