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Breast Reconstruction (Reduction Mammaplasty)


Where do I begin?

A consultation with Dr. Daniel Golshani, a board certified plastic surgeon in Los Angeles, is the first step toward learning whether breast reconstruction is appropriate for your age, anatomy, and health. Designed to fully educate potential patients, Dr. Golshani's consultations typically include a discussion of your goals, the options available to you for reconstructive surgery, the likely outcomes and potential risks and complications associated with the procedure, and the course of treatment that Dr. Golshani recommends for you.


Preparing for surgery

Dr. Golshani will carefully explain the breast reconstruction procedure you will undergo. Prior to your procedure, you will be given specific instructions regarding diagnostic testing, day of surgery procedures, postoperative care, and follow-up information. In addition, you will be asked to sign consent forms to assure Dr. Golshani that you fully understand the procedure that you will undergo and any potential risks or complications related to your procedure.


Kinds of Implants

If you are interested in using implants after your breast reconstruction, Dr. Golshani will want to discuss what type of implant might be the best fit for you prior to your procedure. A breast implant, generally speaking, is a shell made of silicone that is filled with either silicone gel or a salt-water solution (i.e., saline).


The Reconstructive Decision-Making Tree

When a decision is made with the diagnosis of cancer or for preventive measures, a board certified plastic surgeon such as S. Daniel Golshani, M.D., F.A.C.S. should be consulted to discuss options for reconstruction prior to the date of the mastectomy. Important questions to answer are whether immediate reconstruction should be considered or whether reconstruction should be delayed to a later time following the date of the mastectomy. Factors influencing this decision include surgical options, the need for post-operative radiation therapy and/or chemotherapy, patients' general health, and each patient's individual desires.

General options available for reconstruction include the following:
Skin Expansion
  1. Tissue expansion with placement of implants. This is the most common technique employed in breast reconstructive surgery. This procedure combines skin expansion and subsequent insertion of an implant.


Flap Reconstruction
An alternative approach to implant reconstruction involves creation of a skin flap using tissue taken from a patient's back, abdomen, or buttocks. There are different kinds of flap surgery. Below are brief descriptions of the different types of flap reconstruction surgery available to patients.

  1. Use of a muscle flap that can be rotated from the back with an implant for breast reconstruction (latissimus dorsi myocutaneous flap).
  2. Use of a muscle flap that can be rotated from the abdomen without the need for an impant with the additional benefit of receiving a tummy tuck (TRAMFLAP).
  3. Use of a free or super-charged version of any of the above mentioned flaps as well as other available flaps which would require attachment to local breast blood supply with the use of a microscope.



Follow-up Procedures

Most breast reconstruction involves a series of procedures that occur over a period of time. The initial reconstructive operation is usually the most complicated. Follow- up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and areola. Many surgeons may also recommend an additional operation to enlarge, reduce or lift the natural breast so that it matches the reconstructed breast.


Progress and Healing

Initial healing will include fatigue and soreness for 1 to 2 weeks following your reconstructive procedure. Most of your discomfort can be controlled with medication prescribed by Dr. Golshani.

Typically, it takes patients approximately 6 weeks to recover from breast reconstructive surgery. Although reconstruction usually doesn't restore normal sensation to your breast, some feeling may return in time.

Healing will continue after your reconstructive surgery and scars will fade substantially with the passage of time. The better the quality of your overall reconstruction, the less distracting you are likely to find your scars. Continue to follow Dr. Golshani's instructions and attend all of your follow-up visits as scheduled after your procedure. As a general rule, you should refrain from any overhead lifting and strenous activity for 3 to 6 weeks following reconstruction.


Results and Outlook

Typically, a patient's reconstructed breast may feel firmer and look rounder or flatter than their natural breast. The reconstructed breast may not have the same contour as it did prior to the mastectomy. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life following surgery.


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