Breast Reconstruction

• Approach on Breast Reconstruction
• Frequently Asked Questions
• Reconstructive Options
• Your New Look
• Follow-up/Revision Procedures
• Nipple and Areola Reconstruction

• Making a Decision
• Surgical Complications and Risk
• Preparing for Surgery
• After Surgery
• Feeling Yourself Again

Approach on Breast Reconstruction

The diagnosis of breast cancer begins a journey of making many informed decisions which deeply affect your body and life. Using knowledge as a guide for the journey allows you to become an advocate for your own well being. As a health care provider, Dr. Zemmel presents patients with the tools and information to build their knowledge as they embark on their journey. This webpage serves as an instrument of knowledge for past, current, and future breast cancer patients of Richmond Aesthetic Surgery as they make informed decisions about breast reconstruction. Remember, Dr. Zemmel will be there throughout this journey to guide, lead, or assist you with whatever you may need to succeed.

Reconstruction of a breast that has been removed due to cancer or other disease is one of the most rewarding surgical procedures that Dr. Zemmel performs at Richmond Aesthetic Surgery in Midlothian, Virginia. Recent advances in medical technology have made it possible for Dr. Zemmel to create a breast close in form and appearance to a natural breast. Frequently, reconstruction is possible immediately following breast removal (mastectomy), so patients awake from surgery with a reconstructed breast in place and are spared the experience of living without a breast. There are many options to consider as you and Dr. Zemmel explore what treatment course is best for you.

This information will give you a basic understanding of breast reconstruction—when it is possible, how and when it is performed, and what the journey entails. Along with this it will help to explain the pre-surgical plan, the surgical operation, and the post-surgical course, as well as results you can expect. However, it cannot answer all of your questions since a lot depends on your individual circumstances. Please be sure to ask Dr. Zemmel if there is anything you do not understand about the procedures or what you can expect.

From the entire team at Richmond Aesthetic Surgery, we wish you the best of luck and wish you good health and well-being during your journey.

Sincerely,

Neil J. Zemmel, MD, FACS*

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Frequently Asked Questions

What is breast reconstruction?
Breast reconstruction is the recreation of all or part of a breast which has been surgically removed due to cancer or disease. Dr. Neil J. Zemmel at Richmond Plastic Surgery may recreate the new breast using an implant or tissue taken from another part of your body. The goal of reconstruction is to have natural, soft, symmetrical breasts in clothing.

Can I have breast reconstruction?
Any patient who undergoes removal of a part of the breast (lumpectomy or breast conservation therapy), the whole breast (mastectomy), or preventive removal of the breast (prophylactic mastectomy) is eligible for breast reconstruction. New medical devices and breast reconstructive techniques allow Dr. Zemmel to recreate the breast at the time of mastectomy or sometime later and to correct contour abnormalities of the breasts after breast conservation treatment. The best candidates, however, are women who are in good health, do not smoke, and whose cancer, as far as can be determined, will be or has been removed by surgery.

When can I have breast reconstruction?
Breast reconstruction can be done at the time of your mastectomy (immediate) or weeks, months, or even years later (delayed). The decision to have immediate or delayed reconstruction depends on many factors that Dr. Zemmel at Richmond Aesthetic Surgery takes into consideration:

• Breast Cancer Stage
• Breast Cancer type
• Additional Therapies (radiation or chemotherapy) to treat the cancer
• Other medical conditions (such as obesity, heart and lung conditions, smoking)
• Your Personal Preference and lifestyle

Many choose to have delayed reconstruction based on these factors. Some women are not comfortable weighing all of their options during a time of extreme emotional stress when coping with the diagnosis of breast cancer. Some patients may be advised by Dr. Zemmel to wait because of other health conditions. Also, those with metastatic or inflammatory breast cancers may be advised to delay breast reconstruction. Dr. Zemmel will discuss the advantages and disadvantages with you during your initial visit.

