Plastic and reconstructive surgeon Ben Moosavi, MD, of ULTIMATE Plastic & Reconstructive Surgery, is medical director of both the St. Mary’s Breast Center and the St. Mary’s Breast Reconstruction Program, where he offers Hidden Scar breast cancer surgery and Hidden Scar breast reconstruction to his patients. For more information on this surgical approach that helps women look and feel the best they possibly can after mastectomy or lumpectomy, please watch this video.

What is breast reconstruction?

Breast reconstruction helps restore a woman's breasts to their natural shape, size and appearance following a mastectomy, lumpectomy or injury.  It is sometimes performed in its entirety immediately following a mastectomy procedure. Sometimes it is begun at the time of the mastectomy and completed with follow-up surgery. Many factors are considered in the process. Dr. Moosavi and his team educate patients about their options and help determine the plan that is best suited for their health needs and aesthetic goals.

What does a breast reconstruction achieve?

It is often said that breast reconstruction can help a woman feel whole again after a mastectomy surgery, most often due to breast cancer. This surgery can not only restore a breast but self-esteem as well. It can help a woman feel as good, or better, than ever.

Breast reconstruction can:

  • Restore a breast after mastectomy
  • Reconstruct the nipple after surgery
  • Help a woman create the breast size and shape she always wanted.

View these testimonial videos from two patients whounderwent Hidden Scar breast reconstruction by Ben Moosavi, MD, of ULTIMATE Plastic & Reconstructive Surgery.

How is the procedure performed?

Reconstruction is often performed in stages, sometimes beginning just after a mastectomy surgery and sometimes beginning at a later date.
There are different options for how the breast shape will be restored. There is reconstruction using a breast implant, called implant-based reconstruction. Also, there is reconstruction using the patient's own tissue from another part of the body, and relocating that tissue to the breast area to recreate the shape of the breast. That is called flap reconstruction or fat transfer reconstruction. Different types may be combined.Factors that should be considered when deciding which surgery type is best include the type of mastectomy, the cancer treatments that a patient receives and the patient's body type.

Implant-based reconstruction: Two possibilities for implant-based reconstruction are the:

  • Direct-to-implant approach, which is a single-stage reconstruction that is possible for select patients. It is performed post mastectomy and is best suited for patients with good skin preservation of the breast skin after that procedure. A permanent implant is inserted immediately after the mastectomy.
  • Tissue expander-to-implant approach, for which there are multiple stages of reconstruction. Post mastectomy, a tissue expander is inserted between the chest wall and the pectoralis major muscle. A tissue expander is a temporary device that can be gradually filled with fluid to, over time, help skin and other tissue grow and form a natural, soft pocket into which an implant can be inserted. This expander can be inserted immediately following a mastectomy or at a later time. Some weeks after the expander is inserted, the patient visits the plastic surgeon's office one or more times to have the expander filled a bit more via a small injection, until the pocket is the appropriate size. Then another surgery is performed to insert the implant.

Flap reconstruction: There are multiple types of flap reconstruction, which may or may not be combined with implant reconstruction to achieve the desired results. They include:

  • The latissimus flap approach. This is a standard method for breast reconstruction, and it is commonly combined with a tissue expander or implant, giving the surgeon additional options and more control over the aesthetic appearance of the reconstructed breast. This flap provides a source of soft tissue that can help create a more natural looking breast shape as compared with an implant alone.
  • TRAM (transverse rectus abdominus myocutaneous) flap reconstruction. This is the most common method of autogeneous tissue reconstruction, meaning reconstruction using tissue already within the patient's body. This procedure involves using the entire rectuas abdominus muscle to carry to the lower abdominal skin and fat up to the chest wall.  A breast shape is then created using this tissue. In order to transfer the flap to the chest, the muscle is tunneled under the upper abdominal skin. Because it uses the patient's own body tissue, the result looks very natural.
  • DIEP (deep inferior epigastric perforator) flap reconstruction: This method uses an artery and vein at the bottom of the rectus abdominus muscle that provide blood supply to the skin and fat in the lower abdomen. In this procedure, the lower abdominal skin and fat are removed without having to harvest any of the muscle. An incision is made in the muscle and the perforator vessels are teased out from the rectus muscle, ensuring sufficient blood supply for the DIEP flap to survive.
  • TRAM free flap reconstruction. This procedure is similar to the DIEP flap process in that it is based on the deep inferior epigastric vessels.  In TRAM free flap reconstruction, the lower abdominal skin and fat are removed, along with a small portion of rectus muscle. This section of muscle carries blood vessels with the flap, allowing the flap to survive.

Fat transfer reconstruction: Also referred to as autologous fat transfer or fat grafting, this approach is becoming more popular as a breast reconstruction technique. In fat grafting, fat tissue is removed from other parts of the body, such as the thighs, belly and buttocks, using liposuction. The fat tissue is processed into a liquid and injected into the breast to recreate its shape.

What are the risks?

  • Anesthesia risks
  • Infection
  • Bleeding/Blood clotting issues
  • Poor healing of incisions
  • Implant leakage or rupture
  • In flap reconstruction, a risk is partial or complete loss of flap, leading to loss of sensation at the donor area and/or breast reconstruction area.

What can be expected after the surgery?

Will I have bandages/drainage tubes?
Gauze and bandages will be applied to incisions. An elastic bandage or support bra will be in place to support the newly constructed breasts and minimize swelling. Also, a drainage tube may be in place to drain excess fluid.

How soon can I return to work?
Healing takes several weeks. All patients are different and should heed the doctor's advice about when to return to work and normal activities.

How soon until I see results?
Each patient's reconstruction process is different and so the length of time to achieve final results varies greatly.

Is a breast augmentation covered by insurance?

Under the Women's Health and Cancer Rights Act of 1998, all group health plans that cover mastectomy surgeries are also required to cover prostheses and reconstructive procedures. Medicare covers breast reconstruction. Medicaid coverage varies from state to state.