If you are considering breast reconstruction, you are faced with making very personal decisions during an emotional time. It's essential that you engage the support of a team of caring medical professionals, and that you have an accomplished specialist to guide you through your options for breast reconstruction. At Houston Plastic and Reconstructive Surgery, we are fortunate to have a specialist such as Dr. Kendall Roehl. She performs procedures that demand the training and experience few surgeons possess. As a woman, Dr. Roehl understands the unique role that breasts play in your body image and feelings of femininity.
Women preparing for a lumpectomy or mastectomy to treat or prevent breast cancer in the Houston area, or who have already undergone the surgery, can learn more about their breast reconstruction options by requesting a consultation online to meet with Dr. Roehl. You can also call our practice at (713) 999-4366 to schedule an appointment.
Advances in microsurgery and other reconstructive surgical techniques have created more options than ever before for women who choose to get breast reconstruction after a mastectomy or a significant lumpectomy. Dr. Roehl's training and experience includes a prestigious reconstructive microsurgery fellowship at the renowned MD Anderson Cancer Center in Houston.
Breast reconstruction generally is categorized as either immediate or delayed.
Immediate breast reconstruction is performed immediately after your breast surgeon completes the mastectomy. Dr. Roehl works closely with your breast surgeon before, during, and after the procedure to ensure a smooth operation. Many women who choose immediate breast reconstruction benefit emotionally from having a reconstructed breast or breasts when they wake up after the surgery.
Delayed breast reconstruction is an option at any time after a mastectomy is performed. This may be appropriate for patients whose cancer treatment or other circumstances make immediate reconstruction difficult or impossible.
Once the timing of the reconstructive procedure is decided, Dr. Roehl will explain the various techniques available to reconstruct the breast.
A new breast or breasts can be reconstructed using breast implants, or using a patient's own tissue and skin in an autologous flap procedure. Dr. Roehl's expertise in microsurgery enables her to perform what is called perforator flap surgery, a state-of-the-art technique that helps preserve the muscle in the area that supplies the tissue, skin, and blood vessels for the reconstructed breast. Dr. Roehl will help you choose a reconstruction technique based on your unique circumstances and personal preferences.
Patients who choose to reconstruct their breast or breasts with implants typically have the same breast implant choices as cosmetic breast surgery patients. Breast implants offer the benefit of a shorter recovery than a flap procedure because there is only one surgical location. Reconstruction with an implant is usually a 3-step process:
A modified saline implant, called a tissue expander, is inserted in the small pocket between the breast skin and chest muscle created by Dr. Roehl. This is done during the mastectomy operation if you are having immediate breast reconstruction, or sometime later if it's a delayed procedure. A valve attached to the expander allows the surgeon to add more saline gradually over several weeks or months.
During the ensuing weeks and months, your surgeon will add saline to the expander approximately every week, which gradually makes the tissues more pliable and the pocket bigger. The process continues until the pocket is able to accommodate the desired implant size.
In a second outpatient surgery, Dr. Roehl removes the expander and replaces it with the actual implant, which may be either saline or silicone.
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Many women prefer using their own tissue and skin to recreate their breast after a mastectomy. For some women, the idea of breast implants is undesirable, and they feel that a flap procedure will produce a more natural result. Unlike traditional flap procedures, perforator flap procedures leave the muscles at the donor site intact. That means a quicker recovery with less discomfort and you still have the use of all of your muscles. However, few surgeons have the training and experience necessary to perform these perforator flap procedures. Dr. Roehl's extensive, specialized breast reconstruction training makes her one of a handful of surgeons qualified to do this type of procedure.
Perforator flap reconstruction includes:
DIEP flap: Considered the most advanced breast reconstruction surgery currently available, the DIEP flap procedure uses fat, skin, and blood vessels taken from a patient's lower abdominal region to rebuild a natural-looking breast that is warm and soft to the touch. It is similar to the TRAM flap technique that is used in most non-implant breast reconstruction procedures, but doesn't remove any part of the rectus abdominis muscle, which is used in virtually all core movements.
GAP flap: For patients who don't have adequate abdominal tissue available for the DIEP flap technique, Dr. Roehl can instead harvest tissue, skin, and blood vessels from the buttocks area to use in the reconstructive procedure. As in other perforator flap surgery, Dr. Roehl then transplants and reconnects the flap at the mastectomy site using microsurgery. The flap is then sculpted into a new breast mound.
Latissimus flap: Unlike the perforator flap procedures, the latissimus flap reconstructive procedure uses a small portion of the back muscle that gives the technique its name. The latissimus dorsi muscle is located in the upper back. As with other flap procedures, the latissimus flap involves transplanting the muscle, tissue, and skin to the mastectomy site, where a new breast mound is shaped.
Fat grafting: In some cases, a patient's fat is taken from one part of her body using liposuction to help reconstruct the breast. Rarely is there enough fat to use fat grafting alone, but fat transfer can be combined with either a flap procedure or breast implant to give the reconstructed breast more natural contours.
A patient's recovery depends on the type of reconstructive technique used. In general, recovery following implant-based reconstruction requires less time and the patient experiences less discomfort than after a flap procedure. In a flap procedure, there are 2 surgical sites, so the recovery is usually more complicated and takes longer. We provide all patients excellent support throughout the recovery process and provide detailed instructions to help promote healing.
Our board-certified plastic surgeons, Dr. Clayton Moliver and Dr. Kendall Roehl, are two of the leading plastic surgeons in the Houston area. Dr. Moliver has performed thousands of procedures, and serves as Clinical Professor of Plastic Surgery at U of T Medical Branch. Dr. Roehl is a reconstructive microsurgery specialist who has served as a member of the faculty at Texas A&M College of Medicine — Scott & White.Dr. Clayton Moliver Dr. Kendall Roehl