Plastic Surgery and Skin Care
980 237 6953
Before and After
The decision to undergo breast reconstruction surgery is a very personal one. It's amazing that only 33% of women with breast cancer are undergoing reconstruction in the United States. Some women are not even aware that their right to have their breast reconstructed was federally mandated when in October of 1998 the United States Congress signed into law the Women's Health and Cancer Rights Act (WHCRA) which helps to protect woman with breast cancer who choose to have their breast reconstructed after mastectomies. This federal law applies to group health plans, health insurance plans, and HMOs as long as the plan covers the medical and surgical cost of mastectomies. Under the WHCRA, mastectomy benefits must cover:
Reconstruction of the breast that was removed by mastectomy
Surgery and reconstruction of the other breast to make the breasts look symmetrical and balanced after mastectomy
An external breast prostheses (breast form that fits into your bra) that are needed before or during the reconstruction
Any physical complications that occur during the mastectomy, including lymphedema
The American Society of Plastic Surgeons (ASPS) has identified that many woman who are facing breast cancer are not being informed about their options for breast reconstruction and have chosen to be the chief sponsor of the Breast Cancer Patient Education Act of 2013. This federal legislation requires the Secretary of Health and Human Services to plan and implement an education campaign to inform woman of the availability and coverage of breast reconstruction, prosthesis’s, and other options. You may contact The American Cancer Society for more information regarding your rights as a breast cancer survivor.
I would now like to provide you with a brief overview of breast reconstruction, its history, and the surgical options which are currently available.
Throughout ancient times, great controversy produced many theories how breast cancer occurred and the best treatment. Because of the belief that closure of the mastectomy site could conceal tumor recurrence breast reconstruction did not gain wide acceptance until the mid-1900's. Probable the first recognized surgical procedure to reconstruct a breast was performed by Vincent Czerney, a German professor of surgery who in 1862 used a fatty noncancerous fatty tumor from the back to reconstruct a breast mound. In the early 1960's the invention of silicone breast implants spurred the first modern techniques for breast reconstruction. Tissue expanders were first used to allow gradual stretching of the skin to replace the tissue removed during the mastectomy. In 1978, skin, muscle (latissimus dorsi), and fat from the back were used to reconstruct a breast mound. Karl Hartramp introduced in 1982 the use of lower abdominal fat and skin supported by the underlying muscle to reconstruct a breast. The TRAM (transverse rectus abdominus musculocutaneous flap) is still an option for women who would like to use their own tissues for breast reconstruction. Also in the late 1970's the skin and fat normally discarded during an abdominoplasty was used to reconstruct a breast by connecting the blood vessels from the flap to those of the chest wall. Since then, microvascular reconstruction of the breast has undergone many advances. Today smaller blood vessels are being used to support the transplanted tissues often decreasing surgical complications and recovery time.
When to begin breast reconstruction is based upon a woman’s desires, medical condition and cancer treatment. Some elect to begin their reconstruction at the same time as the mastectomy. This is called an immediate reconstruction. It is also possible to perform a delayed reconstruction months or even years following a mastectomy. Both immediate and delayed reconstruction have their advantages and disadvantages and what may be acceptable for one person may not for another. The type of reconstruction is based on your medical history, physical examination, general health and lifestyle as well as your goals. Options for breast reconstruction include:
1) Staged Reconstruction using Tissue Expanders and Permanent Implants - A tissue expander is placed beneath the chest wall muscle and gradually enlarged to stretch the skin of the upper chest. The tissue expander will eventually be replaced by a permanent implant. This type of breast reconstruction is presently the most common performed in the United States.
2) Autologous Reconstruction - The use of your own tissue such your back muscle or lower abdominal skin and fat. Women often like this technique because they get a tummy tuck at the time of their breast reconstruction.
3) Combination of Surgical Techniques - There are times when use of a woman’s own tissue alone may not provide sufficient volume to reconstruct a breast. This is most often the case when the back muscle is used for the reconstruction. A tissue expander may then be placed beneath the muscle at the time of the reconstruction to be filled over several weeks following surgery. The tissue expander will eventually be replaced by a permanent implant. The final result is a breast that looks and feels very natural.
A more thorough description of each procedure may be found on the American Society for Plastic Surgeons website at:
wdf cosmetic and reconstructive plastic surgery 980 237 6958
7731 Little Ave. Suite B.
Charlotte, NC 28226