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Breast Reconstruction

Model - Breast Reconstruction

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 your breast reconstruction surgeon is an accomplished specialist who can guide you through your options. At Houston Plastic and Reconstructive Surgery, we are fortunate to have breast reconstruction specialist Dr. Kendall Roehl on our team. 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 (281) 282-9555 to schedule an appointment. Women visit us in Webster for breast reconstruction from Pearland and Houston, TX and other nearby communities.

Timing of Your Breast Reconstruction

If you have decided to have one or both breasts reconstructed, you and Dr. Roehl will discuss the timing of your procedure, which can either be 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.

Your Treatment Options

Learn about the different approaches to breast reconstruction Dr. Roehl commonly uses.

Advanced Breast Reconstruction Techniques

Advances in microsurgery and other reconstructive surgical techniques enable Dr. Roehl to offer more options than ever for women who choose to have breast reconstruction after a mastectomy or a significant lumpectomy. These techniques fall into 2 categories:

  • Implant reconstruction replaces the breast with a silicone or saline breast implant.
  • Autologous tissue reconstruction replaces the breast with the patient's own tissue. Women choose this option when they want to avoid having an implant. The result is a more natural-looking breast that is soft to the touch. Additionally, since the tissue is harvested from the patient's own body, the risk of tissue rejection is not an issue.

Breast Reconstruction With Implants

Patients who choose to have reconstruction 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 site on the body. Reconstruction with an implant is usually a 3-step process:

  • Expander placement: A modified saline implant, called a tissue expander, is inserted in the small pocket Dr. Roehl creates between the breast skin and chest muscle. 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 Dr. Roehl to add more saline gradually over several weeks or months.
  • Tissue expansion: During the ensuing weeks and months, Dr. Roehl adds saline to the expander about 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.
  • Implant placement: In a second outpatient surgery, Dr. Roehl removes the expander and replaces it with the long-lasting implant, which may be either saline or silicone.

Choose a Breast Reconstruction Specialist

Our breast reconstruction specialist
Dr. Kendall Roehl has training and experience that includes a prestigious reconstructive microsurgery fellowship at the renowned MD Anderson Cancer Center in Houston. She has the expertise required to perform perforator flap surgery, a state-of-the-art technique that eliminates impact to the muscles and optimizes the patient's quality of life.

Traditional Flap Procedures: TRAM Flap & Latissimus Flap

Traditional flap procedures such as the TRAM flap and latissimus flap were once the option of choice for breast reconstruction patients who wanted to avoid implants. These procedures involve forming a new breast mound by transplanting the patient's own tissue from a donor site to form a new breast at the mastectomy site.

A significant drawback to these procedures is that along with removing skin and tissue from another part of the body, muscle is removed as well. The TRAM flap involves removing part of the abdominal muscles, and the latissimus flap procedure uses breast implants and part of the back muscles (latissimus dorsi). While these procedures do make use of the patient's own tissues, the drawbacks include an increased risk of hernia, abdominal bulging, and limited physical movement.

Perforator Flap Procedures

Like traditional flap breast reconstruction, a perforator flap procedure uses the patient's own tissue and skin to recreate the 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. Additional advantages over traditional flap procedures include:

  • Quicker recovery
  • Less discomfort
  • No muscle impairment

However, few surgeons have the training and experience necessary to perform these highly intricate 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.

Types of Perforator Flap Reconstruction

Dr. Roehl is trained and experienced in a variety of perforator flap procedures, which include:

  • 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 soft to the touch. It is similar to the TRAM flap technique that is used in most non-implant breast reconstruction procedures, but it 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.

Breast Reconstruction Recovery

Recovery after breast reconstruction depends on the type of reconstructive technique used and varies between patients.

  • Implant-based reconstruction recovery may take longer for immediate reconstruction than for procedures performed at a later date. Patients can expect swelling and tenderness for the first few days following the procedure, but the majority of swelling will be gone after the first week. While most women report feeling fine after 3 weeks, it can take some women up to 6 weeks to fully recover and resume normal activities. In general, implant reconstruction requires less time, and the patient experiences less discomfort than after a flap procedure.
  • Flap procedures require 2 surgical sites: one at the breast and one at the donor area. Therefore, recovery is usually more complicated and takes longer than with implant reconstruction. Most patients stay in the hospital for 3 to 4 days after surgery and need to return to our office to have surgical drains removed. Most women are ready to resume their regular activities within 6 weeks.

At Houston Plastic and Reconstructive Surgery, we provide all patients excellent support throughout the recovery process and provide detailed instructions to help promote healing.

The Finishing Touches

Many breast reconstruction patients find it satisfying enough to have their breast size and shape restored; they simply want to look and feel complete in clothing. Others want their reconstruction results to look as close to their original breast as possible. Dr. Roehl can refine the breast contours through fat grafting and restore the nipple through nipple reconstruction to put the finishing touches on the reconstructed breast.

Fat Grafting

Fat grafting is a procedure in which Dr. Roehl collects fat from one part of the patient's body using liposuction to enhance another area. Rarely do patients have enough fat to use fat grafting alone for breast reconstruction, but fat grafting can be combined with either a flap procedure or a breast implant to give the reconstructed breast more natural contours. Fat grafting can also be used to fill in depressions on the breast after lumpectomy. This advanced technique can enhance the shape of the breast for results that look more attractive and natural.

Nipple Reconstruction

While not required, many women choose to undergo nipple reconstruction after mastectomy. This is a personal decision that is entirely up to the patient. Nipple reconstruction is typically performed after the reconstructed breast has had ample time to heal, which is usually about 3 to 4 months after surgery. 

Nipple reconstruction is performed as an outpatient procedure and requires a few days of downtime. The nipple can be reconstructed using one or a combination of the following techniques:

  • Tissue from the body: A nipple can be reconstructed using tissue from another area of the body such as the chest or upper thigh. The reconstructed nipple can later be tattooed to have a more natural appearance.
  • Dermal matrix products: Made from a skin substitute, a dermal matrix can be used to construct a new nipple that looks similar to a real one.

Medical Tattooing

Instead of constructing a nipple, some women opt to have a tattooed nipple put on. This option is less painful, and the recovery time is faster — and the woman does not have to go through another surgical procedure.

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Meet Our Doctors

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

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