What are my reconstructive options if I have a mastectomy?
There are three general options for breast reconstruction after mastectomy:

• Breast reconstructions using implants
• Breast reconstructions using your own tissue (autologous reconstruction)
• Breast reconstruction using both implants and your own tissue

During your appointment, Dr. Zemmel will discuss the benefits and risks for each option. This will include the advantages, limitations, disadvantages, and complications of each procedure individualized to your specific scenario. You will also talk about what to expect after reconstruction is performed. It is important to remember that breast reconstruction is a process requiring multiple surgeries to achieve a final result. Together, you and Dr. Zemmel at Richmond Aesthetic Surgery will choose the best option for you based on:

• Body Shape
• Past Surgeries
• Current Health
• Breast Cancer Treatments
• Personal Preferences

How long will it take to finish my breast reconstruction?
The length of time can vary depending on the number of surgeries you require and the need for other breast cancer treatments, such as radiation or chemotherapy. The reconstructive process generally takes 6 months to one year no matter what type of reconstruction you choose if no further cancer treatment is necessary. Some patients will require revisional surgeries to balance the reconstructive breast with the natural breast, and recreate a nipple. The timeline to completion will vary for each patient, but a general guide is:

• First surgery: mastectomy(with tissue expanders or a reconstruction immediately with a permanent implant or free autologous tissue)
• Wait about 3 months for healing or 6-12 months if you need chemotherapy or radiation
• Second Surgery: if you had tissue expanders at the time of your mastectomy this will be when Dr. Zemmel at Richmond Aesthetic Surgery will recreate your breast (permanent implant or free Autologous tissue)
• Wait 3 months for healing
• Third Surgery: surgery to make changes to the size and shape of your reconstructed or natural breasts as needed and perform nipple reconstruction
• Wait 2-3 months for healing
• Fourth Procedure: nipple and areola tattooing in the office

What if I may need or will have radiation therapy?

Radiation affects every patient differently but can cause hyper-pigmentation (skin color changes like a sunburn) and changes in the texture and quality of the skin, muscle, and tissues inside the breast pocket after mastectomy. This firmness of the tissues is known as radiation fibrosis. To prevent this radiation fibrosis from damaging the breast reconstruction, Dr. Zemmel at Richmond Aesthetic Surgery may recommend having a staged surgery, using a tissue expander beneath the breast at the time of mastectomy, especially if you are planning on having Autologous tissue for reconstruction. Dr. Zemmel may recommend having a tissue expander if you are having radiation therapy because there are increased risks for complications with tissue expanders while undergoing radiation therapy. If you are having an Autologous (tissue) breast reconstruction, Dr. Zemmel alternatively may choose to perform your reconstruction at the time of your mastectomy but make the breast larger in volume to allow for the radiation fibrosis changes to the reconstructed breast.

If Dr. Zemmel recommends having a tissue expander, you may undergo radiation treatment with the tissue expander in place. Then later, Dr. Zemmel will replace the expander and reconstruct your breast with autologous tissue or an implant of your choice. For an autologous reconstruction, this prevents the nice, soft reconstructed breast from undergoing changes due to radiation, but not for an implant.

Studies have shown that patients who have radiation therapy are at an increased risk for problems with permanent implants. These problems include capsular contraction (scarring and distortion of the breast), infection, and wound healing problems necessitating the removal of the implant. Dr. Zemmel at Richmond Aesthetic Surgery will help you to make an informed decision if you are to undergo radiation therapy.

What if I may need or will have chemotherapy?

Breast reconstruction should not delay you getting chemotherapy. Your medical oncologist will want to wait until your incisions are fully healed and your drains have been removed prior to starting your chemotherapy. If you have a tissue expander placed at the time of your mastectomy, you may have your chemotherapy while undergoing tissue expansion. Tissue expansion may continue as long as you are comfortable, have no infections, and your blood counts are stable. Dr. Zemmel prefers to fill your expanders about 2 days before your chemotherapy dose, as this is when your blood counts are highest.

Does breast reconstruction increase the risk of my cancer returning or make it harder to detect breast cancer?

NO. The risk of breast cancer returning (recurrence) depends on the stage of the breast cancer, the type of breast cancer (hormone receptors), and additional therapies (chemotherapy or radiation) used to treat breast cancer. Reconstruction has no known effect on the recurrence of cancer in the breast, nor does it generally interfere with detecting cancer if it does in fact return. The surgical, medical, and radiation oncologist will discuss your risk of cancer recurrence with you and decide upon the methods or tests used to detect the cancer. Dr. Zemmel at Richmond Aesthetic Surgery may recommend continuation of clinical breast exams on the reconstructed breast. If your breast reconstruction involves a silicone implant, the FDA recommends that you get an MRI to check for rupture at 3 years, and then every 2 years after that.

