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Breast Reconstruction

Modern Breast Reconstruction in San Antonio Texas

Breast Reconstruction San Antonio TX | Breast Reconstruction

A breast cancer diagnosis is a life changing event.  It traumatizes both the body and the spirit.  It disrupts a person’s life and forces them into a world that is unfamiliar and stressful.  Doctors’ appointments, imaging studies, blood tests, genetic testing, and various treatment options (surgery, chemotherapy, radiation, hormonal therapy)… Trying to research different reconstruction techniques on your own from random online sources is frustrating and often not very productive.  

Dr. Albright appreciates how much patients have to deal with, and his goal is to simplify your individualized reconstruction options.  He wants his patients to understand how options differ and why one approach is better and worse than another.  He is here to answer your questions, and ensure that you are confident with your reconstruction plan.

Dr. Albright will support your choice to pursue breast reconstruction at the time of your mastectomy (immediate reconstruction) or to delay your reconstruction until after your cancer treatments are completed (delayed reconstruction).  He does not pressure patients into surgery, and will always encourage his patients to make the best decision they can at that time.  

Breast reconstruction FAQ’s

Should I have my breasts reconstructed at the time of breast removal (mastectomy), or should I wait?

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Performing an immediate breast reconstruction after mastectomy allows the most natural breast reconstruction, as we will be able to keep most, if not all, of the breast skin and nipple.  Patients will discuss using her own tissue to reconstruct the breast (flap reconstruction) versus an implant or a tissue expander.  Dr. Albright performs the most up-to-date techniques in breast reconstruction including above-the-muscle (prepectoral) reconstruction and direct to permanent implant reconstruction.  

A delayed breast reconstruction surgery differs from performing the reconstruction at the time of the mastectomy because the skin of the breast has been removed. Therefore with a delayed reconstruction, we must replace the missing volume of the breast, but also address the lack of available skin. This is achieved by either stretching the remaining skin on the chest (with a tissue expander below the pectoralis muscle), or by moving new skin from another part of the body to the chest (a flap). Dr. Albright will discuss the pros and cons of both approaches and help you pick the best path moving forward.

What is prepectoral (above-the-muscle) breast reconstruction?

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Prepectoral implant based reconstruction is the most modern type of breast reconstruction and has many benefits over traditional below-the-muscle techniques. When the saline or silicone gel implant is below the pectoralis muscle, the muscle has to stretch across the implant. Not only will this produce more pain, it will also limit how much volume of implant can be placed to reconstruct the breast, and is the main rationale for using an expander (a temporary adjustable but not permanent implant). Since an expander is not a good permanent implant device, it will eventually need to be removed and replaced with a permanent breast implant in a second surgery which may be several months after the first surgery.

Another drawback is the movement the muscle makes when it contracts.  This will typically distort the shape of the breast and is called animation deformity. Furthermore, muscle contraction will also apply a pressure to the implant, and may accelerate implant displacement over time (typically out toward the armpit).  When the implant is placed above the muscle, these issues do not occur.

Dr. Albright is a board certified plastic surgeons with extensive knowledge and experience with this modern breast reconstruction technique. He will examine you to see if you are a good candidate for this new breast reconstruction technique.

What is the recovery like for immediate implant-based breast reconstruction?

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For patients, a breast reconstruction is a significant commitment of time, money, recovery and emotion. Dr. Albright takes this very seriously.  Because complications from breast reconstruction can be so traumatizing (potentially delaying breast cancer treatments!), Dr. Albright utilizes every available resource and up-to-date technique to help avoid these pitfalls. It is also why Dr. Albright puts so much emphasis on postoperative recovery.  

Most patients who undergo above-the-muscle implant-based reconstruction will be limited from exercise for about 5-6 weeks.  In the first two weeks after surgery, you will be unable to reach and pull with the arms, or sleep on your sides. You will also have postoperative drains during this period.  Concurrently, you will be wearing some form of breast support continuously for four weeks.  In weeks 3-4, you will be able to perform range of motion stretches to the shoulders, but will still be somewhat limited on reaching/pulling.  Weeks 4-6, you will be unrestricted with arm movements and able to sleep on your sides.

Most patients will return to work at 2 weeks after surgery (all the rest of patients by 4 weeks) depending on how much reaching/pulling they must perform.  The reconstructed breast volume is relatively stable by 2 months, when patients can purchase new bras.  Final shape and look of the breasts out-of-clothing (assuming no radiation), will be achieved by 4-6 months after surgery for most patients.

How can prepectoral direct-to-implant breast reconstruction (ONE Breast Reconstruction) ultimately be cheaper than other types of breast reconstruction?

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There are several reasons why this approach can ultimately save you money, time, and unnecessary pain. Obviously, the financial savings will depend on the details of your contract with your insurance company, as well as current arrangements between your insurance carrier and Alamo Plastic Surgery. Whether Dr. Albright is an in-network or an out-of-network provider, you could still see substantial savings using this technique.

