Mastectomy/Breast Reconstruction/Silicone Implants

Rinklefree Plastic Surgery, conveniently located in Doylestown, PA offers a variety of surgical breast procedures designed to restore healthy, attractive physical contours. Whether you are interested in breast enhancement, breast lift, breast reconstruction, or breast reduction, Rinklefree Plastic Surgery in Doylestown can help. Below is a list of various breast surgery procedures and treatments offered at Rinklefree Plastic Surgery; contact our office for additional information.

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Many patients diagnosed with breast cancer undergo a breast removal procedure called a mastectomy. Women who have undergone mastectomy can choose to receive breast reconstruction surgery to restore the appearance of the missing breast or breasts.

Reconstructive surgery following a mastectomy can help renew a woman’s sense of femininity and beauty by recreating both the size and shape of the natural breast.

Reconstructive surgery following a mastectomy can help renew a woman’s sense of femininity and beauty by recreating both the size and shape of the natural breast. We help women in Bucks County, Langhorne, Malvern and Montgomery County, as well as nearby towns.

Reconstructive breast surgery is a major surgery that often requires more than one procedure. Patients may choose to receive breast reconstruction at the same time as the mastectomy or wait until they have healed. Reconstruction falls into two categories: breast implants or flap reconstructions. The former involves placing silicone or saline breast implants beneath the chest muscle. Flap reconstructions (TRAM flap, DIEP flap, latissimus dorsi flap and gluteal flap) remove muscle, fat or skin from another part of the body to reconstruct the breasts. While flap methods generally require more recovery time, they produce breasts that feel and age more naturally than breast implants.

DIEP Flap Reconstructive Surgery
DIEP flap breast reconstruction is one of the most advanced techniques for recreating the breast after mastectomy. DIEP, an acronym for “deep inferior epigastric perforator,” has some advantages over other breast reconstruction techniques, including the capacity to form a softer, more natural breast. Below are details about the DIEP flap microsurgical breast reconstruction method, including the pros and cons of the procedure for mastectomy patients.

DIEP flap breast reconstruction involves the removal of skin and fat from the patient’s abdominal area to be used in the creation of a new breast mound. This procedure is similar to the TRAM flap procedure, except unlike TRAM, this method does not migrate any muscle from the abdomen. Deep inferior epigastric perforation (DIEP) refers to the name of the tissue that is used to create the new breast; it is the main blood vessel found beneath the rectus abdominous (the so-called “six-pack” muscles of the abdomen). The surgeon will detach the skin and fat of the stomach and re-attach it to the breast area. He or she will then connect blood vessels in the tissue to blood vessels in the chest to provide proper circulation. Also, the skin of the stomach will be tightened and closed with stitches.

The surgery is complete when the doctor places drains in the breast area to aid with the body’s natural healing process. On average, surgery takes about 5 hours.

The “Free Flap” Reconstruction
DIEP flap reconstruction is sometimes referred to as a “free” flap reconstruction method because the skin and fat of the abdomen are completely detached from their original blood supply and then reconnected to a new supply in the breast area. The TRAM flap procedure, however, doesn’t actually detach tissue of the belly from its original blood vessels. The other main difference between TRAM and DIEP flap is that DIEP flap does not involve the grafting of any muscle tissue.

Gluteal Technique
One option for flap breast reconstruction surgery after the mastectomy is the gluteal technique, also known as the SGAP (superior gluteal artery perforator) or IGAP (inferior gluteal artery perforator). Because the buttocks contain “excess” skin and fat, it is considered by many to be the logical first choice for a tissue transfer. However, SGAP and IGAP procedures are among the most complicated of all microsurgical breast reconstruction techniques. This section discusses the details of gluteal flap reconstruction, as well as the pros and cons of SGAP and IGAP procedures.

What are SGAP and IGAP surgery?
SGAP and IGAP surgeries are techniques that transfer skin and fat from the buttocks to be used in the creation of a new breast mound following a mastectomy. The main difference between SGAP and IGAP is where the tissue is taken from. In SGAP, skin and fat are taken from the top (superior) area of the buttocks. In IGAP surgery, the material is used from the lower (inferior) buttocks area, specifically the crease of the buttock, where the thigh and buttock meet.

