New Breast Reconstruction Blog!

For our latest posts, please head over to our new Breast Reconstruction Blog.

See you there!

Dr C

Breast Reconstruction Options At A Glance

Here's a great infographic summarizing the breast reconstruction options available these days:

Some additional important points:

"Immediate" vs "delayed" breast reconstruction simply describes when the breast reconstruction process begins. Most approaches require more than 1 surgery and the whole reconstruction process can take several months to complete regardless of when it starts. The benefits of immediate reconstruction (same time as the mastectomy) include avoiding the experience of living without a breast, less scarring and better cosmetic results (especially when combined with nipple-sparing mastectomy). You can see patient before and after pictures here.

Many of the above procedures are often combined. For example, tissue expanders or implants can be used in conjunction with flaps. The most common combination is a tissue expander with a latissimus ("lat") flap. Fat grafting is also frequently used in combination with any of the above techniques to address contour deformities, hide implant rippling, add volume, or simply make the results more "natural".

Unfortunately, many of the above procedures are not offered by all plastic surgeons. I encourage all of you to do your own research, ask questions, and if at all possible, consult with plastic surgeons experienced in all types of breast reconstruction before making a final decision.

Dr C
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Dr Chrysopoulo is a breast reconstruction surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with Dr C on Twitter and Facebook.

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What is Breast Reconstruction? What are your Options?

Breast reconstruction makes women whole again after breast cancer. It restores something that nature provided but cancer has taken away. It is covered by insurance in the majority of cases thanks to a 1998 Federal Mandate.

Unfortunately, many breast cancer patients who are facing or who have had mastectomy or lumpectomy are not offered all their reconstructive options.

Women have several breast reconstruction options. These include breast implants and "natural" techniques like flaps and fat grafting which use the patient's own tissue. The nipple and areola can also be recreated.

The animated presentation below provides an excellent overview for women interested in learning more about breast reconstruction and the options available.



I hope this info helps!

Dr C

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Dr Chrysopoulo is a breast reconstruction surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with Dr C on Twitter and Facebook.

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Silicone Breast Implant Rupture - Ultrasound or MRI?

Breast implant rupture is a risk associated with both saline and silicone implants, whether they are placed for cosmetic augmentation or breast reconstruction.

In the case of a saline implant, a rupture is very easy to detect. Saline implants deflate after rupturing as the saline (salt water) leaves the implant and is reabsorbed by the body. Beyond a clinical evaluation, no tests are required to confirm the rupture.

Silicone breast implant ruptures are usually much harder to detect. Early ruptures often go unnoticed by the patient since the silicone remains contained within the capsule of scar tissue formed by the body around the implant. These are known as "intracapsular" ruptures and are the most common. Intracapsular ruptures can progress to "extracapsular" ruptures over time.

Extracapsular ruptures involve a break in the scar capsule around the implant which allows silicone to leak out into the surrounding tissues. Associated changes in the breast can include capsular contracture, distortion, firmness, asymmetry and pain. Extracapsular silicone can also find its way into the lymphatics and lymph nodes.

If your silicone breast implant has ruptured the implant should be removed or replaced, if possible before the rupture becomes extracapsular.

The first step is to confirm the rupture with either an ultrasound or MRI. Most plastic surgeons, myself included, strongly prefer MRI when the patient has symptoms or a rupture is suspected since MRI is more accurate than ultrasound (94 vs 72%) and is less likely to miss a rupture.

Silicone Breast Implant MRI.
White arrow = "linguine sign" of intracapsular rupture
Black arrow = damaged implant capsule

Routine Screening to Check Silicone Implant Integrity

The FDA recommends that patients with silicone gel breast implants (cosmetic and reconstructive) undergo MRI screening to check for silent (intracapsular) rupture 3 years after implants are placed and every 2 years after that. Most plastic surgeons feel these recommendations are excessive since the risk of implant rupture within the first 5 years is very low and MRIs are very expensive. Many surgeons don't feel any routine screening is necessary at all. For those who do advocate for routine implant screening in women without any symptoms or changes on exam, ultrasound is a more cost effective alternative followed by MRI if the ultrasound is positive.

I hope this info helps!

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, TX, specializing in breast reconstruction and cosmetic breast surgery. Patients are welcomed from across and outside the US. To schedule a consultation, please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com. Connect with Dr C on Twitter and Facebook.

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Do you need a CT angiogram before DIEP flap breast reconstruction?

If you've had several previous abdominal surgeries and are considering DIEP flap breast reconstruction, a CT angiogram may be recommended by your plastic surgeon.