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Reconstructive Options

Implant Based Reconstruction

The most common technique for implant based reconstruction combines the use of a tissue expander and subsequently a permanent breast implant. A tissue expander/implant reconstruction requires a minimum of two procedures to complete, and commonly a third is added to refine or “touch up” your result. Nipple reconstruction and fat grafting is usually performed at this third and final stage.

The first procedure of this breast reconstruction occurs at the time of the mastectomy. After the mastectomy has been performed, Dr. Zemmel inserts a device known as a tissue expander beneath the remaining skin and pectoralis muscle of the chest. This device is an inflatable implant that progressively stretches and molds the overlying tissue. The goal of a tissue expander is to create a stable, durable soft-tissue pocket for a permanent implant. Usually the tissue expander will be inflated approximately 50% – 75% of its final volume during the first procedure. The remaining volume will be added during your follow up visits in the office. The tissue expander is a silicone rubber shell which can be filled (expanded) with salt water solution. This helps stretch the muscle and remaining breast skin to the reconstructed breast size that you want. The tissue expander is filled with saline through a magnetic port located inside the expander. In clinic, Dr. Zemmel at Richmond Aesthetic Surgery will periodically inject a salt-water solution into the port to gradually fill the expander over several weeks.

The process continues until the tissue expander size is slightly larger than your desired reconstructed breast size. You may feel a sensation of stretching or pressure in the breast area during this procedure, but most women find it is not too uncomfortable. Filling of the tissue expander usually begins one to two weeks following your mastectomy. Expansion of the expander stretches the skin and muscle to make room for a breast implant, much like a mother’s belly stretches during pregnancy.

Dr. Zemmel also performs the latest tissue expander reconstructions using acellular dermal matrix (Alloderm or Flex HD) techniques. The use of these artificial tissues has a number of advantages over traditional tissue expander techniques:

• Placement of acellular dermal matrix allows Dr. Zemmel to achieve a greater inflation during your initial operation.
• Placement of aceullar dermal matrix allows improved contour of the lower pole, or bottom of the breast.
• Placement of acellular dermal matrix reinforces the soft tissue of the bottom of the breast giving a more durable result.
• Placement of acellular dermal matrix may prevent scar tissue from forming around the final implant.

Your surgery takes 1 to 1.5 hours for one side to be completed, longer if you are having surgery on both sides. You will be kept in the hospital overnight and will be able to go home in 1 to 2 days. This surgery will require placement of surgical drains to remove excess fluids from surgical sites immediately following the operation. In most circumstances, Dr. Zemmel will remove these drains when you come back for your 1 week or 2 week follow-up visit. If there is a lot of drainage, they will stay in for longer. You are likely to feel tired and sore for one to two weeks after reconstruction and take about 4 weeks to feel completely recovered. Most of your discomfort can be controlled by a pain medicine and muscle relaxants prescribed by Dr. Zemmel.

After the skin over the breast area has stretched enough, the expander will be removed in a second outpatient operation and a more permanent implant will be inserted in its place. The need of potential chemotherapy or radiation will affect the timing of your second stage surgery. This typically is much less invasive and requires much less downtime compared to the first procedure. The nipple and areola (the dark skin surrounding the nipple) are usually reconstructed in a subsequent third procedure.

The exchange of the tissue expander for a permanent implant takes about 1 hour for one side, longer for both sides. Dr. Zemmel at Richmond Aesthetic Surgery usually does not place surgical drains, and you can go home the same day as your surgery. You are likely to feel tired and sore for a week or so after the implant exchange, and take 2 weeks to recover completely. Much of your discomfort will be controlled by medication prescribed by Dr. Zemmel.

What are the types of permanent implants?

