Options for Reconstruction
The breast reconstruction program at Northern Light Health is led by Steven Kozusko, MD, a board-certified plastic surgeon. Reconstruction is offered for patients with breast cancer, breast asymmetry, or a history of breast surgery. The surgeries may be provided at the same time as a mastectomy, in a delayed manner, or as a revision.
As the field of reconstruction developed, tissue expanders and implants were the main option offered to women. Now many women opt for using their own body for reconstruction. This includes the Goldilocks breast reconstruction, the latissimus dorsi myocutaneous pedicled flap from the back, and the DIEP (deep inferior epigastric perforator) free flap from the abdomen. Some women desire an aesthetic closure, and other women seek a symmetry procedure.
At our program, we treat women who have undergone previous breast reconstruction with complications or dissatisfaction. It is not uncommon for a woman to have an infection or contracture after tissue expander and implant-based reconstruction. Other women have fibrosis from radiation treatment. Implants are not lifetime devices, and some women need implants exchanged or removed.
While implant based reconstruction often results in an aesthetic outcome and is the most common type of reconstruction offered in the country, many women desire alternatives to avoid foreign material during reconstruction. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant-associated squamous cell carcinoma (BIA-SCC) are rare cancers associated with implants. Breast implant illness is thought to be a range of symptoms potentially linked to implants. Acellular dermal matrix (ADM) is a scaffold placed to position tissue expanders. We offer reconstruction based on a woman’s body (Golidlocks, latissimus, DIEP) in those who seek something other than an implant.
What is the DIEP
The DIEP is a procedure that uses your abdominal skin and fat to make breasts. This skin is located beneath the umbilicus (belly button) and above the pubic bone. It is the tissue that some individuals have removed during a panniculectomy (tummy tuck). This tissue has blood vessels that come up through the abdominal muscles (abs). This tissue, with the blood vessels attached, can be connected to blood vessels near the center of the chest (sternum) and shaped into a breast.
The procedure requires a plastic surgeon who has trained in “microsurgery” which is a specialized technique working with very small blood vessels. That is one of the reasons the surgery takes longer than placing implants. Using the DIEP, though, results in a natural feeling reconstruction that ages with the patient through their lifetime. No further surgery or monitoring of the reconstruction is required once it heals.
What are the risks and benefits
Benefits
- A natural reconstruction using one’s own tissue and no foreign material placed in the reconstruction
- It is one of the main options for a patient that has been treated with radiation and told there is no other reconstruction available
- Utilized to treat implant failure, implant loss, and implant capsular contracture
- Can be completed at the time of mastectomy or anytime in the future after cancer care
- This is a lifelong reconstruction that requires no further treatment once it is healed
Unique Risks
- The flap can fail to heal appropriately due to a vessel clot or poor blood supply and need to be removed
- The abdomen muscles can be injured, resulting in weakness to the “abs” and rarely a hernia
- The lung lining can be injured, resulting in a collapsed lung (pneumothorax)
Is this covered
The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a law passed by the federal government. This law requires coverage for reconstruction for women who undergo mastectomy. It includes all stages of reconstruction and if complications occur that require treatment.
At Northern Light Health, pre-authorization specialists work with your insurance carrier to ensure coverage before surgery is scheduled.
Are you a candidate?
The main factor determining if this surgery is right for you is the amount of abdominal tissue located beneath your belly button. There has to be enough tissue to make breasts but not so much that too much tissue is present to do so successfully. If a woman is not a candidate for a DIEP flap, other options are available including the latissimus flap or a Goldilocks reconstruction.
The Body Mass Index (BMI) is a helpful tool used to determine candidates. Those with a BMI under 35 are usually appropriate for this procedure.
Previous abdominal surgeries also determine if a patient is a candidate. Large open incisions from previous surgeries in the abdomen can affect the blood vessels needed to perform this surgery.
Even if a patient is not a candidate for a DIEP, they may be for another type of reconstruction.
What can you expect
Call 207-973-9950 to schedule an appointment. The team at Northern Light Plastic and Hand Surgery will schedule a 60-minute consultation with Dr. Steven Kozusko. Some women will have a second 30-minute consultation.
After consultation, a woman may or may not need a CT scan of the abdomen (CTA) to evaluate the blood vessels at the DIEP flap. This will be discussed during the consultation.
From there, the timing of the surgery will be discussed and planned. After the surgery, most women will stay in the hospital a few nights to carefully monitor the reconstruction. They will then be followed closely in the clinic over the coming weeks and months. Many women feel recovered from the surgery within 1 to 2 months. Some women work with our physical therapists to strengthen their abdominal muscles after surgery.
The DIEP Program
The DIEP program at Northern Light Health is possible due to many team members. Supporting Dr. Steven Kozusko and Dr. Ronald Bogdasarian are three excellent physician assistants. Eastern Maine Medical Center also provides ICU level of nursing care to monitor the reconstruction every hour during the hospital admission. Board certified trauma surgeons and highly trained administrators, technicians, and providers support you through your journey and care.
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