Breast Reconstruction Atlanta

Acellular dermal matrix, or ADM, is essentially cadaver skin that has been removed of its cells, leaving a scaffold that can be incorporated into your breast reconstruction. Traditionally, ADM has been used as a “sling” to support the bottom pole of your breast, allowing for a larger implant-based reconstruction and helping reduce risks of breast implant capsular contracture. Currently, use of ADMs for breast reconstruction is considered “off label” by the FDA, but they remain a routine tool by the vast majority of plastic surgeons in the United States. Dr. Patel has toured the manufacturing site of one of the major ADM companies, and he can attest to the safety of ADMs available on the market, as well as the respect given to the skin donors. ADMs are specially prepared and packaged before their use in the operating room. In the O.R., Dr. Patel and his team additionally rinse the ADM free of any preservatives and ensure its safe placement into your developed breast pocket.

Autologous fat grafting involves liposuction of an area, typically the abdomen or thighs, to obtain fat that can be purified and injected to a site of breast reconstruction. In some cases, fat grafting can suffice for an area treated by lumpectomy without the need for breast implants or flaps.

Fat grafting can also be useful in the setting of radiation, as the donated fat is rich in stem cells, which are theorized to improve the overall quality of damaged, irradiated tissues. Typically, fat grafting requires multiple sessions for optimal success, as the body tends to resorb a certain percentage of what was injected (it can be as high as one-third to one-half, depending on your body as well as fat grafting technique).

Based on currently available literature at the time of this writing, fat grafting is still considered safe by the plastic surgery community. There is no strong evidence that fat grafting can stimulate breast cancer growth. Dr. Patel still finds fat grafting incredibly useful to correct modest areas of soft tissue deficiency after a lumpectomy or mastectomy with a primary reconstruction.

With overaggressive fat grafting or with poor grafting technique, oil cysts or fat necrosis (dead fat) can result, which can create confusion with any future breast imaging such as ultrasound. Dr. Patel utilizes the most up-to-date fat grafting techniques to ensure only a safe amount of fat is administered with each round of fat grafting.

Good candidates for nipple sparing mastectomy (NSM) include thinner patients and those with less complex breast cancers that are located well away from the nipple areola complex. Having multicentric disease (multiple cancers in the breast) generally prevents you from undergoing NSM. Risks of nipple loss are heightened with this approach, especially as the nipple must rely on blood flow from the remaining tissues of the mastectomy skin flaps, and an implant underneath will exert stress on it as well. Dr. Patel is comfortable performing breast reconstruction in the setting of an NSM, and will work closely with your breast surgeon to optimize your outcome safely. Monitoring the appearance of the nipple clinically and evaluating the mastectomy skin and nipples in the operating room with use of a special angiography device (called “SPY”) are both ways for Dr. Patel’s team ensure an NSM will be successful.

This approach to breast reconstruction involves the use of ADM as a “wrap” around a tissue expander or permanent breast implant, which is then placed above the pectoral muscles and under the mastectomy skin. In this way, the reconstruction is prepectoral, with the major advantage of avoiding having to elevate the pectoral muscles and cause long-term animation deformity issues. Downtime and recovery can be superior to subpectoral reconstruction.

However, performing prepectoral reconstruction requires robust and sufficiently thick mastectomy skin flaps, which can be assessed in the OR clinically and with the use of special technology (SPY angiography). In some cases, the choice of prepectoral versus subpectoral reconstruction can be a “game time” decision depending on the mastectomy skin, and you must be prepared for either possibility if undergoing implant-based breast reconstruction.

Direct-to-implant (DTI) breast reconstruction involves placement of the permanent breast implant (typically, silicone-filled) at the time of mastectomy, providing the major benefit of avoiding a two-stage reconstruction. This option can be very effective for patients who have already undergone breast augmentation before their breast cancer diagnosis, as the skin has already been stretched by the original implants. DTI is not for everyone, however, and if your mastectomy skin cannot accommodate a permanent implant right away, or if radiation therapy is planned, Dr. Patel will counsel you on more traditional reconstructive approaches.

No. Ultimately, undergoing breast reconstruction is a personal choice, and Dr. Patel will provide you with all the data and information you need to make an informed decision. Many breast cancer patients opt against reconstruction altogether and accept the visual defects or contour deformities left behind by a lumpectomy or mastectomy. Having a custom-made breast prosthesis is another, noninvasive alternative to breast reconstruction and remains an option if all other attempts at breast reconstruction have been tried and failed.

By federal law (the Women’s Health and Cancer Rights Act of 1998), insurance companies must allow for surgery and reconstruction of the other breast to make the breasts look symmetrical or balanced after mastectomy.

As follow-up legislation, the more recent Breast Cancer Patient Education Act (BCPEA) aims to improve breast cancer patients’ knowledge of breast reconstruction options and alternatives post-mastectomy. Dr. Patel was part of a larger effort by the American Society of Plastic Surgeons to help convince members of Congress to pass the BCPEA into law in 2015.

One option is to undergo an oncoplastic breast reduction immediately following your lumpectomy (a.k.a. partial mastectomy), in which larger breasts can be reshaped to camouflage the defect created by the lumpectomy. Candidates for oncoplastic breast reduction are similar to those who would otherwise be considered for a regular breast reduction. Large-breasted patients can better camouflage the ‘divot’ created by a lumpectomy than can smaller-breasted patients. When the cancer is localized to one area of the breast, it allows Dr. Patel to decide on the design of your breast reduction. If you have multiple areas of breast cancer (multicentric disease), this approach will likely not be feasible. Always prioritize your breast cancer treatment above all else.