Permanent implants are silicone shells filled with either salt water solution (saline) or silicone gel. The permanent implants are much softer than the tissue expander used. Saline implants have been approved for use by the Food and Drug Administration (FDA) since 1992. Prior to 1992, silicone implants were used. In 1992, due to silicone leaking and fears that silicone caused illnesses and other diseases, the FDA removed silicone implants from the market. After 1992, large medical studies were conducted to check the safety of silicone implants. These studies showed there was NO connection between silicone implants and other diseases. In 2006, the FDA again approved the use of silicone implants for cosmetic uses. They have always remained approved for reconstructive uses. The alternative saline-filled implant, a silicone shell with salt water, is also available if you choose. Dr. Zemmel will guide you through the risks and benefits of choosing a saline versus a silicone implant for your reconstruction.

Dr. Zemmel at Richmond Aesthetic Surgery will discuss the risks and benefits for undergoing breast reconstruction with silicone breast implants, and you will receive a short, detailed patient brochure to educate you on these. Silicone implants require monitoring with an MRI every other year starting at 3 years after surgery because leaks are not easily detected by exam. On the other hand, saline implants do not require monitoring because leaks are obvious when the whole breast is deflated. Be sure to discuss current options with Dr. Zemmel at Richmond Aesthetic Surgery. Both types of implants come in a variety of shapes and sizes. Dr. Zemmel at Richmond Aesthetic Surgery will talk about the various types of implants and help you decided which implant is best for you.

If an implant is used, there is a small possibility that an infection will develop, usually within the first week or two after surgery. In some of these cases, the implant may need to be removed for several months until the infection clear. A new implant can later be inserted at that point.

The most troublesome problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard, sit higher on the chest, and appear smaller. Capsular contracture can be treated in several ways by Dr. Zemmel. Sometimes it requires either removal or “scoring” of the scar tissue, or perhaps replacement or removal of the implant in the operating room. Radiation therapy dramatically increases the risk of tightness around the implant due to radiation damage of all of the surrounding tissues. Ultimately, there is a very high chance that in the first 10 or 15 years after surgery you will need another surgery to replace a malfunctioning implant or change the breast shape. Dr. Zemmel at Richmond Aesthetic Surgery will discuss autologous options (your own body tissue) at your initial visit, which are a more permanent and natural reconstructive choice.

Using Your Own Body Tissue (Autologous or Flap Reconstruction)

Autologous tissue reconstruction, also called flap reconstruction, involves using your own tissue from another part of your body to rebuild your breast. The tissue from your back, abdomen (belly), thighs, or buttocks may be used. Sometimes, the tissue can stay connected to its own blood supply and just be rotated (turned) to reconstruct the breast. This is called a “pedicled” or “attached” flaps. Other times, the tissue is disconnected from your body and its own blood supply; it is reconnected to a new blood supply in the chest. This is called a “free” flap. Free flaps typically do not require the sacrifice of a muscle in order to bring blood flow to the flap.

The name of the flap also changes depending on the area the tissue is taken from. This is called the donor site. Tissue flaps taken from the back are called latissimus dorsi or T-DAP, from the belly are called a DIEP or TRAM or SIEA, from the buttocks are called the SGAP or LGAP, and from the thigh are called TUG. Most of these surgeries require the skills of a microvascular-trained plastic surgeon. This is a complex technique that requires using a microscope to reconnect blood vessels. Dr. Zemmel offers this exciting new technique.

Using Your Belly Tissue

Breast reconstruction using your own tissue (Autologous tissue reconstruction) has the most natural and long lasting results. The words used to name your abdominal tissue change depending on the type and amount of tissue taken. To help explain these words, an understanding of the makeup of your belly (abdomen) is needed. Your abdomen is made up of several tissue layers:

• Top layer-skin
• Underneath the skin is your fatty tissue
• Underneath your fatty tissue is your fascia (thick, tough layer that helps prevents hernias from forming and keeps your muscles in place)
• Underneath your fascia is your muscle, the rectus abdominus, or your “6-pack”

The rectus muscle received blood supply from two blood vessels, the superior epigastric artery and vein, and the deep inferior epigastric artery and vein (DIEP). These vessels spread up the muscle like branches on a tree into smaller vessels that supply the fat and skin tissue. Some different and more superficial vessels are the superficial inferior epigastric artery and vein (SIEA).

