Dr. Jeffrey Rosenburg: My specialty is plastic and reconstructive surgery. I do both cosmetic surgery and I also do quite a bit of reconstructive surgery, probably the number one reconstructive surgery I do would be breast reconstruction. Most of the time today we do breast reconstruction at the same time as the mastectomy.

There are various types of breast reconstruction. We can use implant material. We can use an implant to reconstruct the breast. We can use the patient's own tissue which would come either from the abdomen or the back or some area of the body, or we can use a combination of both. We can use a flap of tissue taken perhaps from the back along with an implant to try to make the best result.

So it really depends on the patient's wishes what type of surgery they've had in the past, how severe their disease is, that sort of thing. Well, what I have brought with me are two types of implants. One is the Tissue Expander which we actually use to at the time of mastectomy to create extra tissue which will later become the reconstructed breast. So what we do is this is basically a deflated silicon balloon, and it's got a filling port in the center. And this device is implanted under the muscle, the pectoralis muscle of the chest at the time of the mastectomy surgery.

The muscles closed over it, the skin is closed over it. So this is completely buried. And after the healing has taken place following the surgery, patient will come to the office and we will use a little magnetic device to locate the filling port under the skin. We put a little bit of local anesthetic in the skin and then we inject a saline solution into the tissue expander. And what happens over time is that the tissue expander will grow. It works on the same principle as pregnancy that's something slowly growing under the skin will stretch the skin.

So after this becomes large enough and matches the other breast we will do a second operation to remove the tissue expander and put in a permanent silicon implant. This is a pretty typical looking implant. The newer implants have been studied quite carefully and we feel they are very safe. They have very sturdy shells and the incidence of rupture, although not zero has been reduced.

Prior to surgery I think most plastic surgeons would like to see a patient a few times to go over the procedure and to review what's really involved. It's very hard for a person to fully grasp everything that's involved with the breast reconstruction in just one visit. So in my practice I like to see them back at least two times prior to the reconstruction. Other than that the preparation for the operation would involve basically the same things which would be involved for a mastectomy.

Recovery would vary depending on the type of reconstruction we do. The simplest type of reconstruction using a tissue expander adds virtually nothing to the recovery time of the original mastectomy. Patients are usually kept in the hospital maybe overnight, and in some cases could probably even go home the same day. The more complex reconstruction using microsurgery free tissue transfer might require several days of hospitalization.

We follow the patients a lot. And a part of the reason for that as I think it's important with breast reconstruction especially to give the patient a lot of emotional support as well as following them after the surgery. It's a traumatic occurrence in any woman's life, and I think it's important to see them as often as you can to try to help get them through the process both emotionally and physically.
An obvious question is, what do women expect after reconstruction -- what should they expect after reconstruction procedure? And the first thing I'd say is that a reconstructed breast is not a real breast in terms of appearance or sensation. We can get pretty close to matching the other breast. But in some cases what we have to do is to do another operation on the normal breast to try to either elevate it or reduce it or in some way match the reconstructed side.

So it's not uncommon that we tell them women when they come in for a breast reconstruction consultation that they may require surgery on the other breast in order to match them up as closely as possible.

My recommendation to women would be that consultation with a plastic surgeon following course or discussions with their general surgeon can be very beneficial both in long-term psychological outcome as well as the physical appearance.

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