Reconstructing Breasts with Sensation

Most women facing mastectomy and breast reconstruction want to know what kind of feeling their new breast(s) will have.

Unfortunately mastectomy leaves many women with very little feeling long term (if any), regardless of whether they have breast reconstruction or not.

There is some good news though.... Most women undergoing DIEP or SIEA flap breast reconstruction are also candidates for reconstruction of the sensory nerves in the breasts that provide feeling. The feeling in the new breast won't be as good as what Mother Nature provided but it's certainly a lot better than the alternative. A nice bonus at the very least.

Once the tummy tissue (flap) is moved up to the breast, a sensory nerve in the flap is connected microsurgically to a breast nerve in the chest that was cut by the mastectomy. New nerve cells grow from the chest nerve into the flap nerve over time allowing the reconstructed breast to develop feeling.

If you're feeling brave, here's a short video clip of how the two nerves are connected. You can also see the pulse in the blood vessel connections to the new breast:

I hope this info helps.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap and Alloderm One-Step. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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DIEP Flap Breast Reconstruction

Here's a short video about DIEP flap breast reconstruction after mastectomy.... details about the procedure and why it has become the gold standard in breast reconstruction.

Hope you find it useful.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap and Alloderm One-Step. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Alloderm Breast Reconstruction

Alloderm is now being used routinely in breast reconstruction. Here's what you need to know...

First off, what is it? AlloDerm is derived from donated (cadaveric) human skin. It is FDA approved and is used in many different types of reconstructive surgery including breast reconstruction. Before being packaged for use, the Alloderm undergoes a multi-step process that removes all the cells that can lead to tissue rejection: even though it comes from another person, your body does not reject Alloderm because the immune cells are removed. Alloderm essentially acts as a scaffold and over time, the patient's own cells grow into it.

Since it is a human (cadaveric) product, the U.S. Tissue Bank rigorously screens all tissue donors' medical records. All donors must be negative for Syphilis, Hepatitis B and C, and HIV 1 and 2. AlloDerm grafts are also examined under the microscope before and after processing to rule out contamination.

Alloderm is frequently used in implant-based breast reconstruction (and has been for years). The tissue expander or implant is placed under the pectoralis (chest) muscle. The more tissue coverage over the implant, the better the results. Unfortunately, the pec muscle cannot cover the entire implant. The Alloderm is used to cover the lower part of the implant that is not covered by muscle.

Advantages:
- Stabilizes the implant in position.
- Allows for complete implant coverage.
- Can allow the creation of a full-sized breast when the tissue expander/implant reconstruction is performed at the same time as the mastectomy.
- No risk of rejection.
- Once incorporated by the body, resists infection as well as the patient's "natural" tissue.

Disadvantages:
- Like anything that is implanted in the body, there is an initial (low) risk of infection (until it becomes incorporated).
- Can cause temporary redness in the skin over the Alloderm.
- Costly but usually covered by insurance.

Many plastic surgeons, including myself, use Alloderm routinely when performing breast reconstruction with tissue expanders and implants.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap and Alloderm One-Step. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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"Fighter"

This film is dedicated to all who fight breast cancer.... past, present, and future.

Breast Reconstruction Can Be Performed Any Time

Did you know breast reconstruction can be performed at any time, even years after a mastectomy?

"Immediate breast reconstruction" is performed at the same time as the mastectomy and typically provides the most natural results with the least amount of scarring. Unfortunately, for many women this simply isn't an option....

For starters, 70% of women facing mastectomy aren't even told that reconstruction may be an option for them. They undergo surgery only to find out some time later that they could have woken up from their mastectomy with new breasts instead of having to experience a flat chest.

Of the women that are informed, some may not have access to a reconstructive plastic surgeon where they live and have to travel for reconstruction.

Other women are not candidates for immediate reconstruction because unfortunately the disease is too advanced at the time of diagnosis.

Sometimes radiation therapy is recommended as part of the breast cancer treatment. Most plastic surgeons prefer to hold off on reconstruction until the patient is several months out from her last radiation therapy. This allows the tissues to recover and soften up as much as possible to improve the results of the subsequent reconstruction.

As you can see, there are several reasons why a women wanting breast reconstruction may not be able to have it straight away, ideally at the same time as the mastectomy.

Whatever the reason for delay may be, it is important to remember there is no time limit when it comes to breast reconstruction - it can be performed at any time, even years after mastectomy.

Like immediate reconstruction, delayed breast reconstruction is also covered by insurance regardless of how many years have passed since the breast cancer diagnosis.

