Breast Reconstruction
For some women, plastic surgery involves more than cosmetic surgery, it may also involve reconstructive surgery. At Criswell & Criswell Plastic Surgery, our surgeons recognize the importance of offering reconstructive options to our patients.
There are many reasons that women may desire and need reconstruction. Whether the cause of the deficit is congenital, such as Poland’s Syndrome, or the result of a mastectomy after breast cancer, breast reconstruction surgery is a wonderful option for women to help restore the look and feel of a natural breast.
There is no one right reconstructive plan for women desiring breast reconstruction. Both Dr.'s Kara and Bryan Criswell understand how personal this decision-making is and wish to offer you the opportunity to discuss all possible options.
We hope the information below will help provide some basic information that you may wish to consider as you make this very personal decision. We encourage you to call to make an appointment with either Dr. Kara Criswell or Dr. Bryan Criswell to further discuss which option is best for you.
Breast Reconstruction Options:
Breast reconstruction is generally performed in multiple stages. It can be performed as immediate reconstruction (at the same time as your mastectomy), or as delayed reconstruction, months or even years after. Regardless, it is rarely completed in only one operation and can often involve multiple procedures over many months. We want our patients undergoing breast reconstruction to be aware of the different stages and understand that our surgeons are committed to provide the best outcome throughout every stage.
The American Society of Plastic Surgeons website can be a great resource for patients exploring their options. To see representative photographs of breast reconstruction, please see the link to the website: (ASPS photos).
Breast reconstruction with Implants
For many patients, breast reconstruction with implants is a great option. The first stage involves placing a tissue expander beneath your chest muscles. This expander is a balloon-like device made from gel. Over time, saline fluid is added in order to inflate the expander and stretch the skin. 
This expansion takes place over a few weeks to months, with regular office visits. Eventually, the skin and muscle are stretched sufficiently so that there is room for the placement of a more permanent implant.
Stage two involves placing this implant. The balloon expander is removed, and your surgeon will then insert a breast implant. The implant can be saline filled or silicone gel ('gummy bear' style). The choice of implant is between you and your surgeon, but generally speaking, the gel implants give a more natural look and feel.
Stage three involves the reconstruction of your nipple and areola. Skin from the central portion of the breast is used to recreate the nipple. This is generally performed as a separate surgery a few weeks after the placement of the implant. Once your surgeon has surgically created the nipple and areola, many women go on to have the area tattooed so that the color match is natural. Dr. Criswell uses a medical tattoo device to permanently color the areola. This is done in the office over one or two sessions. (ASPS link for photos)
Breast Reconstruction with Autologous Tissue (Using your own tissue)
The TRAM Flap
While expander and implant surgery is a great option for some women, others may choose to undergo breast reconstruction with a flap, making use of their own tissue to recreate their breast.
The TRAM flap (transverse rectus abdominus myocutaneous flap) uses a patient’s lower abdominal skin and fat to reconstruct the breast. There are many variations of this type of surgery with multiple names, but the basic idea is this: During this surgery, the skin and fat of the lower abdomen is moved to the position of the breast. It is either rotated up with some of the abdominal muscles (a pedicled TRAM flap), or it is brought up into position and then blood vessels are sewn together to provide a blood supply (a free TRAM flap). 
Other variations involve sparing the abdominal muscles partly or completely (the muscle sparing TRAM flap, and the DIEP flap). Regardless of which is used by your surgeon the abdominal tissue is transferred to your chest to restore the shape of your breast. The abdominal incision is then closed much as an abdominoplasty would be, leaving you with both a reconstructed breast and a tummy tuck. The surgery generally takes 3-6 hours and requires a few days stay in the hospital. Many women are able to return to simple activity within the week, and most women can resume full activities within 4-6 weeks.
The second stage of this reconstruction involves restoring the nipple and areola. Skin from the central portion of the breast is used to recreate the nipple. This is performed a few months after the original surgery, either in the hospital or as an office procedure. Once your surgeon has surgically created the nipple and areola, many women go on to have the area tattooed so that the color match is natural. (ASPS link for photos)
The Latissimus Flap
The latissimus flap, like the TRAM flap, uses a woman’s own tissue to restore her breast. The latissimus flap uses the skin and muscle from the upper back and rotates this tissue around to the front of the chest. While the latissimus can be an excellent choice for some women, because of the popularity of the TRAM flap, it is often reserved for patients in whom the TRAM reconstruction is not a good option. This group of patients includes extremely thin patients without much abdominal tissue, or those who have previously undergone extensive abdominal operations.
During this surgery, an incision is made in the back, often hidden the bra line. The skin and muscle of the latissimus is then rotated forward to the chest wall, to recreate the breast. 
The latissimus flap is a smaller flap than the TRAM, and it is often not large enough to restore adequate volume to the breast. In these cases, a woman can chose to either have an implant placed with the latissimus flap, or possibly undergo a breast reduction on the other breast.
As mentioned in the above reconstructive options, the nipple and areola are restored during an additional stage. (ASPS link for photos)
Charlotte has many wonderful resources for women with breast cancer. Carolinas Breast Friends is one of them. It is a non-profit organization committed to uniting and helping women with breast cancer in all stages of survivial. The organization centers on those who want to create a social and educational outlet for women united in a sisterhood of survival and hope. For additional links, click here.
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