When I was training, I very vividly remember being taught by an older plastic surgeon that the goal for breast reconstruction was for a woman to appear symmetrical and balanced in clothing, and that out of clothing “all bets were off.” This statement immediately struck me as unsatisfying, and I aimed to set a different standard for myself and my patients.
A decade later, as I meet with patients daily to develop personalized breast reconstruction plans that address their unique concerns, those words couldn’t be more untrue. As a plastic surgeon specializing in natural breast reconstruction, it is my goal to empower women with advanced breast reconstruction options that will make them feel confident and whole in their skin.
I truly believe that breast reconstruction, planned and performed well, can deliver beautiful, natural-looking results, but I judge success in breast reconstruction by how my patients feel, not only by the outward appearance of our results. I want my patients to feel confident and empowered both in and out of clothing.
For many years, implant-based reconstruction was the only type of breast reconstruction offered to women. In the last couple of decades, natural reconstruction has been increasingly refined to be very safe and continues to become more accessible. There are now hundreds of plastic surgeons who take insurance and can perform natural breast reconstruction, myself included. So, what exactly is natural breast reconstruction? There are several types, including DIEP flap surgery and aesthetic flat closure.
Natural reconstruction means that a patient doesn’t have to have an implant. Instead, I can create a breast out of her own tissue that will last for a lifetime and doesn’t have to be replaced or maintained. Considered the gold standard in reconstructive breast surgery, DIEP flap reconstruction transplants skin and fat from the abdomen to the chest to create beautiful, natural-feeling breasts using an advanced technique called microsurgery.
Utilizing the same tissue we would remove during a tummy tuck, we can reconstruct new breasts in a size that is determined by the patient and the amount of tissue that she has available. That’s one of the most incredible parts of the surgery: we’re able to work with what a woman’s body has naturally given her. As an added bonus, many women find that they like the appearance of their stomach area more after this surgery. While women often carry more weight and excess skin in their abdominal area, especially if they’ve given birth, there are other options for those who do not. This can include a PAP Flap, in which tissue from the small roll of fat below the buttocks area is transferred to the chest.
These factors, paired with the fact that there are very few risks, contribute to DIEP flap surgery being a viable option for breast cancer patients seeking breast reconstruction. The ultimate decision, of course, is always up to the patient in consultation with her treatment team. Using one’s own tissue is a good option for a woman who is interested in the most natural option and doesn’t want an implant.
Another option that a woman may consider is an aesthetic flat closure, in which the tissues of the chest are closed as smoothly as possible without an implant or added natural tissue, resulting in a contour that mirrors the shape of the chest wall. This is a great option for patients who know they want a flat closure, for those who are undecided or for those who aren’t medically ready for another reconstructive option.
In order to determine what will work best for a woman in her cancer journey, it’s important that she is able to have an entire treatment team involved early on. This team may include her breast surgeon, medical oncologist, radiation oncologist (if needed), reconstructive surgeon and even individuals to support her mental and physical health, like a therapist or nutritionist.
I encourage women to engage in planning for their breast reconstruction as a way to achieve the best results possible, but also as well as a chance to plan for the future in general. Meeting with a breast reconstructive surgeon early on allows the entire treatment plan to be taken into account and lays the framework for a successful reconstruction that prioritizes cancer treatment. This is particularly important when radiation may be part of the journey.
As we often say in our office, we can’t always control what happens to us, but we can control the way we respond. Our team is here to ensure you feel seen and supported along your journey. If you are interested in learning more about your breast reconstruction options, please contact us.