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap and Alloderm One-Step. In-Network for most US insurance plans. Patients routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Breast Reconstruction Makes Breast Cancer Patients Whole Again After Mastectomy

Alarmingly, 70% of American women facing surgery for breast cancer are not told about the option of breast reconstruction.

Perhaps one of the best things about breast reconstruction is that it can be performed at any time….  you can never “miss the boat” so to speak. Regardless of the timing of the procedure, breast reconstruction enables women to feel whole again, not just physically but also emotionally.

There are several reconstructive options ranging from breast implants to using the patient’s own tissue. Tissue (or “flap”) procedures recreate a “natural”, warm, soft breast and are associated with fewer complications than breast implants.

Breast reconstruction can be performed at the same time as the mastectomy ("immediate reconstruction") or any time after mastectomy ("delayed reconstruction"). 
When the mastectomy and reconstruction are performed at the same time, a skin-sparing mastectomy can usually be performed which saves most of the natural breast skin envelope. Only the actual breast tissue under the skin is removed. The reconstruction then "fills" this empty skin envelope. In some cases nipple-sparing mastectomy can be performed. This preserves the nipple and areola as well as all the breast skin.



Skin-sparing (and nipple-sparing) mastectomy and immediate breast reconstruction produce the most "natural" results with the least scarring. Patients undergoing immediate reconstruction also avoid the experience of a flat chest altogether. Immediate reconstruction is therefore preferred whenever possible and should be the goal for patients with early breast cancer (stage I or II).

In some cases breast reconstruction cannot be performed at the same time as the mastectomy. Reasons include advanced breast cancer (stage III or IV), inflammatory breast cancer, the plan for radiation therapy after mastectomy, and lack of access to a reconstructive plastic surgeon.

As I already mentioned at the beginning of this post, most women unfortunately are not made aware of their breast reconstruction options. I therefore encourage all women interested in breast reconstruction to research their options and seek a referral or consultation with a plastic surgeon specializing in breast reconstruction.

You can see real patient results after immediate and delayed breast reconstruction in our photo gallery here.

Dr C


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PRMA Plastic Surgery specializes in advanced breast reconstruction procedures that use the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap reconstruction. We are In-Network for most US insurance plans. Patients are routinely welcomed from across and outside the USA. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Improve How Your Scars Heal

Wounds need a lot of energy to heal well. Since energy can only come from food, it is vital to eat healthily especially before and after surgery, or after an injury. Crucial nutrients for wound healing include protein, zinc and the vitamins A and C.

So what are the best things to eat? Meats, nuts, beans and dairy products are great sources of protein. Yogurt, green peas, beef, oysters, black beans and crab are great sources of zinc. Carrots, tomatoes, sweet potatoes, spinach and apricots are great sources of vitamin A. Citrus fruits and green leafy vegetables are great sources of Vitamin C.

Unfortunately, the body does not divert enough vitamin C to the skin. Using a topical scar treatment containing a stable form of vitamin C will increase the amount of vitamin C reaching the skin.

Good hydration is also crucial so it is important to drink enough water. Dehydration causes the skin and soft tissues to lose moisture and become dry. Dry wounds do not heal well. A good goal is to drink eight (8 oz) glasses of water a day. Avoid caffeinated products because caffeine can cause dehydration. Scar treatments containing dimethicone silicone also help boost hydration by trapping moisture. This improves scar healing.

Smoking can also really affect healing. The nicotine in cigarette smoke causes blood vessels to shrink, so tissues do not receive enough of the nutrients and oxygen required for healing. At best, this can cause the wound healing process to take much longer. At worst, smoking can cause wounds to breakdown and open up. These “problem” wounds typically eventually heal but leave the worst scars. Unfortunately, many smoking-cessation products will also increase the risk of healing problems because of the nicotine they contain!

Cigarette smoke also contains carbon monoxide. This combines with blood cells preventing them from carrying oxygen. This lowers the level of oxygen in the blood. Since oxygen is vital for healing, it is crucial to stop smoking to decrease the risk of healing complications.

Another great thing to do is exercise. Regular aerobic exercise improves healing and boosts the immune system. Start with walking and progressively build up to more of a sweat (but don’t forget to get the “all-clear” from your doctor if you are recovering from surgery).

Dr C


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PRMA Plastic Surgery specializes in advanced breast reconstruction procedures that use the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap reconstruction. We are In-Network for most US insurance plans. Patients are routinely welcomed from across and outside the USA. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Traveling for Breast Reconstruction - Help with Travel and Accommodation Costs

A growing number of breast cancer patients are now choosing to travel for their care, particularly for some of the more advanced breast reconstruction procedures. Insurance may cover the health care expenses but the cost of the hotel and air fare falls on the patient.

