Breast Reconstruction Mobile, AL
Dr Randy Proffitt is the only Plastic Surgeon in Mobile, Alabama and on the entire Gulf Coast who is fellowship trained in and offers both “Free” DEIP flap and TRAM Flap Breast reconstruction. “Free” DEIP and TRAM flaps have a much better blood supply to the breast reconstruction. This results in more consistent healing and less risk of tissue loss. In the case of DEIP flap Reconstruction, it also spares the abdominal muscle(s) as compared to the pedicled TRAM flap. This results in stronger abdominal muscles and less risk of abdominal “hernia”. Up to 30-40% of “pedicled” TRAM flaps have problems with wound healing of the breast reconstruction.
According to the National Institute of Health (NIH) 230,000 women in the United States are diagnosed with breast cancer every year and thirty-five percent (80,500) will choose a mastectomy (removal of the breast) as their course of treatment. Once the decision to have a mastectomy has been made, the choice to reconstruct should be considered next. We hope to provide you with information to help you make your decision easier. Dr. Proffitt encourages you to learn as much as you can before deciding whether reconstruction and/or what type of reconstruction is best for you.
View more plastic surgery photos
No one source of information can give you every fact or answer all your questions. At your consultation with Dr. Proffitt you will watch a video about breast reconstruction options, have a thorough examination and discussion that will include your history, and view typical results of breast reconstructions. Dr. Proffitt will also give you his recommendation tailored to fit your special circumstances. We hope that through your breast reconstruction we will restore not only your physical appearance but help renew your emotional well being.
Options in Breast Reconstruction
- No reconstruction: this often means wearing a special bra fitted with an external prosthesis in order to achieve a symmetrical appearance in clothing.
- Reconstruction using breast implants: following your mastectomy, Dr. Proffitt will insert a tissue expander beneath your skin and chest muscle. A tissue expander is a silicone shell with a valve mechanism. The tiny valve mechanism, which will be incorporated into the expander just underneath the skin, will be periodically injected with a sterile salt-water solution (saline) to gradually fill or “expand” the expander over several weeks or months. After the skin over the breast has stretched enough, the expander is removed and the permanent implant inserted. Both saline and silicone filled implants are options for the more permanent implant. Information on both types of implants will be provided to help you make the best decision for you. The nipple and areola are reconstructed in a subsequent procedure.
- Reconstruction Using Your Own Tissue (Autologous) TRAM/ DIEP FLAP: Dr. Proffitt’s approach to autologous reconstruction is predominately the use of the free TRAM/DIEP flap. The free Transverse Rectus Abdominus Muscle flap (TRAM) involves removing the skin, fat and a small portion of muscle (along with the blood vessels) from the lower abdomen and reshaping the flap into a breast while reconnecting the abdominal blood vessels into blood vessels in the chest. This produces a breast mound of your own tissue. No implant is necessary. This operation involves two surgical sites- the area where the tissue is harvested and the breast. Both areas will have scars and although they will fade over time, they will never completely go away. Although a Pedicle Tram Flap (the flap is not removed but stays attached to its original blood supply and tunneled up to the breast) is more widely used, Dr Proffitt’s training and experience has demonstrated the advantages of a free TRAM/DIEP flap versus a pedicle TRAM flap. A free TRAM has a better blood supply and therefore less tissue healing problems. Some surgeons believe that the free TRAM also results in a more natural shape. There is also the added benefit of better abdominal contouring.(tummy tuck). Free TRAM flaps are less common than pedicle flaps because free flaps require the skill of a plastic surgeon who is experienced in microvascular surgery. Dr. Proffitt is the only plastic surgeon on the gulf coast to have completed a fellowship in exactly this type of surgery (microvascular).
- Whether you chose reconstruction with tissue expanders or autologous tissue, Dr. Proffitt may also use a new method of tissue support. Plastic surgeons often use synthetic mesh to support tissue as it heals. Recently a new product (acellular dermis) has become available. Acellular Dermis is a product of human tissue in which the human cells are removed thereby reducing any risk it carries disease or that your body will reject it. It is regulated by the U.S. Food and Drug Administration (FDA). Dr. Proffitt uses acellular dermis frequently in both expander/implant reconstruction and in the abdomen to prevent weakness in the abdominal wall after TRAM flaps. View before and after photos of TRAM Flap breast reconstruction.