Latissimus Dorsi Technique
Many post-mastectomy patients choose to receive tissue-based reconstruction instead of breast reconstruction with implants. While this is considered a more complicated procedure, it has distinct benefits including producing a natural-feeling breast. One of the options for tissue-based breast reconstruction is latissimus dorsi flap reconstruction. This procedure uses skin, muscle, and fat from the upper back to create a new breast mound.

What is Latissimus Dorsi Flap Reconstruction?
The latissimus dorsi is the long muscle that runs beneath the armpit and diagonally across the back; when you raise your arm, the muscle can be felt along the side of the rib cage. During latissimus dorsi flap reconstruction, the surgeon uses this area of muscle and skin to build a new breast. Because of this muscle’s proximity to the chest area, utilizing tissue from this region for breast reconstruction after mastectomy is a popular technique among cosmetic surgeons. Additionally, the muscle and skin flap can remain attached to its natural blood supply, making the procedure less complicated than “free flap” procedures such as DIEP flap and gluteal flap reconstruction.

Latissimus Dorsi Flap Procedure
Latissimus dorsi flap breast reconstruction is a unique procedure because the flap is not completely disconnected from its source at any point during surgery. This flap is sometimes referred to as a “pedicle flap.” During this breast reconstruction, a tunnel is created beneath the skin from the back muscle to the breast area. Through this tunnel, the surgeon transfers the flap to the breast area. Also, any blood vessels that were cut during the procedure are reconnected with microsurgery.

Once the flap is in place, the surgeon forms the tissue into the desired shape and sutures it into position. Finally, the back and chest incisions are closed, and recovery begins. In some instances, a surgeon may also place a breast implant in order to produce more aesthetic results. Because the musculature of the back is slightly diminished after surgery, some patients are left with minor asymmetry, though back strength and function and minimally affected.

Both forms of gluteal flap reconstruction are known as “free” flap microsurgeries. This means that the “flap” of skin and fat that is taken from the buttocks is completely detached from the donor site and original blood supply, and then connected to a new supply of blood vessels at the breast area. This is unlike TRAM flap and latissimus dorsi procedures which keep tissue connected to their original blood vessels. During SGAP or IGAP surgery, your surgeon will transfer skin and fat to the breast area, shape a natural-looking breast mound, and connect it to the appropriate blood vessels. Once this is complete, all incisions are closed, and the recovery process begins.

TRAM Flap Breast Reconstruction Procedure
TRAM breast reconstruction surgery can be accomplished as a pedicle flap procedure or a free flap procedure. A pedicle flap procedure simply means that the skin and muscle that is being used to create a new breast is left intact with its natural blood supply. During a free flap procedure, however, the skin and muscle are completely detached from their original blood supply and re-attached at the breast area.

Pedicle Flap Reconstruction
Pedicle TRAM flap breast reconstruction is very popular and is generally a quicker surgery than free flap procedures. In this technique, one side of the abdominal muscle is folded upon itself and pressed through a “tunnel” under the skin that connects to the breast site. This allows most of the blood vessels to remain intact and provide blood to the newly created breast.

Free Flap TRAM Reconstruction
During free flap microsurgical breast reconstruction, the surgeon removes the entire section of abdominal tissue and attaches it at the site of the new breast. The extracted tissue includes an artery and vein, which are preserved and reattached to blood vessels in the chest area. This ensures that a healthy blood supply reaches the transplanted tissue, making it easier to shape the new breast. This specific procedure uses a relatively small amount of abdominal muscle tissue. Therefore abdominal strength is not affected as much as with the pedicle flap technique.
We serve residents of Bucks County, Langhorne, Malvern, Montgomery County and the neighboring Pennsylvania communities. For more information on breast reconstruction surgery and breast lift surgery, call us today.

Candidates for Mastopexy / Breast Lift

Candidates for breast lift surgery are women who’s breasts have lost volume and elasticity, you may wonder whether breast lift surgery can help. Women often seek a breast lift after experiencing significant weight loss, pregnancy, or aging, which can all cause breasts to sag. Mastopexy can have enormous benefits for your appearance and quality of life, although it is not right for everyone. At your initial consultation, your doctor will determine whether you are a good candidate for a breast lift.

Ideal Breast Lift Candidates
Ideal breast lift candidates are women in good health who are seeking a remedy for drooping breasts. It is important to have realistic expectations about the results of breast lift surgery. Although a breast lift can be performed on any size of breasts, women with smaller breasts typically enjoy the greatest benefits.