A CT angiogram (CTA) is a special type of CT scan that examines the blood vessels in the abdomen to determine if they are intact and able to be used for DIEP flap reconstruction. It can also provide a "road map" for the surgeon and help locate the largest blood vessels ("perforators").

Sometimes the vessels needed for the DIEP flap may have been damaged by previous abdominal surgery. Although the majority of previous abdominal surgeries are not a contraindication for DIEP flap reconstruction (except a tummy tuck), there is a small chance that the blood vessels may be damaged in patients that have had multiple previous abdominal surgeries or certain procedures.

While some surgeons obtain CT angiograms on their patients routinely before DIEP flap surgery, in our opinion not all patients need the study. A very good example is patients who have never had abdominal surgery. Much depends on surgeon preference and experience.

It is also important to realize that the test exposes patients to radiation; in many cases, patients have already had more than their fair share of radiation as part of their breast cancer treatment! At PRMA, we usually only recommend a pre-operative CTA in patients that have had multiple previous abdominal surgeries and there is a question about the vascular anatomy.

There is no doubt, despite the radiation exposure, a CTA can be an excellent planning tool when needed. Be sure to discuss any concerns you have regarding previous abdominal surgeries and the need for a CT angiogram with your plastic surgeon.

I hope this info helps!

Dr C

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Dr Chrysopoulo is a breast reconstruction surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

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What is a Microsurgery?

Microsurgery is a very intricate, specialized type of plastic surgery performed using delicate instruments, sutures finer than human hair and high powered magnification provided by either a microscope or high-powered loupes. Microsurgeons can repair and reconnect very small blood vessels and nerves less than 1mm in diameter.

Microsurgery has allowed significant advances in many surgical fields. Breast reconstruction has been transformed completely.

We can now replace tissue removed by a mastectomy with the patient's own tissue transplanted from another part of their body. Unlike conventional tissue reconstruction techniques (like the TRAM flap), the latest microsurgical techniques ("perforator flaps") carefully preserve the patient's underlying muscles. The tissue is disconnected from the body, transplanted to the patient's chest and reconnected using microsurgery.

Preserving underlying muscles lessens postoperative discomfort making the recovery easier and shorter. It also helps the patient maintain muscle strength long-term which is particularly important for active women.

Below is a video of microsurgery performed during a DIEP flap breast reconstruction. Here we are connecting the DIEP flap artery to the internal mammary artery in the chest under the microscope:

I hope this info helps!

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, Texas and an active member of the American Society for Reconstructive Microsurgery. He specializes in DIEP flap breast reconstruction and other state-of-the-art breast reconstruction procedures. He is in-network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to schedule a consultation.

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When should you see a Breast Reconstruction Surgeon?

It is very important for patients to learn about all their breast cancer treatment options, including breast reconstruction, as soon as possible after the initial breast cancer diagnosis.

It should go without saying that the top priority is always going to be to treat the cancer first, to try to cure the patient. However, treatment decisions early on in the process often determine the physical results the patient has to live with for the rest of her life.

If you think you may be interested in reconstruction, it is very important to see a breast reconstruction surgeon before any breast cancer surgery is scheduled. Of course this needs to be in a timely manner so as not to delay your cancer care. This is the only way to ensure you are truly involved in your treatment plan.

Seeing a reconstruction specialist very early on also allows patients interested in immediate breast reconstruction, (reconstruction performed at the same time as the mastectomy), to pursue it if they are candidates. Immediate reconstruction typically provides the best results and avoids the experience of living without a breast. For those who are not candidates, knowing they will have the option of reconstructive surgery once all their other breast cancer treatment is completed, (known as "delayed reconstruction"), is often a huge source of strength and relief.

Learn more about the differences between immediate and delayed breast reconstruction here.

I hope this info helps!

Dr C

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Dr Chrysopoulo is a breast reconstruction surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

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Tattoos to Cover Mastectomy and Breast Reconstruction Scars on the Rise

For years, tattoos have been used to apply the finishing touches to breast reconstruction. A form of medical tattooing is used to add color to the reconstructed nipple and areola as the final stage of the reconstructive process. Recently, 3D tattooing has also become available to add even more life-like results.

Some breast cancer patients are now turning to more "traditional" ink-based tattoos to cover their mastectomy or breast reconstruction scars in more elaborate ways.