Now, some patients may qualify for financial assistance to cover these extra expenses thanks to two special programs:

Assistance with Air Travel Expenses

The American Cancer Society (ACS) Air Miles program is a joint effort between Mercy Medical Airlift (MMA)/National Patient Travel Helpline (NPATH) and the American Cancer Society. The program is designed to help patients with the cost of air fare when traveling for cancer-related treatment. Please call the ACS at (800) 227-2345 to find out if you are eligible for help with air travel. More information regarding the Air Miles program can be found here.

American Cancer Society (ACS) Accommodation Program

San Antonio hotels have partnered with the American Cancer Society to offer breast cancer patients accommodation at either low or no charge on a space-available basis. This program is for patients who receive treatment at least 50 miles from their place of residence. One caregiver is welcome to travel with the patient At least two weeks advance notice is usually required. The program only applies to lodging Monday through Thursday. We encourage patients living more than 50 miles from San Antonio to call the American Cancer Society on (877) 227-1618 for more information and to take advantage of this opportunity.

Hope that helps!

Dr C

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PRMA Plastic Surgery specializes in advanced breast reconstruction procedures that use the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap reconstruction. We are In-Network for most US insurance plans. Patients are routinely welcomed from across and outside the USA. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Tattoos that tell Breast Cancer Stories

Thank you to all our Facebook fans who submitted pictures of their breast cancer related tattoos. As a special thank you, all the submissions were included in this film, 'Breast Cancer Stories.'

These tattoos are truly amazing and inspiring.

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PRMA Plastic Surgery specializes in advanced breast reconstruction procedures that use the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap. We are In-Network for most US insurance plans. Patients are routinely welcomed from across and outside the USA. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Finding the Best DIEP Flap Surgeon for You

If you are considering DIEP flap breast reconstruction, finding the right surgical team is key. Before deciding which surgeon is the best DIEP flap surgeon for you, consider asking the following questions:

1. Are you certified by the American Board of Plastic Surgery? Your surgeon should be a board certified plastic surgeon with extensive training and experience in microsurgery.
2. How much experience do you have with this type of surgery - How many have you performed? It is preferable that your surgeon has successfully performed over 100 DIEP flap reconstructions.
3. What's your success rate? Top specialist centers boast a success rate of at least 98%.
4. How long does the surgery take? This will vary between institutions based on experience. The most experienced surgeons typically take between 3-6 hours depending on whether one or both breast are being reconstructed (not including the mastectomies).
5. How often do you plan to perform a DIEP flap but end up changing the procedure to a free TRAM flap during the surgery? The "conversion rate" to a free TRAM flap should be very low.
6. How many microsurgeons will be performing the surgery? Since the DIEP flap procedure can be so technically demanding, it is preferable to have two microsurgeons performing the surgery rather than just one. Not only will this ensure you benefit from the expertise of two specially trained surgeons, but it will also significantly cut down the length of the procedure and anesthesia time.
7. Do you have residents or fellows? Will they be performing any of my surgery? Some centers have surgeons-in-training known as "residents" or "fellows" that may be helping with your surgery or even performing part of it. This may or may not be something you are comfortable with considering the complexity of the surgery. 
8. Do you "balance bill"? Centers like PRMA that are in-network for most insurance plans will ask the patient to pay ONLY what's laid out by the patient's insurance plan (ie copay, deductible, etc). Other centers "accept insurance" and will often help the patient get money back from their insurance company - however, the patient is still expected to provide the difference between what the insurance pays and the doctor's fee. This is known as "balance billing". Make sure to ask ahead of time to avoid nasty financial surprises down the line.
9. Do you have Insurance Specialists on staff? Unfortunately, some patients will face difficulties in gaining access to DIEP flap specialists even though insurance companies are federally mandated to pay for the cost of breast reconstruction. Here again it pays to seek out centers that specialize in these procedures as typically an insurance specialist is available to help patients with insurance issues. Again, this can prevent a nasty financial surprise after your surgery.

Hope that helps!

Dr C

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PRMA Plastic Surgery has successfully performed several thousand microsurgical breast reconstructions, and typically performs over 500 DIEP flaps per year. We specialize in advanced breast reconstruction procedures that use the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap. We are In-Network for most US insurance plans. Patients are routinely welcomed from across and outside the USA. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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