The tissue taken from your abdomen can consist of all layers or only some layers. Also, the tissue may be moved staying attached to the blood supply (TRAM), or disconnected from its blood supply connecting to a new blood supply in the chest (free flap). The amount of tissue and blood supply used to create your new breast determines the name of the breast flap. Dr. Zemmel at Richmond Aesthetic Surgery will help decide which type of flap is best for you.

The Transverse Rectus Abdominus Muscle Flap (TRAM)

This flap consists of skin, fat and the “6-pack” muscle itself, and finally some fascia. The TRAM flap is usually rotated on its remaining blood supply (pedicled) or disconnected from its own blood supply and reconnected to the blood in the chest (free flap). Since this flap involves removing your muscle, and sometimes your fascia, there is a higher risk of hernia or weakness of the abdominal wall.

The pedicled TRAM flap is a safe reliable procedure and has been offered for over 30 years. Dr. Zemmel will examine you carefully to determine whether you are a candidate for a soft tissue reconstruction. He may offer you the options of either a pedicled TRAM flap or a DIEP or Free TRAM flap.

There are a number of benefits of DIEP flaps over traditional pedicled TRAM flaps. They include:

• The ability to retain complete muscle function of the abdominal wall
• Reducing the risk of abdominal wall hernia
• Elimination of prosthetic mesh placement in the abdomen
• Ability to shape a more natural, contoured breast
• Reducing the risk of fat necrosis

Abdominal Muscle Sparing and Perforator Flaps

The DIEP Flap

Advances in surgical techniques have allowed surgeons to lessen the amount of muscle or fascia that is used for abdominal wall (belly) flaps. Now, Dr. Zemmel avoids taking any muscle or fascia by using the small blood vessels spreading up from the muscle to the skin called perforators (DIEP) or from the more superficial source called the superficial inferior epigastric artery and vein (SIEA). Both the DIEP and SIEA are muscle sparing and use no muscle with the belly tissue, lowering the chance of hernia formation or abdominal wall bulge. There are three types of muscle sparing flaps that Dr. Zemmel at Richmond Aesthetic Surgery performs:

• Free Muscle Sparing TRAM: A flap made up of belly skin, fat, and a very tiny part of the rectus muscle. This flap is disconnected from its own blood supply and then reconnected to the blood supply in the chest. If a large amount of muscle has to be taken because of the anatomy of your abdominal wall, then Dr. Zemmel may have to reinforce it with a supportive layer of mesh to prevent hernia formation.
• Free Deep Inferior Epigastric Perforator Flap (DIEP): A flap made up of belly skin and fat ONLY. The flap is disconnected from its own blood supply and then reconnected to the blood supply in the chest using the deep inferior epigastric artery and vein and its perforators. This the most common procedure performed by Dr. Zemmel at Richmond Aesthetic Surgery. Not only does the fat and skin removed at the time of surgery reconstruct a supple, naturally appearing breast, but it also provides for a “tummy tuck” effect.
• Free Superficial Epigastric Artery Flap (SIEA): A flap made of belly skin and fat ONLY. The flap is disconnected from its own blood supply and then reconnected to the blood supply in the chest using the superficial inferior epigastric artery and vein and its perforators. Since the superficial epigastric artery and vein are very small, and only exist in about 30% of patients, few can have this flap.

Regardless of which of these three innovative techniques Dr. Zemmel performs, they are more complex than implant-based reconstruction. Scars will be left at both the tissue donor site (lower belly) and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the reconstructed breast is made entirely with your own tissue, the results are more permanent, natural, and there is no concerns about implant complications. In some cases, you will have the added benefit of an improved abdominal contour.

You will be required to stay in the hospital for three nights. During this stay, Dr. Zemmel and nurses will monitor your flap to make sure that it is receiving enough blood supply. No matter what type of flap is used, problems with the blood supply can occur. The color, temperature, and pulse of the skin will be checked. A machine that listens to your blood flow (Doppler) and another which looks at how much oxygen the flap is getting (Vioptix) will help to monitor also. If your flap has blood supply problems, Dr. Zemmel may have to take you back to the operating room to assess and correct the problem. This happens in less than 10% of patients. If the problem cannot be fixed, approximately 2-3% of all patients, another method for your breast reconstruction will be offered.

