Breast reconstruction should be offered to every patient who is undergoing a mastectomy. The reconstructive options, including no reconstruction, should be discussed with the plastic surgeon prior to the mastectomy surgery. In general, the methods of breast reconstruction are divided in two types; autologous (your own tissue such as skin and fat) tissue reconstruction; and with breast implant. Dr Kim generally recommends the autologous tissue reconstruction (TRAM flap procedure), if possible, largely because of the long-term superiority of the result after TRAM Flap reconstruction. The reconstruction using a breast implant is also a valid option, although in general, it is difficult to obtain symmetry of the breasts using this technique.
Breast Reconstruction can be done at the same time with the mastectomy or at a later date as a separate procedure. However, in general, the immediate reconstruction will provide overall superior aesthetic result. Dr. Kim and surgical team usually work together to do immediate reconstruction at the time of mastectomy.
TRAM (Transverse Rectus Abdominis Myocutaneous) Flap reconstruction is now considered the gold standard for the breast reconstruction when available. The idea is to use the excess skin and fat tissues in the lower abdomen (they are usually thrown away during a tummy tuck procedure) to rebuild the breast mound after mastectomy. The incision in the abdomen is therefore similar to that of a tummy tuck running a curvilinear fashion in the lower abdomen. We also relocate the umbilicus (navel) at the same time as in the tummy tuck. In general, a patch of skin including the nipple and areola is removed at the time of mastectomy, and this patch of skin will be replaced by the skin from the abdomen. Technically, this procedure is done as “pedicled” or “free” depending upon the surgeon’s preference and the specific conditions of individual patients. Often, Dr Kim performs a “Delay” procedure to strengthen the flap (tissue in the lower abdomen) 2-3 weeks prior to the reconstructive procedure. This procedure entails a small incision in the lower abdomen and tying off vessels in the lower abdomen, done as an outpatient procedure.
The TRAM flap reconstruction requires a hospitalization after surgery, usually 4-5 days. It will take 4-6 weeks of recovery time before one can be comfortable in resuming daily functions, and 3 months for a completely recovery, although individual result varies.
Secondary procedures—Occasionally after breast reconstruction, patients present with asymmetry of the breast after reconstruction. This could be the difference of shape of the breast or volume of the breast. If the normal breast is ptotic (droopy), a mastopexy (breast lift) of the normal breast may be recommended to achieve the symmetry of the breast. These touch-up procedures are usually done at least 6-12 months after the initial reconstruction. Additionally, at this time, a nipple reconstruction can be done using the local breast skin. Areola will be tattooed to give the color later. Some patients may need to have chemotherapy after the mastectomy, and therefore, these secondary procedures are usually performed after such therapies are completed.
Breast Reconstruction with Implant
The placement of a breast implant provides relatively simple solution for breast reconstruction. The reconstructed breast with an implant can be somewhat firmer than normal and the shape of the breast tend to be round and lifted, lacking natural drooping of the breasts. It is recommended to patients with small breasts, and those who do not wish or do not qualify for TRAM flap reconstruction. This reconstruction is a two-stage procedure. First, a tissue expander is placed in the breast area and then expanded over three to four months period by adding saline solution intermittently. This expansion process stretches skin of the breast area so that there will be enough space for the implant placement.
Breast Reconstruction with Latissimus Flap and Implant
Some patients may be considered a good candidate for a combination procedure to use latissimus dorsi myocutaneous flap and implant. This procedure uses the muscle in the back and small amount of skin to rebuild the breast mound. However, because this tissue itself is quite small in volume, it would not provide sufficient volume comparable to the normal other breast, therefore, this flap is combined with the use of a breast implant. The benefit of the procedure is that this is a single stage procedure, and the postoperative recovery is easier than the TRAM flap.
Excessively large breasts often cause back pain, neck and shoulder pain, as well as difficulty maintaining personal hygiene and developing rash under the breasts. The patients usually experience difficulty finding adequately fitting bras. The large breasts tend to interfere with daily physical activities. Breast reduction procedures are very effective in relieving such symptoms associated with large breasts.
The type of procedure depends upon the amount of excess, however, most commonly, Dr Kim performs an anchor shaped (key hole pattern) incision to reduce the breast size. The scarring, particularly along the inframammary fold (along the bottom of breast), is a significant issue and anyone who considers this procedure must have a thorough discussion with the surgeon prior to surgery.
This procedure may be covered by your insurance company.
Facial deformity caused by injury, congenital anomaly, or cancer can be successfully reconstructed by various methods. The type of procedure used depends upon the location and size of the defect.
Dr. Kim prescribes a systemic approach to the scar management, including surgical scar revision, routine tape therapy, silicone tape treatment and Kenalog (steroid) injection. Scar management is an integral part of the plastic surgery practice due to the significant variation in scarring. There are measures one can take to reduce the chance of significant scarring. These include: meticulous surgical techniques, prevention of infection, steroid injection, application of pressure, release of tension at scar, etc. Also, scars that cause functional problems, such as over a joint causing limitation on ranging, should be treated with scar revision.
Surgery of the Hand
Dr. Kim provides the comprehensive care for the patients with hand problems. Procedures range from simple laceration of fingers, and infection in the nails, to complex fractures of the fingers, tendon laceration, carpal tunnel syndrome, and arthritis.The hand therapist and occupational therapist are the integral part of the hand rehabilitation. Aggressive hand therapy program is offered to every patient with a hand injury.
Microsurgery refers to the surgical technique where a microscope is used to perform sophisticated surgical procedures on very small structures, such as small vessels or nerve. In plastic surgery, microsurgery is used to assist in transferring tissue from one part of the body to another part of the body, commonly called a free flap transfer.