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Plastic and Reconstructive Surgery

UCLA Division of Plastic & Reconstructive Surgery offers options for immediate breast reconstruction

01/01/2011

CU-Plastic SurgeryThe UCLA Division of Plastic & Reconstructive Surgery offers immediate breast reconstruction as an option for women undergoing mastectomies. Our plastic surgeons provide consultations in conjunction with general surgeons and surgical oncologists in order to incorporate reconstruction into a patient’s surgical treatment plan, ensuring patients achieve an optimal cosmetic and psychological outcome once they are cancer-free.

The technique used depends upon a number of different factors (age, anatomy, medical history, history of radiation therapy, etc.) but most patients are able to choose between a breast reconstruction utilizing silicone or saline implants and a microvascular free-flap reconstruction. Most women have a comfortable familiarity with breast implants and the aesthetic results they can achieve. A free-flap reconstruction uses skin and fat transferred from the stomach to reconstruct the breast. Free-flap techniques used at UCLA avoid the need to transfer the abdominal muscle along with the skin and fat tissue.

Tissue expanders

In this procedure, a plastic surgeon inserts a temporary implant under the pectoralis major muscle of the chest wall. Saline is injected into the implant post-operatively. As the implant’s volume increases, it slowly stretches the overlying tissue, creating a pocket for a permanent silicone or saline implant. Depending on the desired size and the surface area of available tissue, the process can take anywhere from several weeks to several months. Once the expander has reached the desired volume, a second surgery is necessary to exchange it with a permanent implant.

Breast implants

In a procedure similar to a breast augmentation, a plastic surgeon uses an implant — either silicone or saline — to replace the tissue lost during the mastectomy. Both types of implants have a silicone elastomer shell (a type of plastic that resists rupturing and does not break down in the human body). As their names imply, silicone implants are filled with a liquid silicone gel, while saline implants are filled with saline (salt water). Both implant types come in a variety of sizes, shapes, and surface textures, and silicone gel implants come with varying degrees of gel cohesiveness.

Numerous studies have demonstrated that silicone gel implants are as safe as saline implants, though the different fillers have different textures and will give the breast a different post-operative feel. Women undergoing reconstruction using implants should carefully consider both types of implant in order to make an informed decision.

An additional surgery may be necessary to reconstruct the nipple and areola.

Free flaps

Autologous breast reconstruction with a free flap is a more complicated operation than an implant reconstruction. It uses skin and fat transferred from the stomach to reconstruct a patient’s breast. The Deep Inferior Epigastric Perforator (DIEP) flap and the Superficial Inferior Epigastric Artery (SIEA) flap techniques used at UCLA allow surgeons to reconstruct the breast without the need to transfer the abdominal muscle, which tends to weaken patients and lengthen recovery time.

Free-flap reconstruction requires a longer hospitalization and recovery period than implant reconstruction, but often results in a more natural-appearing breast. It is also more durable than an implant reconstruction, avoiding potential complications such as leakage, deflation, and capsular contracture that can occur years after breast reconstruction with implants.

UCLA performs more microsurgical breast reconstructions than any other facility in the Western United States. Our surgeons are board certified in plastic surgery and have completed an additional fellowship in microvascular surgery. Their training and experience have allowed them to achieve a free-flap success rate of 99 percent.

Immediate versus delayed reconstruction

Immediate reconstruction allows patients to undergo breast reconstruction concurrently with their mastectomy, minimizing the physiological impact of changes in body image and sense of wholeness many patients experience. Delayed reconstruction utilizes many of the same procedures and techniques to reconstruct the breast, but is performed after the patient has healed from her initial mastectomy.

In the past, physicians advised patients to delay reconstruction in order to minimize the risk of surgical complications delaying their chemotherapy and radiation treatments. However, many studies have shown that immediate reconstruction does not delay these treatments. When there is a high likelihood of cancer recurrence, or in cases when the tumor has metastasized to other organs, it may be necessary to delay reconstruction, but in the majority of cases, breast reconstruction can be performed concurrently with a mastectomy.

Immediate reconstruction provides tissue that is softer and easier to work with, allowing the surgeon to craft a more naturally contoured breast, with less visible scarring and an improved aesthetic result.

Plastic Surgeons Specializing in Breast Reconstruction

Andrew Da Lio, M.D.
Clinical Professor

Christopher Crisera, M.D.
Associate Clinical Professor

Jaco Festekjian, M.D.
Associate Clinical Professor

Joan Lipa, M.D.
Associate Professor

UCLA Breast Center Physicians

Helena R. Chang, M.D., Ph.D.
Professor of Surgery
Director, Revlon/UCLA Breast Center

Robert Bennion, M.D.
Professor of Clinical Surgery
Revlon/UCLA Breast Center

Paul Schmit, M.D.
Professor of Surgery
Revlon/UCLA Breast Center

Raquel Prati, M.D.
Assistant Clinical Professor of Surgery
Revlon/UCLA Breast Center

Contact Information
UCLA Division of Plastic and Reconstructive Surgery
200 UCLA Medical Plaza, Suite 465
Los Angeles, CA 90095-6960

(310) 825-5510 Plastic and Reconstructive Surgery
(310) 825-2144 UCLA Breast Center





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