When Should I Have Breast Reconstruction?
Immediate versus Delayed Reconstruction
Immediate reconstruction will result in less surgery, anesthesia and down time. Some patients also choose immediate reconstruction to avoid any emotional distress from the absence of a breast mound. However delayed reconstruction is sometimes a better choice depending on the patient’s overall health and stage of breast cancer. Some women will choose to wait and cope with the diagnosis of breast cancer and subsequent mastectomy before weighing all the options of reconstructive surgery. Whether delayed or immediate breast reconstruction is the best decision for you, begin talking about reconstruction as soon as you are diagnosed with cancer. Your mastectomy surgeon, medical oncologist and Dr. Proffitt will work together to detail a plan that best for you.
Where Will Surgery be Performed?
Dr. Proffitt has privileges at all local hospitals and outpatient centers and will coordinate your surgery at the hospital of your choice in conjunction with your mastectomy surgeon.
How Long Will I be in the Hospital?
The table below provides approximate length of your hospital stay after breast reconstruction.
|Type of Surgery||Delayed Reconstruction||Immediate Reconstruction|
|Free TRAM||5 to 7 days||5 to 7 days|
|Tissue Expander Placement||Outpatient procedure <24 hours||1 to 2 days|
|Implant Placement||Outpatient procedure <24 hours||Outpatient procedure <24 hours|
|Nipple Reconstruction||Outpatient procedure||Outpatient procedure|
Can Breast Reconstruction Hide Cancer or Cause a Recurrence?
Studies show that breast reconstruction either with a flap or implants rarely, if ever, interferes with the detection or recurrence of breast cancer.
What About my Other Breast?
If you are facing unilateral breast reconstruction you may be concerned about symmetry between your reconstructed breast and the remaining breast. To achieve symmetry,you may elect to have a procedure on your non-reconstructed breast such as a breast lift, reduction or augmentation.
Questions to ask Dr. Proffitt at Your Consultation
Dr. Proffitt encourages you to print out the following list of questions and to write down any other questions as you think of them and bring them to your consultation. It is often helpful to bring a friend or family member with you to help remember what is said during your appointment. Please ask any questions you may have. It is important for you to make an informed decision about your breast reconstruction.
- Can I have breast reconstruction?
- When can I have reconstruction done?
- What types of reconstruction could I have?
- What is the average cost of each type? Will my insurance cover them?
- What type of reconstruction do you think would be best for me? Why?
- How many of these procedures have you (plastic surgeon) done?
- What results can I expect?
- Will the reconstructed breast match my other breast?
- How will my reconstructed breast feel to the touch?
- Will I have any feeling in my reconstructed breast?
- What possible problems should I know about?
- How much discomfort or pain will I feel?
- How long will I be in the hospital?
- Will I need blood transfusions? If so, can I donate my own blood?
- How long it take for me to recover?
- What will I need to do at home to care for my incisions (surgical wounds)?
- Will I have a drain (tube that lets fluid out) when I go home?
- How much help will I need at home to take care of my drain and wound?
- When can I start my exercises?
- How much activity can I do at home?
- What do I do if my arm swells (this is called lymphedema)?
- When will I be able to go back to normal activity such as driving and working?
- Can I talk with other women who have had the same surgery?
- Will reconstruction interfere with chemotherapy?
- Will reconstruction interfere with radiation therapy?
- How long will the implant last?
- What kinds of changes to the breast can I expect over time?
- How will aging affect the reconstructed breast?
- What happens if I gain or lose weight?
- Are there any new reconstruction options that I should know about?
Back to Normal With Your New Look
- It may take up to six weeks to recover
- Reconstruction cannot restore normal sensation to your breast but in time some feeling may return
- Surgery scars will fade over time but will never completely disappear
- Your reconstructed breast may feel firmer and look rounder or flatter than your natural breast
- Your reconstructed breast may not exactly match your opposite breast
- The goal of breast reconstruction is to restore your breast shape, fullness, and to make your breasts look balanced when you are clothed. For most mastectomy patients, breast reconstruction improves their appearance, self esteem, and quality of life. Dr. Proffitt and his staff will support you through every stage of your breast reconstruction and work closely with your other physicians.