Dr. R. Brannon Claytor Discusses Breast Reconstruction

Breast cancer is overwhelming. Where do I start?
The diagnosis of breast cancer is devastating. Once this diagnosis has been thrust upon you your whole world starts spinning and it's very difficult to figure out the what's the next step should be. It's important to slow down, take a deep breath and select the people who are going to be important in the process. You will need a breast cancer surgeon, a breast reconstructive surgeon and an oncologist. Each one of these people will fill an important part in the process of your recovery.

What does breast reconstruction entail?
It's important to have an early consultation with a plastic surgeon to find out what your options are. Working with a general surgeon and the plastic surgeons together enables you to keep you options open. Your surgery for treating the cancer is tailored to you. Your breast reconstruction surgery should be as well. A consultation with a plastic surgeon will help you discover what the various kinds of surgery involve. Some surgeries include short recovery while some recovery times are longer. It is important to be informed of the latest techniques and procedures before starting the cancer treatment process.

Most breast reconstructions can be started at the time of the cancer surgery. If you are having a mastectomy, it is possible to place tissue expanders at the time of surgery. This will begin the reconstructive process. You will need a subsequent surgery to remove the expander and place an implant. This will re-establish your breast volume and shape. In addition, if you are only having a lumpectomy, you may be a candidate for reshaping the breasts so that they are a similar shape and size and have a more natural look.

My experience with breast reconstruction surgery after cancer
My extensive experience in breast reconstruction includes a residency in plastic surgery, a fellowship in microvascular surgery which focused on breast reconstruction, 6 years on the Breast Team at Maine Medical Center and Mercy Hospital in Portland, Maine participating in a multidisciplinary approach to treating Breast Cancer, attendance at numerous national, regional and academic settings on Breast Reconstruction, and a number of publications and presentations at professional conferences on the topic of improved aesthetic results and reduced complications for breast reconstruction. I am happy to provide patients with a comprehensive list of these works and the multitude of clinical scenarios under which I have performed breast reconstruction such as tissue expander reconstruction, delayed tissue expander reconstruction, delayed reconstruction with autogenous tissue of the abdomen, immediate reconstruction with TRAM and correction contour deformities with lipo-grafting.

Are there different types of breast reconstruction?
Options for reconstruction are numerous and each one can be tailored to what your goals are. Reconstruction can be performed with your own tissue. It can be a combination of your own tissue and an implant or even fat grafting from one part of the body to the other. It is important to work with a breast reconstructive surgeon who has had experience in a wide breadth of types of operations. This allows you to work together to come up with an operation that suits you best.During your consultation process you will have the opportunity to sit down and look over photographsof patients that I have treated. Photographs are helpful in giving you some ideas about the expected outcomes. Breast reconstruction can be individualized for the patient depending upon their age, their activity level and the amount of time they want to commit to the reconstructive process. We work together to figure out what your ultimate goals are.

What will my new breasts feel like?
The goal of a reconstructed breast is for them to feel like natural breasts. The problem with that is that the patient’s sensation is frequently altered. That is generally because the nerves to the breast are part of the cancer that is removal. Therefore, not much sensation is retained after a mastectomy. If this is a significant goal for the patient during the reconstructive process then some of the newer modalities that are available may be best. It is best to discuss these goals with your plastic surgeon.

What will my reconstructed breast look like?
For reconstruction with implants, the reconstructed breast will appear somewhat deflated immediately after surgery. After the mastectomy portion of the procedure the tissue expander is placed. It is not completelyinflated, therefore the breast envelope will appear somewhat flattened. Over a period of weeks the tissue expander is inflated and the breast envelope grows to regain the breast shape. The shape of the breast after several months will appear more like a breast mound not a full final breast shape, but you will regain the volume. It will be during the subsequent procedure when the tissue expander will be removed and the permanent implant will be replaced. At that point, you will have achieved the final shape of your reconstructed breast. The entire process can take approximately one year. This will include the placement of the permanent implant and the nipple reconstruction. Some times this process cantake a little longer if there is chemotherapy and/ or radiation therapy.

Does insurance cover insurance reconstruction?
Insurance coverage for breast reconstruction covers not only the affected side but also the matching surgery for the contralateral breast.