Dr. Gilbert Wesley Lee, MD, FACS

There are a few different methods used to create the round shape of the breast on the chest. A flap of fat, skin, and muscle can be taken from the side, abdomen or buttock and implanted on the chest to create a breast from the patient's own tissue. Alternatively, the skin over the chest may be gradually stretched to allow for the placement of an implant. Stretching of the skin is done using expanders, which are similar to breast implants, except they increase in size when saltwater solution is injected into them. Many women also choose to combine the flap procedure with implant placement to achieve their desired result. Once the new breast shape is formed, a nipple can be created and even tattooed to match the other side.

Reconstruction may be done in a single surgery or broken up into multiple procedures:

• Immediate reconstruction rebuilds the breast right after mastectomy. This method is not recommended if additional chemotherapy or radiation is needed after surgery.
• Delayed reconstruction occurs after chemotherapy or radiation has been given. These treatments may decrease the volume or alter the color of the reconstructed breast, so they should be completed before the breast is rebuilt. This type of reconstruction may happen weeks, months, or even years after mastectomy.
• Staged reconstruction splits the reconstructive process into two parts. The first part inserts temporary expanders to stretch the skin and is done immediately after breast removal surgery. The second part replaces the expanders with implants after chemotherapy or radiation treatments have been given.

Breast reconstruction is not perfect. The two breasts may not always look exactly identical, although they will be close. There may be small scars, and a loss of sensation in the reconstructed breast. A reconstructed breast will not produce milk, so patients may have trouble breastfeeding. Still, reconstruction is a great option for women who want that part of their appearance back.

Before the procedure, a skin evaluation is done to determine which type of peel will produce the best results. Dark skin tends to respond well to light peels, while severely sun-damaged skin will likely benefit from a moderate or deep peel. Pre-treatment creams and sunscreen need to be applied every day for several weeks prior to the procedure. Doing this may help shorten the healing process.

During the peel, the area to be treated is cleaned thoroughly, and the chemical solution is applied on the skin for several minutes, which produces a stinging sensation. A neutralizing agent is then used, and the stinging sensation gradually goes away. For more intense peels, a cool compress may be placed on the area to relieve any stinging or burning, or the solution may be applied in intervals to limit exposure to the strong chemicals.

Following a light peel, there will be redness and swelling, which typically fade in a few days. Swelling after a moderate or deep peel may last for a week, and mild redness may continue for a few weeks. To help improve the final results of a peel, treated areas must be kept cool, moisturized, and protected from sunlight.

During dermabrasion, a nurse or other healthcare professional holds the skin taut so that the doctor can apply gentle but constant pressure on the skin using the device. Depending on how much skin needs treatment, it may take a few minutes to over an hour to complete the surgery.

A waxy or moist dressing is placed on the skin at the end of the procedure. The treated area will be red and swollen for about two to three weeks. Itchiness and tingling will likely be present for some time. Although less common, enlarged pores, cold sores, rashes, and permanent skin discoloration may also occur. Normal activities may be resumed about two weeks following dermabrasion. However, swimming in chlorinated water and sports that involve the use of balls should be avoided for four to six weeks.