Breast Reconstruction in Lubbock, TX

Breast reconstruction surgery following the removal of a breast because of cancer can be one of the most confidence-inspiring surgeries a patient can undergo. Plastic surgeons Dr. Schmid, Dr. Mooty, and Dr. Daniele can help patients decide which of the many new advancements in reconstructive techniques will be the most beneficial to our patients from West Texas and East New Mexico and then work closely with the patient’s other doctors to determine the optimal course of action. For patients who have had a mastectomy and their remaining chest tissue has been damaged or is not suitable for tissue expansion, TRAM (Transverse Rectus Abdominus Musculocutaneous Flap) breast reconstruction can be a good option for breast reconstruction surgery. During this procedure, Dr. Schmid, Dr. Mooty, or Dr. Daniele of The Lubbock Plastic Surgery Institute will use muscle, fat, and skin from the patient’s abdomen to create a new breast mound and replace tissue in the chest area. The advantage of a TRAM flap over breast implants is that symmetry can be improved without altering the unaffected breast and the patient will have a tighter lower abdomen. TRAM flap reconstruction is a major operation and more extensive than a mastectomy. It requires good general health and strong emotional motivation. Patients who are overweight, smoke cigarettes, have had previous surgery at the flap site, or have any circulatory problems are not be a good candidate for TRAM flap surgery. In addition, patients who are very thin, may not have enough tissue in their abdomen or back to create a breast mound with this method. The best candidates for this procedure are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy. However, reconstruction is also frequently possible immediately following a mastectomy so the patient undergoes anesthesia once and will wake up with a breast mound already in place. Post-mastectomy breast reconstruction is not a simple procedure. There are often many options to consider so patients should schedule an initial consultation at our Lubbock or Midland offices so our medical professionals discuss options and individualized treatment plans.

During your first consultation to discuss reconstruction surgery, it is important to disclose where you are in the treatment process and which cancer surgeon is treating you, as well as provide any necessary pathology reports. The reconstruction process may take place in multiple steps if the breast tissue needs to be stretched to make room for implants. This discovery phase will help guide the reconstruction process so patients end up with a new breast that is the size, shape and look they want.

Each reconstruction technique will be tailored according to the patient’s physical health, aesthetic goals, and personal preferences. There are many factors playing into the approach that will be taken. The ultimate goal is to ensure the patient is healthy and happy with their final breast results.

There are two primary categories of breast reconstruction techniques:

• Procedures that involve using a breast implant
• Procedures that are autologous (use the patient’s own body’s tissue to reconstruct and recreate the breast)

Breast reconstruction using silicone or saline implants is a common approach that generally starts with the use of a tissue expander to help form a suitable pocket for an implant.  The expander may be inserted after the mastectomy procedure or during the same operative session. Over the course of several months, the expander will slowly be enlarged using a sterile solution injected through a port residing under the skin. During the scheduled reconstruction surgery, the expanders are removed and replaced with permanent implants.  

It is also possible, occasionally, to go straight to a silicone or saline implant at the time of mastectomy, referred to as "Direct to Implant" reconstruction, which Dr. Daniele specializes in.

If there is limited tissue inside the breast, or limited skin on the outside, tissue may be used from another part of the patient’s body to supplement this loss. The most common areas to support this process are the buttocks, thigh or abdomen. This is an autologous approach to breast reconstruction. The TRAM flap (Transverse Rectus Abdominus Myocutaneous), the DIEP flap and SIEA flap techniques involve taking skin and fat from the abdomen and relocating it to the breast. The Latissimus Dorsi Flap is another common method using tissue from the patient’s back.

Dr. Daniele specializes in offering nipple repositioning, to help promote preservation of the nipple during mastectomy, and an overall aesthetically pleasing breast shape.  Dr. Daniele also offers nerve preservation and reinnervation techniques to improve the sensation to the nipple and areola after mastectomy.

In the rare event that the nipple and areola cannot be saved by your oncologic surgeon, plastic surgeons offer different options for reconstruction.. The loss of one’s nipple and areola can be as unnerving as the removal of the breast itself. However, reconstruction techniques have advanced greatly, allowing plastic surgeons the opportunity to recreate these areas of the breast to give a natural, aesthetically appealing appearance. In a separate procedure, the nipple is created using existing breast skin or from the abdominal or latissimus flap. Using a tattoo technique, the areola is recreated with a skin graft taken from the thigh, abdomen or back.   

Breast reconstruction surgery is performed under general anesthesia at an accredited surgical facility. Some patients may be required to stay in the hospital to be monitored for complications. Patients who have had reconstruction using a flap technique will usually be required to stay in the hospital for 2-5 days. The recovery process can be somewhat lengthy, but many view it as the final step in their cancer journey thus the experience can be very rewarding.  Most women are thankful to have had the opportunity to restore their breasts and are satisfied with their results. 

This is a very specialized surgery that requires extensive knowledge, skill and experience. It is very important to research and find a qualified and reputable plastic surgeon who has experience with breast reconstruction surgery.  

In many situations, it is recommended to start the reconstruction process at the same time as the mastectomy. Therefore, it is a good idea to have your breast cancer surgeon and your plastic surgeon begin communicating about the steps that will follow. An advantage of doing the procedure immediately is waking up from your mastectomy surgery with the reconstruction process in place. The soft tissue that surrounds the breast will heal simultaneously with the reconstruction, which can enhance the final results. 

A reconstructed breast will not have the same sensation as the breast did before the mastectomy. However, over time, some of this sensation will return to normal. This will depend on the extent of the reconstruction process and will vary by patient. This can be improved with nerve preservation and reinnervation techiques, a field of plastic surgery that Dr. Daniele specilaizes in.