Breast Reconstruction

Breast implants, including saline or silicone implants, can be used to reconstruct the breast mound.

This is typically performed in 2 stages, with the placement of an expander at the time of mastectomy followed by a second operation in order to exchange the expander for the permanent implant. In the right candidate,  it can be done in a single stage as well. 

The majority of patients decide to use a silicone implant as they tend to look and feel more natural compared to the saline implant. The patient may need some additional coverage with an acellular dermal matrix in order to provide additional coverage of the expander/implant. The product will ultimately be incorporated into the patient’s own tissue. Dr. Szpalski favors a prepectoral placement of the implants when feasible. Otherwise, it will be placed underneath the pectoralis major muscle. The second operation for exchange the expander for the permanent implant is typically performed in conjunction with any symmetry procedures on the contralateral breast if needed. Fat grafting often happens at the same time or at a later time. 

In the case of tight chest tissue, Dr. Szpalski may first insert a tissue expander, a modified version of a saline implant that has a valve to gradually make room for the implant. When the desired size is achieved, the tissue expander is removed and replaced with saline or silicone implants. 

For some patients, a one-stage breast reconstruction using full-sized silicone gel breast implants which can be placed at the same time as a mastectomy is an option. Only smooth, round devices are used by Dr. Szpalski.

Flap breast reconstruction uses skin, tissue, or muscle from a donor area of the body, such as the abdomen, back, or buttocks, to reconstruct the breast mound. An advantage of flap reconstruction is a natural look and feel, as part of your own body is used to construct your new breast.

Some flap options tunnel the tissue beneath the skin to the chest to maintain the flap’s blood supply, creating a new breast mound (pedicled flap). These flaps can either be a muscle from the back or skin and fat from the lateral chest or back. In both cases, the flood supply of the tissue is not disrupted (different than a free flap reconstruction).

Other flap options completely detach the tissues from the body, then reattach them through microsurgery (free flap). It is a significantly more challenging operation and, in order to rebuild the breast, requires the surgeon to harvest tissue from another place on the body and transfer that tissue to the breast. This operation typically spans approximately 6-12 hours and will require a hospital stay of approximately 3-5 days. It requires microsurgical expertise, a subspecialty of plastic surgery in which Dr. Szpaski is specifically trained. She has extensive training, skill, and experience in the field of microsurgery. While flap procedures may be more invasive, the results can match the appearance and feel of natural breasts.

There are multiple flap options that Dr. Szpalski will review with you during your consultation.

Fat grafting, or fat transfer, is a commonly used technique to reconstruct the breast after mastectomy or lumpectomy. During the fat grafting procedure, small amounts of fat are removed from another part of your body (usually the abdomen or thighs). This shouldn’t be confused with procedures such as liposuction, since such small amounts of fat are removed. The fat is then purified and then injected into the areas of the breasts that need filling using cannulas to skillfully inject individual droplets of fat into the breast. The fat then incorporates into skin or breast’s existing adipose, or fat tissue.

Autologous fat grafting offers a wonderful versatility. It is a fantastic tool to correct lumpectomy defects that were not reconstructed at the time of the breast surgery for example. 

Another great use of graft transfer is as a complement to two-stage implant-based reconstruction. It remains the most common method of breast reconstruction, and in most cases, this technique benefits from adjunctive fat grafting to correct minor contour deformities or asymmetries. In these cases, smaller volumes of fat injection are transferred to provide a more natural feel and look of the breasts.

In some cases, higher injection quantities can be an alternative to conventional procedures for whole breast reconstruction. That being said, often more than one fat grafting treatment may be needed to achieve a good aesthetic since there is a limit on how much you can transfer in one setting. 

Dr. Szpalski will discuss with you during your consultation to see if fat grafting is the right procedure for you.

Breast reconstruction is an intimate and personal journey. There is no “best breast reconstruction method.” There is only what is best for each unique body, history, needs, and goals. 

And for some, this means no breast reconstruction per se but an aesthetic flat closure. This can also be called post-mastectomy chest wall reconstruction, and it is a medical term for going flat. It is also a form of reconstructive surgery since poorly closed mastectomy scars can be uncomfortable and even painful. 

It can be done at the time of mastectomy (immediate) or in a delayed fashion. Depending on the patient’s anatomy,  Dr. Szpalski will remove extra skin and fat and tighten and smooth out the remaining tissue to create a flat chest wall contour. 

Creating a beautiful and flat chest closure is more complicated than it looks, particularly for patients with large breasts, comorbidities, or previous breast surgeries. 

Multiple techniques can be used to achieve a beautiful long lasting result, and Dr. Szpalski will review each option with you during your consultation.