A breast cancer diagnosis and the subsequent mastectomy bring profound physical and emotional changes. Breast reconstruction surgery can play a deeply meaningful role in the healing journey, helping women feel whole again and regain confidence in their bodies. Dr. Bram Kaufman, a board-certified plastic surgeon and director of plastic surgery at MetroHealth Medical Center in Cleveland, is a trusted specialist in all forms of breast reconstruction, from implant-based techniques to complex microsurgical flap procedures.
When Should Reconstruction Be Considered?
Breast reconstruction can be performed either immediately at the time of mastectomy (immediate reconstruction) or at a later date once treatment is complete (delayed reconstruction). Both approaches have advantages, and the right timing depends on the patient’s cancer treatment plan, overall health, and personal preferences.
Immediate reconstruction has the advantage of preserving the breast skin envelope and often producing better cosmetic outcomes. Delayed reconstruction allows patients to complete radiation and chemotherapy before undergoing reconstruction, a consideration that matters because radiation can affect implant outcomes and may make autologous reconstruction more appropriate.
Implant-Based Reconstruction
Implant-based reconstruction is the most commonly performed technique and typically proceeds in two stages. In the first stage, a tissue expander is placed beneath the chest muscle at the time of mastectomy. Over the following weeks and months, the expander is gradually filled with saline through a port, stretching the skin and muscle to create a pocket for the permanent implant. In the second stage, the expander is replaced with a permanent silicone or saline implant.
Newer techniques using acellular dermal matrix (ADM) or prepectoral (above the muscle) placement have expanded the options available and may allow for single-stage implant reconstruction in select cases.
Autologous (Flap) Reconstruction
Flap reconstruction uses the patient’s own tissue, typically from the abdomen, back, or thigh, to create a new breast mound. Because it uses living tissue with its own blood supply, flap reconstruction tends to produce the most natural-looking and natural-feeling results, and it ages gracefully alongside the rest of the body.
DIEP Flap
The Deep Inferior Epigastric Perforator (DIEP) flap uses skin and fat from the lower abdomen without sacrificing the underlying muscle. This microsurgical technique requires specialized training, but it avoids the abdominal weakness that can result from older flap techniques. Dr. Kaufman’s fellowship training in microsurgery makes him highly qualified to perform this procedure.
Latissimus Dorsi Flap
This technique uses skin and muscle from the upper back to reconstruct the breast. It is particularly useful in patients who have received radiation to the chest, as it brings well-vascularized tissue into the reconstructed area. It can be used alone or in combination with an implant.
Nipple and Areola Reconstruction
Breast reconstruction is not complete without addressing the nipple-areola complex. Nipple reconstruction can be performed as a minor outpatient procedure several months after the main reconstruction, once the reconstructed breast has settled. Areola tattooing is performed last and can create a remarkably natural appearance.
Symmetry Procedures for the Opposite Breast
In many cases, a procedure is also performed on the opposite breast to achieve symmetry, whether a lift, reduction, or augmentation. Under the Women’s Health and Cancer Rights Act, health insurance plans are generally required to cover symmetry procedures on the opposite breast.
Insurance Coverage
The Women’s Health and Cancer Rights Act mandates that health insurance plans covering mastectomy must also cover breast reconstruction, prostheses, and treatment for complications at any stage. Dr. Kaufman’s office can assist patients in navigating coverage questions.
Dr. Kaufman provides breast reconstruction to patients in Cleveland, Beachwood, Pepper Pike, Lyndhurst, and the surrounding Northeast Ohio region. To discuss your reconstruction options, contact Dr. Kaufman’s office directly.
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