Tissue Expander Implant reconstruction
The most common method used to reconstruct a breast after mastectomy involves placement of a temporary implant device known as a tissue expander into the mastectomy space. Over time, the expander is filled, expanding the remaining skin and tissues in preparation for placement of the final implant.
In non-nipple sparing mastectomy, a nipple can then be created from the expanded tissues together with a graft of skin to become the areola. Additionally, fat grafting around the upper perimeter of the implant can blend the contour more naturally and pigment can then be introduced into the reconstructed nipple and areola (tattooing) to create a lifelike breast and nipple areola.
I place air in my expanders because it is lighter initially and allows for more rapid expansion. I switch out the air for saline at the end of expansion process. I use thin sheets of alloderm (acellular dermal matrix) combined with pectoralis muscles for partial muscle coverage which allows for quick expansion and better shaping. I removed this allograft and replace it completely with an extra thick sheet of alloderm at the second stage procedure which allows me to refine the breast shape. I feel this approach is a far better way to create post mastectomy breast shape.
Latissimus Flap with Implants
I believe direct to implant reconstruction is safest when combined with latissimus muscle (and skin) flap. It is superior for women who prefer to wake up from a mastectomy with a completed or near completed breast reconstruction. Latissimus flap with implant is specifically beneficial for women who have had breast lift, reduction surgery or implants prior to needing a mastectomy. I create an internal bra out of muscle while placing an implant. The results can be aesthetically superior to all other methods of reconstruction and although there is a scar on the back, patient satisfaction is extremely high.
I believe this operation is poorly understood by patients and surgeons alike and its value in breast reconstruction is under appreciated.
Latissimus flap is also quite useful in reconstructing a breast that has been radiated or one that failed either tissue expander or DIEP flap reconstruction.
Tram and DIEP Flap Reconstruction
The use of abdominal tissue to recreate a breast at the time of mastectomy (immediate) or at any point after mastectomy (delayed) can be performed with the muscle carrier attached (pedicle TRAM flap) or as microsurgical free tissue transfer (DIEP flap).
The perceived downside of a TRAM flap stems from the use of more muscle in the flap transfer and the potential abdominal wall weakness or hernia that might come about. I have 25 years performing this operation and can say that the results can be very natural and since I have such extensive experience with tummy tucks, my abdominal portion of the TRAM flap is generally very strong and quite aesthetic. Some surgeons consider the abdominal portion as an afterthought, whereas I use it as an opportunity to create enhanced aesthetics.
Oncoplastic Breast Reconstruction
The use of local tissues to reconstruct a breast which is undergoing lumpectomy or partial mastectomy all in the same surgery simultaneously is known as oncoplastic reconstruction. This is where is it very important that the plastic surgeon is creative and a quick thinker on the spot since the resulting defect left behind by the breast surgeon is often impossible to predict in advance.
The foundation of these reconstructions stems from my experience with auto augmentation mastopexy and I believe that is why my outcomes here are greatly appreciated by both patients and their breast oncology surgeons.
We take pride in what patients say about us
It has been a long and exciting journey, 3 years and a total body lift later, Dr. Spiro met and far exceeded all of my expectations. Dr. Spiro makes you feel special and deserving, that it is never too late and you are never too old to make a change. He expects the best results, and with Dr. Sprio you are getting the best!
For many reasons, my journey took longer than expected, but throughout Dr. Spiro assured me that when I was ready for each stage of reconstructive surgery he would be ready, willing and able to get the job done. When I look in the mirror each day I’m astounded at how wonderful and natural my breasts look — just as he promised they would. As any mastectomy patient can tell you, this process makes you feel as if you are losing a piece of yourself. Dr. Spiro made me whole again.