You will also have 3-4 surgical drains depending on if one or two breasts are reconstructed. In most circumstances, these drains will remain in for 1-2 weeks; if they have a lot of drainage even longer. The recovery time for flap reconstruction is about 4 weeks. You will be sore for about a week or two and then begin to improve every day; however, it is normal to feel fatigued in the weeks following surgery.

Other Methods of Free Autologous Tissue

• Using your buttocks tissue (SGAP, IGAP): This type of reconstruction is reserved for patients who do not have enough skin and tissue on the belly, have had previous belly surgery to preclude a DIEP, do not want implants, and have enough buttocks tissue to recreate a breast. These flaps are made of skin and fat from the buttocks. Their blood supply is disconnected from the buttocks and then reconnected to the internal mammary artery and vein in the chest. You will have a scar hidden in the bikini line and slight indent around the donor site area from where the tissue is taken. The SGAP is a great alternative and provides for a natural and moderate volume breast.
• Using your thigh tissue (TUG): The transverse upper gracilis (TUG) flap is made up of skin, fat and muscle from the thigh. The gracilis muscle that is taken is considered “expendable” and patients do not report any weakness of the leg after surgery. The TUG is usually done for patients who do not have adequate skin in the buttocks or belly. The TUG flap is a small sized flap and thus can only be used for those that do not require a large volume breast reconstruction. The incisions from the TUG are hidden in the groin area. This area is warm, moist and dark, and undergoes a lot of motion while sitting, standing, or using the bathroom which makes it a higher risk for poor healing and infection.
• Using your back tissue (Latissimuss Dorsi & T-DAP): The latissimus dorsi flap from your back is made up of skin, fat, and muscle (latissimus dorsi muscle). The T-DAP flap is made up from skin and fat ONLY. Both the latissimus dorsi and the T-DAP flaps remain attached to the their blood supply, and are rotated through the arm pit to recreate the breast on the chest. The scar is often well-hidden in the bra strap on the back. Often, the flaps are not large enough to recreate a breast, and an implant will be required under the flap. People generally do not have a problem from missing the muscle in the back and continue their normal daily living. However, if you are a competitive rock climber, swimmer, or tennis player, you may be affected and show weakness.

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Your New Look

Your reconstructed breast may feel slightly firmer and look rounder or flatter than your natural breast. It may not have the exact same contour as your breast before mastectomy, nor will it exactly match your opposite breast. However, small revision surgeries performed by Dr. Zemmel at Richmond Aesthetic Surgery may improve the contour and symmetry. These differences will generally be apparent only to you. Therefore, you should decide what differences you would like to change and discuss them with Dr. Zemmel. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery. Dr. Zemmel is involved in trying to understand how the quality of life of a woman changes after free flap surgery when compared to implant-based reconstruction through ongoing research.

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Follow-up/Revision Procedures

Most breasts reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery, or revisions, may be required to enlarge (augmentation), reduce, or lift (mastopexy) the natural breast to match the reconstructed breast. It is almost always performed to improve the symmetry, shape, size, and/or contour of the reconstructed breast itself. Often, improvements in the contour and symmetry of the reconstructed breast are accomplished by using fat grafting. In this procedure, fat is taken by liposuction from an area of the body (belly, thighs, buttocks) and then injected into the reconstructed breast where symmetry and contour is needed. These secondary procedures are outpatient procedures and rarely require the use of drains. The recovery time is based on the extent and complexity of the procedure, but usually rangeds from a few days to a couple of weeks.

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Nipple and Areola Reconstruction

Once you and your surgeon are pleased with the shape, size, and symmetry of your breast reconstruction, and you have had time to heal, you may consider having nipple reconstruction. Your reconstructed nipple will be different than a natural nipple. It will not be able to have temperature or other sensations and may have a different texture.

If you choose to have your nipple reconstructed, there are different options. First, you can choose to have a 3-D tattoo only and no surgery at all. A second option, and most common, is to use the skin of your reconstructed breast to recreate a nipple. This nipple bump will be the color of your reconstructed breast skin, and will not have an areola (colored portion around the nipple). The areola and nipple can then be colored using a tattoo. The tattooing can be done at Richmond Aesthetic Surgery. The third option is not to have a nipple reconstructed at all. Dr. Zemmel at Richmond Aesthetic Surgery will guide you through this decision-making process and help you reach the best decision.

