Breast Reconstruction in Pittsburgh, PA

Pittsburgh plastic surgeon, Dr. James Fernau, offers breast reconstruction surgery for individuals who have had a mastectomy as part of breast cancer treatment, or those who have had their breasts surgically removed due to trauma or injury. Breast reconstruction surgery aims to restore the breast back to a normal appearance. It can often restore a woman’s self-image and confidence after suffering such a significant loss. For breast cancer patients specifically, there are a number of reconstruction procedures available that are generally discussed early on during the mastectomy planning. This surgery may be done simultaneously with the mastectomy, known as immediate reconstruction, or it may be staged in separate sessions, known as delayed reconstruction. It will be up to the breast cancer surgeon and Dr. Fernau as to the best approach to take. Each surgical case will vary.

The surgical planning for a breast reconstruction typically begins at the same time as the planning for the mastectomy. There are points to consider such as how soon the patient will have the reconstruction and what type of reconstruction technique is best per the surgical case. It will need to be decided whether implants or tissue grafts are used, what type (if any) nipple and areola reconstruction will be used, and other techniques that are specific to the patient’s circumstance. The general goal is to help the patient regain a normal appearance of the breasts as part of the final phase of breast cancer treatment.

Surgical techniques vary and today, patients are getting more options that can match their personal preferences. It is important to find a highly specialized plastic surgeon to perform breast reconstruction and one who will work with the cancer surgeon to achieve a natural result.

Breast implants are a common method used with a reconstruction procedure. When implants are being considered, the reconstruction process is usually performed in a multi-stage treatment session. A tissue expander is placed in between the chest muscle and the skin during the mastectomy. This expander will be gradually filled with a saline solution to expand the skin and eventually replace it with an implant. Sometimes, the saline-filled expander is retained instead of an implant.

Flap procedures harvest skin and muscle tissue from donor sites and transfer it to the breast. The surgeon may choose between one of the following common techniques:

• TRAM flap involves grafting skin and muscle tissues on the lower part of the abdomen.
• DIEP and SIEA flap graft tissue from the lower part of the abdomen, but harvests only the skin and fat tissues instead of muscles.
• Latissimus Dorsi flap uses skin and muscle tissues from the upper back.
• GAP flap uses skin, fat and muscle tissues from the buttocks area.
• TUG flap harvests skin, fat and muscle tissues from the inner thighs near the buttocks area.

When a breast is surgically removed, the nipple and areola are not spared. To recreate this area, skin and muscle tissues are grafted and formed to look like a nipple while the areola is achieved by tattooing. This is done when the breast reconstruction has fully healed.

Breast reconstruction uses general anesthesia, and the patient is often required to stay in a hospital if done simultaneously with the mastectomy. Patients who have flap surgeries sometimes stay up to 5 days for monitoring. There will be discomfort and pain within the first week, and the patient may feel disoriented with the newly formed chest. Temporary drain tubes and bandages are placed to assist in healing. It can be unnerving to go through a major body change; however, patients find it gratifying and relieving that they are able to once again look and feel normal as they start their new journey towards becoming a cancer survivor.

While most cosmetic procedures are not covered by insurance, breast reconstruction as part of cancer treatment is usually covered. The Women’s Health and Cancer Rights Act of 1997 allows the recovering cancer patient to undergo the surgery and apply insurance coverage towards the total cost. It is difficult to place an actual dollar amount towards this surgery as many factors are involved. Our billing and insurance coordinator will work to define the costs and confirm benefits that may apply.

With breast reconstruction, a plastic surgeon will work alongside the cancer surgeon and be primarily involved and responsible as it pertains to restoring the appearance. It is a highly specialized surgery so it is critical to choose a plastic surgeon that has years of successful experiences in this type of surgery.

If a patient knows she will want to restore her breasts with a reconstruction procedure, it is recommended that this process begins at the time as the mastectomy. During the breast removal portion, the tissue expanders can be put into place, which eliminates a new surgery. This ultimately decreases the risk for complications.

Because the breast is completely removed and a new one is formed, there will be a loss of sensation. Over time, there is a possibility that this sensation can be slowly regained. This is different for every patient. While some patients regain their sensitivity, there is no guarantee that this will be the case for everyone.