Restoring Your Body, Reclaiming Your Confidence
Breast Reconstruction Ashburn, Leesburg
Breast reconstruction surgery is a source of hope for women who have lost one or both of their breasts to cancer. With a practice focusing especially on breast surgery, Dr. Timothy Mountcastle possesses the experience and compassion necessary to rebuild your breasts and help you reclaim your confidence after a mastectomy. If possible, Dr. Mountcastle may partner with your breast cancer surgeon to perform your reconstruction at the same time as your mastectomy, which often yields the best cosmetic results.
If you are a cancer survivor who wishes to learn more about restoring your contours through breast reconstruction, please contact our Ashburn, Leesburg, or Reston office today.
Breast Reconstruction Techniques
The goal of breast reconstruction surgery is to restore the chest as closely as possible to its appearance prior to cancer treatment. Dr. Mountcastle will use one of several techniques to accomplish this goal. Because there is insufficient tissue on the chest wall after a mastectomy for the placement of a breast implant, reconstructive surgeries typically involve a skin expansion or flap technique.
Skin Expander with Breast Implants
The simplest reconstructive breast surgery involves the placement of a tissue expander under the skin, which can be done either at the time of the mastectomy or at a later date. The insertion of the skin expander is performed using either intravenous or general anesthesia during a procedure that lasts roughly two hours.
Every week thereafter for approximately four to six months, a saline solution is injected into the expander through an internal valve, which causes the skin gradually to stretch. When the skin has stretched sufficiently, the expander is replaced with a saline or silicone breast implant. At this point, any scar tissue resulting from the use of the expander will also be removed.
The reason an implant cannot be placed during the mastectomy has to do with wound healing and tension. After a portion of the skin and nipple-areola complex has been removed, tension must be minimal in order for the wound to heal. Only after the wound has healed can the saline solution be injected into the tissue expander; this eliminates the possibility of a suture breaking, causing the expander to become exposed. Because expanders are vulnerable to bacterial accumulations that cannot be effectively treated with antibiotics, exposure to outside elements would necessitate its removal. After an infected expander or implant is removed, the area must be free of foreign material for as long as three months before another attempt at reconstructing the breast can be made.
Breast reconstruction using a skin expander offers the benefits of minimal pain and a short recovery time when compared to flap procedures. However, the process is gradual, as restoration requires several months, multiple office visits, and, in some cases, further surgery. There is also a risk of infection and exposure, contracture, or rupture of the implant.
DIEP Flap Procedure
Dr. Mountcastle is one of the few plastic and reconstructive surgeons in the greater Washington, D.C. area with the skill and knowledge necessary to perform a deep inferior epigastric perforator (DIEP) flap procedure. This advanced technique uses the patient’s own tissue to reconstruct the missing breast, transferring skin and fat from the abdominal region to the chest. Because the skin and fat below the belly button are similar to breast tissue, the result is a reconstructed breast that looks and feels as natural as possible. Additionally, breasts reconstructed with the DIEP flap technique are longer lasting than those reconstructed with implants, which may need to be replaced after 10 to 15 years. Dr. Mountcastle routinely performs DIEP flap reconstructions with a co-surgeon, Dr. Reza Mirali-akbari, as the complex nature of the procedure requires the skill of two plastic surgeons in order to achieve the best possible results.
The removal of skin and fat from the abdominal region produces results similar to those achieved with a tummy tuck, and many women consider the smoother, flatter appearance of the abdomen to be an added benefit of DIEP flap reconstruction.
The DIEP flap is a newer version of the long-used TRAM (transverse rectus abdominis myocutaneous) flap. The two procedures are very similar, differentiated primarily by the fact that the TRAM flap removes the rectus abdominal muscle along with the fat and skin, while the DIEP procedure leaves the muscle untouched. Much lower rates of hernia formation and abdominal weakness have been noted among patients treated using this muscle sparing technique.
To perform the DIEP flap reconstruction, Dr. Mountcastle makes an incision slightly above the bikini line in order to remove the necessary skin, fat, and blood vessels from the abdominal region. These tissues are reshaped to create the new breast, and the blood vessels are expertly linked to existing vessels in the chest using a technique known as microvascular surgery. A single reconstruction procedure lasts approximately four to six hours, and patients should expect a recovery time of approximately two to four weeks.
The primary benefit to choosing DIEP flap reconstruction is that it requires fewer surgeries than reconstruction using a skin expander. The success rate of this surgery is approximately 95 percent, and success is dependent on the blood vessels being micro-sutured together properly.
The procedure takes its name from one of the blood vessels involved in the procedure. DIEP stands for “deep inferior epigastric perforator,” which is the major blood vessel feeding the tissues removed from the lower abdomen. This blood vessel is sutured to the blood vessel in the chest called the internal mammary artery. Both blood vessels are extremely small – about the size of a pinhead – and sewing them together under a microscope takes great care. Patients need to stay in the hospital for three to four days after surgery to ensure that the blood vessels connected in surgery do not present complications. In 5 to 10 percent of cases, it is required that this connection be checked for clots or flow problems.
While the DIEP flap procedure offers natural-looking breast reconstruction results with minimal risks, it does require a longer hospital stay and recovery period. Contact Dr. Mountcastle to discuss breast reconstruction at his Ashburn, Leesburg, or Reston office, where he will help you choose the surgery that is right for you.
SGAP and ALT Flap Procedures
For patients who have insufficient abdominal tissue, using the buttocks or outer thigh offers additional options for reconstruction of the breast. No two patients are alike, and some have more fat in the thigh or buttocks region. Using the same microsurgery techniques as the DIEP flap procedure, SGAP and ALT flap procedures provide patients without excess abdominal fat alternative methods of breast reconstruction.
Fat Grafting
Fat grafting is a useful method of adding volume to the breasts. It also provides a potentially ideal solution for patients who had only a portion of their breast removed with a lumpectomy. Using the same fat grafting techniques he uses to perform breast augmentation, Dr. Mountcastle carefully removes fat from appropriate areas on the body. This fat is then cleaned, drained of its impurities, and re-injected into the breast.
Additional Procedures
After the placement of the breast implant, additional grafting procedures may be desired in order to reconstruct the nipple and tattoo the areola. Women who have had a mastectomy to remove one breast may find that a surgical enhancement of the remaining natural breast is useful in ensuring symmetry. Dr. Mountcastle is committed to providing patients with the most natural-looking reconstructions possible, and will work with you to ensure that the goals you have for your breast surgery are met. According to the 1998 breast reconstruction law, your insurance company must cover all of these additional surgeries.
Learn More about Breast Reconstruction Surgery
While the treatment of cancer may require women to undergo mastectomy, it does not mean that they will have to live without one or both of their breasts. We invite you to schedule a consultation to learn more about breast reconstruction surgery at the Ashburn, Leesburg, or Reston office of Dr. Mountcastle today.