If you've ever considered getting an elaborate tattoo to hide your breast cancer scars, rest assured you're not alone! I'm seeing more and more breast cancer patients doing just that. Here are some examples:

Tattoo over right mastectomy scar
Source: iconosquare.com

Tattoo over left breast reconstruction scar
Source: launchboulder.pmpblogs.com

If you're considering a tattoo yourself, here are some more examples of tattoos used to cover mastectomy and breast reconstruction scars.

From a surgical standpoint, I don't see a problem with patients choosing to go this route. It's a very personal decision. Tattooing won't "ruin" a breast reconstruction. However, tattooing of course does have its risks including skin infections (e.g. MRSA), allergic reactions to the dyes, additional scarring, ink deposition in lymph nodes and cartilage, and even blood borne diseases (e.g. tetanus, hepatitis B and C). Tattoo pigments can also occasionally interfere with MRI exams and decrease the quality of the images.

Like anything, doing your research is crucial. Please make sure you choose a reputable and experienced artist and review examples of their previous work ahead of time.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, TX, specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

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Does Immediate Breast Reconstruction Delay Chemotherapy?

Many patients think or are told they cannot have immediate breast reconstruction (reconstruction at the same time as mastectomy) because it will significantly delay chemotherapy. In reality, breast reconstruction very rarely interferes with chemotherapy.

Patients that have immediate reconstruction and need chemotherapy can start their treatments once they have healed from their surgery. This usually takes about 4 weeks. The healing time required before chemotherapy is about the same whether patients have mastectomy alone or mastectomy and reconstruction.

A small percentage of patients develop wound healing problems after their cancer surgery and may need slightly longer to heal completely. Even in these situations, studies have shown there is typically no delay in starting chemotherapy. Patients must also realize that wound healing problems can also happen after mastectomy alone.

In addition to the psycho-social benefits, immediate breast reconstruction is associated with less scarring and better cosmetic results. Patients that have delayed breast reconstruction, ie reconstruction some time after the mastectomy, complete all their breast cancer treatment before proceeding with reconstruction.

I hope this info helps.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon and microsurgeon in San Antonio, TX specializing in state-of-the-art reconstructive breast surgery. He and his partners at PRMA are in-network for most major US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients on Facebook.

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What Does Flap Breast Reconstruction Involve?

If you're considering breast reconstruction using your own tissue (a "flap" procedure), it's important to know that achieving the best results usually involves several stages and takes time.

BEFORE skin-sparing mastectomies and DIEP flaps

AFTER skin-sparing mastectomies and DIEP flaps

The patient in the pictures above required the following stages to complete her breast reconstruction:

Stage 1: The Initial Breast Reconstruction

Whenever possible, breast reconstruction should be performed at the same time as the mastectomy. This is known as "immediate breast reconstruction". This allows for less scarring because the natural breast skin envelope can usually be preserved ("skin sparing mastectomy"). Only the nipple, areola and breast tissue under the skin is removed. The patient above had bilateral skin-sparing mastectomies and DIEP flap reconstruction using tissue from her lower abdomen.

In some cases, the nipple and areola can also be preserved. This is called a nipple-sparing mastectomy.

Immediate reconstruction enables the patient to wake up from the surgery "complete" and avoid the experience of a flat chest altogether. Most women with early breast cancer (stage I or II) are candidates for this approach.

If immediate reconstruction isn't an option, or the patient prefers to wait, the reconstruction can be performed "delayed", any time after the mastectomy. Patients having radiation are often advised to delay reconstruction. Other reasons for delaying reconstruction include advanced breast cancer (stage III or IV) and lack of access to a specialist surgeon.

Stage 2: Revision
This is the "fine-tuning" phase and is usually performed as an outpatient procedure. This stage involves shaping the breasts and making them as symmetric as possible. Fat injections can be used to address any contour deformities and make the breasts look and feel even more natural. The donor site scar (scar from where the flap tissue was taken) is revised to make the area look as good possible. Nipple reconstruction is also usually performed at this stage if the patient did not have a nipple-sparing mastectomy.

Stage 3: Micro-pigmentation/Tattooing
This office procedure applies the "finishing touch". Color is added to the reconstructed nipple-areola complex to make the results even more natural. Women now also have the option of a 3D tattoo which can look very life-like, with or without a surgically reconstructed nipple-areola.

Each stage is performed 3 months apart which means that the entire reconstructive process can take several months. Insurance authorization is also required before each stage.

I hope this info helps.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon in San Antonio, TX specializing in the DIEP flap and other state-of-the-art breast reconstruction procedures. He and his partners at PRMA are In-Network for most US insurance plans. Patients are welcomed from across and outside the US. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with others touched by breast cancer on Facebook.

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