Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.
Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.
The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life. Although surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed.
Types of Breast Reconstruction:
Tissue Expander/Implant Reconstruction
A permanent implant can sometimes be placed immediately at the time of the mastectomy, however reconstruction with an implant often requires tissue expansion. Tissue expansion stretches healthy skin to provide coverage for a breast implant. Reconstruction with tissue expansion frequently allows a faster and easier recovery than flap procedures, but it is sometimes a more lengthy reconstruction process.
It typically requires several office visits over 2-3 months after placement of the expander to gradually fill the device through an internal valve to expand the skin. A second surgical procedure will be needed to replace the expander with a permanent implant.
Surgical placement of a breast implant creates a breast mound. Secondary procedures are often done to further improve shape and symmetry and to create a new nipple and areola.
TRAM is short for transverse rectus abdominis muscle, which is a muscle in the lower abdomen between your waist and pubic bone. A flap of this skin, fat, and muscle are used to reconstruct the breast in a TRAM flap breast procedure.
TRAM flaps are commonly performed, due to TRAM flap tissue being natural living tissue which feels quite similar to breast tissue — making a good substitute.
Latissimus Dorsi Flap
A latissimus dorsi flap uses muscle, fat and skin from the back tunneled to the mastectomy site. In some cases the the flap is used alone to cover a mastectomy defect, but an implant is often used underneath the flap to reconstruct an adequate size breast mound. In contrast, implants are typically not necessary with TRAM flaps to create a full size breast mound.
While implant reconstruction and flap reconstruction can both be very effective in creating a good breast mound, additional procedures are often done at a later time to further improve breast contour and symmetry.
- Nipple and areolar reconstruction: typically minor outpatient procedures where a small skin flap is done to create the raised nipple and then medical tattooing is done to create the darker pigmentation of the nipple and areola.
- Secondary contouring procedures are often done to improve the contour and position of the reconstructed breast and the lower breast crease.
- Surgery is commonly done on the opposite breast to reduce, lift, or augment the breast to better match the reconstructed breast.
- All of these procedures are typically covered under health insurance.
Hand surgery is a specialized surgery — often treating pain and dysfunction related to disease and injury. It can increase the strength, function, and flexibility of fingers and hand.
Dr. Monacelli has extensive training and experience treating many types of hand problems. Common hand problems that he treats include:
- Carpal Tunnel Syndrome
- Trigger fingers
- Ganglion cysts
- Hand and wrist lumps
- Dupuytren’s contracture
Scars — whether they’re caused by accidents or by surgery — are unpredictable. The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon’s skills or techniques.
Many variables can affect the severity of scarring, including the size and depth of the wound, the blood supply to the area, the thickness and color of your skin, and the direction of the scar. How much the appearance of a scar bothers you is, of course, a personal matter.
While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection of certain steroid medications, application of silicone gel pads, or through surgical procedures known as scar revisions.
Surgical scar revision typically involves removing or releasing the old scar tissue and repairing the wound with various techniques with the hope and expectation that it will heal better than before. In some cases this is not always possible.
Skin cancer is the most common form of cancer in the United States. More than 500,000 new cases are reported each year — and the incidence is rising faster than any other type of cancer. While skin cancers can be found on any part of the body, about 80 percent appear on the face, head, or neck, where they can be disfiguring as well as dangerous.
Dr. Monacelli has extensive training and experience in treating skin cancers all over the body, but particularly in difficult areas such as the nose, eyelids, lips, ears, and other areas on the face. He works closely with dermatologists, pathologists and oncologists in treating all types of skin malignancies, and reconstructing these areas to preserve function and minimize deformity.