A question frequently asked in the breast reconstruction community for those planning any type of breast reconstruction is, what are the surgical stages of breast reconstruction? I reached out to the experts to do a video. Dr. Minas Chrysopoulo of PRMA answers the question. I summarize the conversation with Dr. C in this blog. You can watch the entirety of the conversation in the at the end.
Dr. C begins with a very important statement,
“Breast reconstruction should really be considered a process rather than as one procedure. For most people it is going to take more than one surgery to get the best results.”
Breast Reconstruction: Stage 1
It is preferable to have both the mastectomy and reconstruction done at the same time, known as immediate reconstruction. This often yields better results because there is less scarring and looks more natural. Sometimes, because of the diagnosis, stage of the cancer, even an access issue of a specialist in the area, this is not possible. Immediate reconstruction, however, does not mean all the breast reconstruction is finished at the time of mastectomy. It means the reconstructive process is started at the same time as the mastectomy.
There are select instances when a plastic surgeon can finish a breast reconstruction “in one go”, as Dr. C states. There is a big push for direct to implant, sometimes called DTI, reconstruction. In the right candidate, if you have a high-quality mastectomy, it is very possible to get a great result in this situation. But, as Dr. C says, “Many, many things need to be right for that to happen.”
He also points out that it is not impossible to have a one stage breast reconstruction. However, it is a rarity. In most instances, if you are hoping to achieve the best results, you should anticipate more than one surgery.
What does the Second Stage of Breast Reconstruction Involve?
Coordinated care between the breast surgical team, the breast surgeon and plastic surgeon, is paramount. The quality of the mastectomy in DTI will determine the final results and why it is so important for the breast and plastic surgeon to coordinate their technical skills for the benefit of the patient. At times contour defects may happen after any type of reconstruction, implant-based or autologous, using your own tissue as in DIEP flap reconstruction. Fat grafting can help in this situation in stage two. There may also be a lift or reduction done at the second stage to achieve symmetry.
My personal advice as a patient who has had DIEP flap breast reconstruction, be patient. After the first stage of reconstruction, your breasts need time to heal. The second stage is when the fine tuning can be done.
Surgical Stages May Depend on the Plastic Surgeon
Dr. C says it is not impossible to have even a DIEP flap reconstruction in one stage, but it truly depends on the plastic surgeon and their practice. The abdominal area is very much a part of the reconstructive process in a flap surgery. To do aggressive cosmetic touches to the donor site at the same time as the DIEP can increase the risk of wound healing in the abdominal area. Healing is prioritized at stage 1. Make the patient whole and get them home and healed with a successful reconstruction. At PRMA they feel this focuses on what needs to be in place at stage one to allow them to maximize the cosmetic results later.
Speak to your own surgeon. Know what your expectations and personal goals are with what your surgeon feels they can accomplish for you.
I feel this statement from Dr. C sums up the difference between the surgical stages of breast reconstruction quite nicely.
“The first surgery makes them physically whole and the second surgery as the opportunity to make them look as physically good cosmetically.”