  • Be over the age of 18.
  • Have drooping breasts (breasts with stretched skin and less volume than in the past).
  • Be physically healthy and emotionally stable.
  • Not be pregnant or breastfeeding.
  • Not be planning to become pregnant.
  • Be at a stable weight with no plans for major weight loss.

Breast Lift after Pregnancy
Pregnancy and breastfeeding are two of the most common causes of drooping breasts. Therefore, many women begin to consider a breast lift after they have children. Most doctors recommend that you postpone mastopexy until after you have finished having children. Although breast lift surgery will not hinder you from becoming pregnant, future pregnancies could alter your results and cause your skin to stretch further. By waiting to have a mastopexy, you are more likely to extend the results of your surgery.

Breast Lift after Massive Weight Loss
Massive weight loss can give you a new lease on life. However, because excess weight will stretch your skin, weight loss can also leave you with drooping breasts. Once you have achieved your goal weight (or have come close to it), a breast lift can restore firmness and the shape of your breasts. To avoid a second surgery, you should postpone mastopexy if you plan to lose further weight.

After sizeable weight loss, you may have excess skin across other areas of your body. In addition to a breast lift, you may want to discuss additional body sculpting procedures with your surgeon. These could include a tummy tuck, thigh lift, arm lift, or even a full body lift.

The Procedure

No two breast reconstruction surgeries are alike. Each surgery patient has had a distinct experience with cancer, may be in various stages of remission, and has their own individual health conditions and cosmetic goals. Because of these differences from patient to patient, there are several ways that the surgery can be performed. These various surgery methods accommodate to the specific needs of the patient, and the recommendations of the surgeon. Some women have a mastectomy and breast reconstruction surgery at the same time, while others are advised to wait until after their mastectomy is complete to undergo breast reconstruction surgery. Regardless of the timing, the procedure generally takes place over several stages. The following sections introduce patients to the breast reconstruction process.

Breast reconstruction surgery is a comprehensive procedure that requires the use of general anesthesia. This means that the patient will be unconscious during surgery and will not experience any pain, or be away of what is taking place during surgery. In addition, they will have no recollection of the surgery when they wake up. During a pre-surgery consultation, the surgeon will discuss the use of anesthesia. It is important for your health and safety to disclose any drug allergies or health conditions so your doctor can choose the right anesthetic for you.

Once anesthesia has been administered, surgery begins with incisions. The size and location of the incisions will vary based on which type of breast reconstruction surgery you undergo. Implant reconstruction requires the fewest number of incisions, which are typically made across the center of the breast area. Flap reconstruction techniques, including TRAM flap, DIEP flap, gluteal flap, and latissimus dorsi reconstruction require more incisions because they involve the relocation of tissue from one area of the body to the breast. In both breast reconstruction techniques, the size and number of incisions will affect scarring and healing time.

Creating the new breast
The way the breast mound is created will also vary based on the type of surgery being performed.

Implant Reconstruction
Implant reconstruction takes place over several stages. During an initial procedure, a balloon expander is placed beneath the skin and chest muscle in order to stretch the area. In the following weeks and months, liquid will be added to the expander to stretch the skin enough to fit the desired implant size. Once the skin has stretched enough, surgery is performed to place a silicone or saline implant. In some instances, both steps may be performed at the same time. Permanent skin expanders serve as an effective breast implant as well. This eliminates a second surgery to place the implant. Your surgeon will decide if this is a viable treatment option for you.

Flap Reconstruction
Flap reconstruction involves taking tissue from one area of the body (the abdomen, buttock, or back), and relocating it to the chest. Blood vessels in the transplanted tissue are re-attached to new ones in the chest area. This new tissue will serve as the breast mound. In some instances, an implant may be placed as well. Due to the additional incisions, flap reconstruction surgery will result in more scarring, and require more healing time than straight forward implant reconstruction.

Sutures and Bandages
After the surgeon has created a symmetrical and natural-looking breast mound, the affected areas will be closed with sutures and bandaged. Your surgeon will provide post-operative instructions to ensure a speedy and complication-free recovery. For many patients, the full recovery period lasts about six weeks. During this time, strenuous activity should be avoided. Just as with surgery, breast reconstruction recovery is unique to each individual. It is important to discuss your specific recovery with your surgeon.


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