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Making a Decision

Many options are available for breast reconstruction. Dr. Zemmel will recommend the best options for you based on your body size, shape, medical issues, personal values, personal preference, cancer, and need for chemotherapy or radiation. As you consider the options recommended by Dr. Zemmel at Richmond Aesthetic Surgery, ask yourself the following questions:

• How do I want to look in and out of my clothes?
• How much time am I willing to spend recovering from surgery?
• What physical activities do I participate in that could be affected by surgery to my belly, back, or buttocks?

Use the answers to these questions to help you chose what option you like.

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Surgical Complications and Risk

Many women who must lose their breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with these procedures. During the consent procedure, Dr. Zemmel at Richmond Aesthetic Surgery will discuss all the risks and benefits of the procedures.

The plastic surgery procedure recommended for you is safe, is likely to have benefits for your body, and is well planned. You have requested this because you seek a change in your body, to improve and heal it.

There are certain aspects of your healing that we will have no control over–how predictable healing is will depend on your skin, underlying muscle and bony structure, and hereditary influences as well as dietary factors. Be patient; neither you nor Dr. Zemmel can speed up your body’s healing mechanisms. Slight irregularities and under correction or small scars may result. Minor revisions after surgery is preferable to excessive operation and over-operation at the initial procedure.

Plastic Surgery is a combination of art and science, and it is not an exact science. Some of the factors involved in the outcome (such as your specific healing characteristics) are not within Dr. Zemmel’s control, and therefore it is not possible to guarantee and result.

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Preparing for Surgery

You can begin talking about reconstruction as soon a you are diagnosed with cancer, or when you find out that you are genetically predisposed to cancer. Dr. Zemmel at Richmond Aesthetic Surgery will work to develop a strategy that will put you in the best possible condition for reconstruction.

After evaluation, Dr. Zemmel will explain which reconstruction options are most appropriate for your age, health, anatomy, body type and goals. Be sure to discuss your expectations openly. Post-mastectomy reconstruction can improve your appearance and renew your self confidence—but keep in mind that the desired result is an improvement and not perfection.

Once you have scheduled a surgery date, Dr. Zemmel will provide you with specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain medications or vitamins. Dr. Zemmel will also give you information regarding blood work and tests needed prior to surgery, and will have you receive a CT scan prior to any free tissue breast reconstruction.

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After Surgery

Your first follow-up visit following your surgery will be within the first 5-7 days after you are discharged from the hospital. At this visit, Dr. Zemmel at Richmond Aesthetic Surgery will see how your newly reconstructed breasts are healing, as well as your donor sites. You may have one or more of your drains pulled if they are ready, sutures may also be removed, and a thorough examination will assure that you are on the proper post-operative track. Dr. Zemmel will discuss the next step in the process and answer any questions you may have regarding activity or anything else.

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Feeling Yourself Again

Many women want to know when they can get back to doing everyday things like driving, carrying shopping bags, or doing housework and gardening. This will vary depending upon the type of surgery you have had and upon you as an individual.

It is usually fine to start driving again when you feel that you could safely do an emergency stop or moving the steering wheel around suddenly and are NOT taking any pain medicine. Some women find this possible to do within a couple of weeks of surgery, and others find it takes longer. Some automobile insurance companies have specific guidelines about when you can drive again after an operation, so it is helpful to check with them before doing so.

Follow Dr. Zemmel’s advice on when to begin stretching exercises and normal activities. As a general rule, you will want to refrain from any overhead lifting, strenuous sports, and sexual activity for 2 to 4 weeks following reconstruction. You will also be referred to a physical therapist after your surgery for exercises to help with recovery.

Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return. Never place a heating pad or ice pack on your breast after you have had a mastectomy for the risk of possible burns or frost bite. Ask Dr. Zemmel at Richmond Aesthetic Surgery the possibility of highly innovative technique of reconnecting nerves during DIEP flap surgery.

Dr. Zemmel would like to thank you for choosing Richmond Aesthetic Surgery to provide your care, and looks forward to helping you on your journey.

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Contact Richmond Aesthetic Surgery

To learn more about breast reconstruction options, or to schedule a consultation with one of our experienced plastic and reconstructive surgeon, please contact Richmond Aesthetic Surgery.
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