Dallas Breast Reconstruction

Breast reconstruction is an integral part of the treatment of breast cancer. Breast reconstruction can happen at the time of mastectomy or at a later date as a separate operation. The timing depends on a variety of factors. These may include the women’s wishes, desires and goals, the type and size of tumor, the possible need for post-operative radiation therapy or chemotherapy. These decisions are made by the woman in consultation with her surgeon, oncologist, and plastic surgeon. At our Dallas Breast Reconstruction Center we will guide you through this process.

The overall goals of breast reconstruction are to create a breast mound, to achieve a normal and symmetric silhouette, to limit patient morbidity, and to avoid the need for an external prosthesis. In more recent years our goals have progressed to achieve improved aesthetic results regardless of the route. Breast reconstruction can be divided into three broad categories: implants with or without tissue expansion, autologous tissue, and a combination of implants and autologous tissue. Regardless of the type of reconstruction chosen, it typically requires more than one procedure to complete breast reconstruction. It is very important to make sure all available options for breast reconstruction are presented and discussed. Dr. Haddock performs all types of breast reconstruction and can guide you to make an individualized and informed decision.

The timing of breast reconstruction is another important factor to consider. Breast reconstruction can occur at either the time of mastectomy or at some point after the initial mastectomy is completed. These two time frames are referred to as immediate or delayed reconstruction.

Most surgeons agree that the aesthetic result and technical ease are improved in an immediate breast reconstruction compared to delayed reconstruction. At centers that perform immediate breast reconstructions, the breast oncologic surgeons typically utilize skin sparing mastectomies. This method of mastectomy allows for local control of the breast cancer while preserving the breast boundaries. When breast reconstruction is performed in the immediate setting, there is no scar contracture to overcome and the skin envelope helps maintain the natural borders of the breast. By preserving the natural skin brassiere, the reconstruction is more straightforward and leads to a reconstruction that is more symmetric to the opposite breast.

In delayed reconstruction, the natural borders no longer exist. The plastic surgeon must recreate the mastectomy defect and redefine the borders. The quality of the chest skin must be critically evaluated, as some patients will have had chest wall irradiation in which case the resulting scar and skin contracture may limit the projection and ptosis of the breast pocket. This may lead to difficulty expanding the skin or may require recruitment of skin for the breast from another part of the body.

In many situations Dr. Haddock utilizes what is termed a delayed immediate approach. This involves placing a tissue expander at the time of the mastectomy. In a delayed fashion this can then be converted to a DIEP flap or PAP flap. If the patient has not determined the route for definitive reconstruction then there is still time to make this decision. This also allows more control over the breast shape and longterm cosmetic result. Dr. Haddock will discuss the options at length so that the patient is completely comfortable with her decision.

Overall, breast reconstruction, either with implants or autologous tissue, has shown to improve the patients’ quality of life by restoring the patients’ sense of self and body image. It does not hinder the treatment of the cancer or hide any recurrences. In fact, breast reconstruction aids in the total recovery of the breast cancer patient through physical and mental rehabilitation.

In modern breast reconstruction there are a number of options for patients. While this is a great advantage over previous years it can be very overwhelming for patients to chose. The most simple way to think about it is in terms of three choices. A patient can chose to undergo breast reconstruction with an implant, her own tissue, or a combination of an implant and her own tissue. The most common methods in Dr. Haddocks practice are implants, DIEP flaps or PAP flaps. Dr. Haddock also offers lumbar artery perforator flaps (LAP Flaps) and lateral thigh perforator flaps when needed.

No matter what route you chose for breast reconstruction it is important to ask questions and be fully comfortable with your surgeon. Additionally, you should make sure your surgeon is experienced in breast reconstruction and is passionate about this work. Dr. Haddock has performed thousands of breast reconstruction procedures. This includes over 3,000 flap based breast reconstructions and over 3,000 implant based breast reconstructions. Dr. Haddock has presented at multiple regional, national and international meetings on breast reconstruction.

In our Dallas Breast Reconstruction center we offer state of the art treatment with the most advanced methods of reconstruction available. Most surgeries are performed at Clemens University Hospital. Here we have specialized teams and hospital units that focus on our breast reconstruction patients. We have a number of patients that chose to travel to Dallas for breast reconstruction. We are happy to assist you in this process.

We have a coordinated approach to provide the best experience possible for our patients.  This involves an enhanced recovery after surgery (ERAS) protocol for both tissue expander surgery as well as all flap based surgeries.   These pathways have significantly decreased required pain medications and required length of stay for our patients.

Reconstruction of the nipple-areolar complex is an important component to complete breast reconstruction as the nipple is the central focus when viewing the breast. This has also been shown to have a major psychological benefit to the patient when compared to those without nipple areolar complex reconstruction. Most methods of mastectomy remove the nipple-areolar complex along with the breast tissue as the nipple contain extensions of the ductal system that are also at risk for neoplastic disease. The resulting initial post-op reconstruction is therefore left without a nipple.

For the best result Dr. Haddock recommends either a nipple reconstruction and areolar 3D tattoo or at a minimum a 3D tattoo for the entire nipple and areolar complex. This is typically performed three months after the size and shape of the breast is as desired. In some situations, a patient might be concerned about the projection of the nipple reconstruction. The surgical reconstruction can be tailored to the patient's wishes, either smaller or larger is typically possible. The 3D tattoo can also enhance the appearance of projection without too much projection through clothes.

Although most forms of mastectomy remove the nipple-areolar complex, the nipple sparing mastectomy, removes the breast tissue but spares the nipple and areola. A discussion with the surgical oncologist will determine whether the patient is a candidate for this type of procedure. If the patient is not a candidate for a nipple sparing mastectomy, nipple areolar complex reconstruction has been shown to have a positive impact on a patient’s satisfaction with the cosmetic result of the breast reconstruction. Results of all options are shown in the photo gallery.