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Breast Reconstruction Surgery following Mastectomy for Breast Cancer

Surgeons in the Division of Plastic Surgery at Penn Medicine offer the most advanced treatment options for patients in need of cosmetic and reconstructive surgery,as well as a comprehensive skin care program.

At Penn,breast reconstruction has evolved to encompass three approaches:implants with or without tissue expansion,autologous tissue reconstruction,and a combination of implants and autologous tissue. Penn Plastic Surgery offers saline and silicone based implants,including the recently introduced stable cohesive silicone gel (or “gummy bear”) implants. The latter are available investigationally,a result of Penn Plastic Surgery’s commitment to clinical research to advance breast reconstruction techniques and implants.

The stable cohesive implants are composed of a denser,more form-stable silicone gel,and are available in a variety of molded shapes and sizes to accommodate a wide range of patient anatomies and preferences. Implants composed of the new gel are expected to be more durable and to have fewer issues with leakage than standard silicone implants.

Currently,Penn Plastic Surgery performs 400 autologous breast reconstructions a year. These procedures use the patient’s own tissue,and by comparison to implants,are generally considered to provide a more natural appearance. Patients at Penn have the option of free transverse rectus abdominus myocutaneous (TRAM) flap,deep inferior epigastric perforator (DIEP) flap and superficial inferior epigastric artery (SIEA) flap breast reconstruction.

All of these procedures are performed microsurgically and avoid the “muscle tunnel” approach necessary for some reconstruction surgeries. Microsurgery permits the major veins and arteries to be severed at the donor site and reattached at the chest and armpit adjacent to the site of reconstruction with very low complication rates.

Reconstruction of the nipple-areolar complex is an important component to complete breast reconstruction and has been shown to have a major psychological benefit to the patient. Penn Plastic Surgery offers nipple reconstruction as a two-step office procedure that includes the establishment of a nipple projection followed by tattooing by a micropigmentation specialist to restore the natural
appearance of the nipple and areola.

Case Study 1

Mrs. L,a 54-year-old woman,came to the Center for Human Appearance at Penn for an autologous breast reconstruction two years after a radical right breast mastectomy. A free deep inferior epigastric artery perforator (DIEP) flap procedure was planned. Prior to surgery,a duplex ultrasound identified the most suitable perforator vessels at the abdominal harvest site to ensure adequate flap perfusion.

During the procedure,the appropriate perforators and the deep inferior epigastric vessel were incised microsurgically and transferred with skin,fat and blood vessels to the mastectomy site. The donor site was then closed. Following placement of the flap and the assurance of good perfusion,Mrs. L’s left breast was lifted to ensure symmetry. Total operative time was 5.5 hours. Mrs. L remained in the hospital for four days and was sent home to recover.

Seven months later,she returned to Penn for nipple reconstruction and tattooing. At her one-year follow-up,she expressed satisfaction with the shape and contour of her breast
reconstruction (Figure 1).

Case Study 2

Ms. M,a 38-year-old woman,presented to the Center for Human Appearance for a total,bilateral nipple-sparing mastectomy for the treatment of ductal carcinoma in situ (DCIS) followed immediately by breast reconstruction surgery. After a consultation to discuss her options she chose to have implant reconstruction with investigational stable cohesive silicone gel implants.

During the mastectomy procedure,Ms. M received a tissue expander beneath the skin and muscles of her chest wall containing a small amount of saline. She was discharged from the hospital on postoperative day two. Three weeks later,she returned for the first of a series of bi-weekly saline injections via the valve in the tissue expander to stretch the muscle and skin to accommodate the implants.

At four months post-surgery,Ms. M returned for the second stage of her breast reconstruction. During this procedure,the tissue expanders were removed through the original incision and the cohesive silicone gel implants placed. Ms. M went home the same day to recover. At her one-year follow-up,virtually no evidence of the bilateral total mastectomy was apparent (Figure 2).

Faculty Team

The experienced surgeons in the Division of Plastic Surgery at Penn Medicine offer the most advanced treatment options for patients in need of cosmetic and reconstructive surgery,as well as a comprehensive skin care program. In addition to breast reconstruction,specialty areas include craniofacial reconstruction,congenital anomalies,reconstruction following tumor and trauma,microsurgical techniques,cleft lip and palate surgery,and cosmetic facial and body surgery.

Performing Breast Reconstruction Surgery at Penn

Suhail K. Kanchwala,MD
Assistant Professor of Surgery

Stephen J. Kovach III,MD
Assistant Professor of Surgery

David W. Low,MD
Professor of Surgery

Joseph M. Serletti,MD
Henry Royster–William Maul Measey Professor of Surgery

Liza C. Wu,MD
Assistant Professor of Surgery

Medical Aesthetician/Micropigmentation

Mandy Sauler

Micropigmentation at Penn Medicine


Micropigmentation is a cosmetic procedure used to restore the natural appearance of the nipple and areola following breast reconstruction.

Performed by a specialist at Penn,micropigmentation involves a preliminary consultation to ensure that the color,shade and size of the tattoo are both appropriate for the patient’s skin tone and account for scar tissue,if present.

For women who have had a single mastectomy,the micropigmentation specialist will match the pigment to ensure a complementary appearance.

The objectives of micropigmentation may involve more than one session to permit
the skin to fully absorb the pigment.

Aftercare instruction is included to
ensure best outcomes.

Access

Center for Human Appearance
Perelman Center for Advanced Medicine
East Pavilion,1st Floor
3400 Civic Center Boulevard
Philadelphia,PA 19104

Download a pdf of this Clinical Briefing.


Clinical Briefings™:Clinical Reports from Penn Medicine

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