Dr. Rhee’s approach to breast reconstruction begins with listening to you, the patient. Different patients have different priorities, and fitting the reconstructive method with your particular situation is the primary concern. Whether or not a decision is made to proceed with breast reconstruction, he will furnish you with as much information as you desire or need to make an informed decision. You will be an integral part of the decision process.
Ultimately, the goal is to provide you with a pleasing, beautiful result in as safe a manner as possible. Dr. Rhee has worked with dozens of breast surgeons and will work with your surgeon in a coordinated fashion to help facilitate care during this frequently busy time.
The following information is presented in outline form and may be used as a reference before your consultation with Dr. Rhee. It is meant to help organize your thoughts regarding reconstruction and to help introduce some terminology. If the information is overwhelming, don’t worry as your consultation is meant to answer these questions. It is frequently helpful to have another family member with you during your initial consultation to act as “another pair of ears.”
The following website is also a helpful source of information for patients contemplating breast reconstruction.
Additional information regarding breast reconstruction can be found at this website.
Immediate vs. Delayed Reconstruction
In the world of plastic surgery, the term immediate breast reconstruction refers to performing the first stage of breast reconstruction at the same time as the mastectomy. Conversely, the term, delayed reconstruction refers to performing the first stage of breast reconstruction at some interval after the mastectomy. There are pros and cons to each of these approaches, and this will be discussed with you at your consultation.
Implant (Prosthetic) vs. Autologous (Your Tissue) Reconstruction
TRAM flap: This stands for transverse rectus abdominis musculocutaneous flap. It was developed in the early 1980’s and is a way of using abdominal tissue for breast reconstruction.
Free flap: Generally refers to moving tissue from one part of the body to another while re-connecting the blood vessels that keep the tissue alive. It can refer to any number of flaps. For breast reconstruction, it typically refers to a TRAM flap. A DIEP flap is one type of free TRAM flap. Dr. Rhee does not perform this procedure, but if it is the right one for you, he will refer you to the appropriate center.
Latissimus flap: Was developed in the 1970’s and refers to the use of back tissue for breast reconstruction. It is usually still necessary to use an implant for volume, as the back typically lacks enough tissue to reconstruct the breast by itself.
Tissue expander reconstruction: One stage (all done at the same time as the mastectomy—sometimes referred to as direct to implant). Two stage (2 distinct procedures to accomplish the reconstruction, typically involving a tissue expander).
This refers to preoperative design of mastectomy incisions in an effort to maximize skin preservation for breast reconstruction. There are numerous potential designs and the choice of design is dependent upon your specific circumstances.
Safety of Breast Implants
Gel implants have been available since 1963 and have gone through several generations of basic design.
1st Generation: Thick shell with Dacron patch
2nd Generation: Thin outer shell, high rupture rate at 10 years
3rd Generation: Stronger outer shell with more cohesive gel
There is no evidence indicating that silicone breast implants are carcinogenic in humans. Almost every rheumatologic disorder has been blamed on breast implants in various anecdotal reports. At the present time, most experts agree that the evidence that breast implants are linked to rheumatologic disorders is unconvincing at best.