Dr. Lampert Breast Reconstruction patient discusses procedure

Introduction

Breast restoration after a mastectomy or lumpectomy is a vital part of the rehabilitation process. Women identify strongly with their breasts as a part of their sense of femininity. For some patients, the loss of a breast can have more of a psychological impact than the actual cancer itself. Breast reconstruction surgery is not approached in the same way as cosmetic breast surgery; even though the goal is always an aesthetic end result. Reconstructive breast surgery focuses on creating a new breast that closely resembles one's natural anatomy.

Dr. Joshua Lampert: Miami Breast Reconstruction Surgeon

Breast reconstruction requires coordination with the patient’s cancer surgeon (or surgical oncologist) so that reconstruction can be scheduled as soon as possible. Most of Dr. Lampert’s breast reconstruction patients begin the process the same day, immediately after the tumor removal. There are many methods of breast reconstruction, from breast implant-based reconstruction to using the patient’s own tissue—or a combination of both. Dr. Lampert works closely with the surgical oncologist and patient to maximize patient safety and provide the best method of reconstruction for the individual patient.

Prophylactic Mastectomy and Breast Reconstruction

More frequently, patients are undergoing prophylactic mastectomy for genetic reasons. Some patients have a strong family history of breast or ovarian cancer. Genetic testing of these individuals (or their mothers) may reveal a mutation in one of the BRCA genes. BRCA genes normally help protect women from getting breast cancer. However, a mutated BRCA1 gene or BRCA2 gene that does not function correctly is associated with increased genetic damage that may lead to unregulated and rapid cell division. A mutation in one or both of the BRCA genes may be inherited and put the patient at a much higher risk for breast cancer or ovarian cancer in their lifetime.

Patients should consider BRCA genetic testing if they have a family history of any of the following:

• Breast cancer diagnosed under the age of 50 years old
• Breast cancer and ovarian cancer
• Both breasts with cancer (bilateral breast cancer)
• Multiple breast cancers
• Males with breast cancer
• Ashkenazi Jewish family descent
• At least two primary types of BRCA1 or BRCA2-related cancers in one family member (pancreatic, fallopian tube, peritoneal, and prostate cancers)

Patients with any concern or question for genetic testing regarding breast cancer should seek genetic counseling first with a healthcare professional who is experienced in cancer genetics. Dr. Lampert can refer you to a qualified healthcare professional for such counselling if there is any question at all.

Patients with a harmful genetic mutation of the BRCA1 or BRCA2 on gene testing may elect to have prophylactic mastectomy performed. Patients having prophylactic mastectomy more frequently are able to have a nipple-sparing mastectomy performed.

Nipple Sparing Mastectomy: Who is a candidate?

The surgical oncologist’s job is to surgically remove all breast cancer and optimize the patient’s chances for cancer-free survival. Subsequently, the plastic surgeon’s job is to reconstruct the breasts as aesthetically as possible. Having two teams—and a specialist in each discipline—helps optimize the chances that the patient will be both cancer-free and have an aesthetically pleasing breast reconstruction without compromise to either goal.

Although Dr. Lampert is able to reconstruct the entire nipple if necessary, there is a significant aesthetic and cosmetic benefit to nipple preservation during mastectomy when it is safe to do so. A nipple sparing mastectomy often results in a rather excellent aesthetic result, using either implants or the patient’s own tissue. Some nipple sparing reconstructions can actually resemble a cosmetic breast augmentation in final appearance. Nipple preservation will be determined by the surgical oncologist based on the stage, size and location of the breast cancer. Whether a prophylactic, nipple sparing, skin sparing, or more extensive mastectomy is necessary, Dr. Lampert will take the necessary time to discuss all reconstructive options and answer any questions.

Immediate One Stage Reconstruction Concurrent with Mastectomy

This is an option for some women who will not need radiation therapy and who have had skin sparing or nipple sparing surgery. Once the surgeon has completed removal of the breast tissue, an implant is placed immediately. Frequently, a mesh (or acellular dermal matrix) is placed to help position the breast implant properly. If the patient requires nipple reconstruction, this is usually performed 3 months later. Dr. Lampert considers breast reconstruction one of his greatest duties, not only to restore contour and form, but also to help with the psychological trauma associated with the loss of a breast.

Correcting Previous Breast Reconstruction

Dr. Lampert sees patients in need of breast reconstruction due to problems that have developed as a result of outdated surgical techniques. Some defects that he routinely corrects include:

• Asymmetry
• Shifting implants
• Incorrectly sized implants
• Implants that are placed too wide
• Nipple and areola malformations
• Large mastectomy scars
• Disfigurement such as divots or hollows or prior failed breast reconstructions
• Capsular contracture

Candidates for Breast Reconstruction Surgery

The vast majority of women who undergo a single or double mastectomy are candidates for breast reconstruction. However, not every woman wants to immediately undergo more surgery and so prefers to delay the decision. Less frequently, some patients have such invasive and metastatic disease that delayed reconstruction is the safest option. In addition, some women live very happily with a prosthesis and never have reconstructive surgery at all. Most patients desire breast reconstruction to restore form and function and continue to look great in their favorite evening dress.

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Recovery

After surgery, a surgical bra is worn to help minimize swelling and provide support to the reconstructed breast, or breasts. A drainage tube is placed so that excess blood and fluid do not accumulate in the tissues. Pain and anti-nausea medication are ordered to ensure patient comfort.

Very specific instructions are provided concerning bathing, eating, when to resume normal activities and when to return for the first post-operative visit. Dr. Lampert makes himself always available so that his patients have peace of mind knowing that they can communicate with him should the need arise between visits.

Breast reconstruction surgery is the final stage of recovery for women who have lost one or both breasts due to cancer. It is physically and emotionally stabilizing for a woman to be able to feel normal when looking into a mirror or shopping for clothes. Breast reconstruction can help women enjoy their lives going forward with confidence after surviving breast cancer.