In Dr. Albright's experience, prepectoral direct to implant breast reconstruction is often a single reconstructive surgery at the time of mastectomy, with a very low rate of revision surgery. About 25% of his patients will undergo a second reconstructive revision surgery, with the majority of these surgeries being simply fat transfer to improve implant rippling (a visual and more cosmetic concern rather than a functional problem). With fewer surgeries, there is often less cost seen by the patient because traditional expander reconstruction has a 100% revision rate (expander needs to be exchanged for the permanent implant. Commonly, since this exchange is often delayed by several months after your initial surgery, it commonly occurs in a different calendar year when your deductible has been reset.

There is also a potential cost savings with less postoperative recovery time compared to other types of breast reconstruction, whether implants below the muscle (traditional technique) or flap reconstruction. With prepectoral breast reconstruction, Dr. Albright's patients are getting back to work sooner than his previous under-the-muscle reconstructions and flap reconstructions.

What about postoperative radiation therapy and breast implants?

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Radiation is often used in breast cancer treatment to try to limit growth of any remaining cancer cells in the breast. It achieves this by causing damage to rapidly dividing cells.  However, it is not selective, and damages all the cells in the area. When the cells lining the blood vessels become injured, scarring may develop and ultimately limit blood flow to the skin.  Without normal blood flow, oxygen and micronutrient delivery may be compromised reducing your ability to heal wounds. Additionally, delivery of infection-fighting white blood cells may be decreased which increases your risk of infection with surgery.  Putting these issues together, we see why operating on radiated tissues has a high complication rate.  This is true for both implant-based and flap-based reconstruction.

However, implant reconstruction in the setting of radiation gets a bad reputation when compared to using your own tissue, as implants have a higher overall failure rate. But implant based reconstruction can still be performed in patients facing possible or even planned postmastectomy radiation.  These select patients will need to be otherwise ideal candidates for implant-based reconstruction to limit other risk factors for reconstruction failure. Dr. Albright will discuss these risks with you and your family so you can make an informed decision.

What about previous radiation history and breast implants?

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Even in Dr. Albright’s hands, these patients have a very high complication rate. The most important reason why this happens is because the radiation has already caused permanent damage to the tissues by restricting blood flow. Attempting to reconstruct these tissues when they have already been damaged is less predictable for wound healing and infection.  Even if patients get through the initial healing from surgery, most patients will develop capsular contracture around an implant within 5 years. Dr. Albright is rightfully cautious and highly selective when offering (or not offering) implant-based breast reconstruction to patients who had previous breast radiation.

What will happen to my nipples with mastectomy and reconstruction?

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The plan for the nipple and areola (pigmented skin around the nipple) depends on both oncologic needs (treating the cancer), and cosmetic issues. Your breast surgeons may need to remove the nipple and areola if your cancer is close to or could be close to the undersurface of these structures. It is not a good idea to leave cancer in the breast just to save the native nipple or areola. Typically Dr. Albright will discuss the cancer issues with your breast surgeons but will always defer to your breast surgeons when it comes to treating your cancer.

There are also cosmetic considerations when trying to keep the nipples. If the breasts are very large, there may be too much skin of the breast to be able to adequately fill with an implant. Additionally, as the nipple will be the furthest skin from intact blood vessels (all the vessels that were traveling through the breast tissue itself are now gone), there can be issues with wound healing at the nipple. Occasionally, the blood supply to the nipple is not adequate even if the patient was an ideal nipple-sparing mastectomy patient, and, unfortunately, this will only be apparent during the surgery (when you are asleep on the table). Therefore, Dr. Albright always discusses the possibility of losing a nipple during the procedure even if the plan is to save the nipple. If you have any questions or concerns, give us a call and we will be happy to schedule a visit to discuss.

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Breast Reconstruction
“ Being diagnosed with breast cancer was one of the hardest and emotional things a women and family can go through. Dr Albright and his staff were amazing, caring, and understanding. My husband and I couldn't have gotten through it without the kindness and empathy we received from all of them. I would, and have recommended Dr Albright to anyone but especially women going through something as difficult as breast cancer. ”
Breast Reconstruction
“ After my mastectomy, I was frightened and unsure whether to have reconstruction. After meeting Dr. Albright, I was confident and less afraid. After the total procedure, I am very pleased with my new breasts. I feel more confident after the procedure. Dr. Albright is truly a professional and wonderful doctor. I would recommend him to anyone contemplating this operation. His staff is also very professional and caring. ”
Jill Pankow
Breast Reconstruction
“ Being diagnosed with breast cancer was one of the hardest and emotional things a women and family can go through. Dr Albright and his staff were amazing, caring, and understanding. My husband and I couldn't have gotten through it without the kindness and empathy we received from all of them. I would, and have recommended Dr Albright to anyone but especially women going through something as difficult as breast cancer. ”
Breast Reconstruction
“ Dr. William Albright is one of a kind. He greets you with open arms and understands the seriousness of the illness you may be dealing with at the time of your first visit. Being a breast cancer survivor he was there with me from Day 1 of my first surgery. He was always there to help me with a kind word if you were having questions and always available on the weekends. With the surgeries that Dr. Albright performed on me healed with no problems and I couldn't be happier with the results. ”
Jodi Schuster
Breast Reconstruction
“ Friendly, Helpful, Caring and Professional - I have already recommended Dr. Albright to a friend. His office staff are always friendly, caring and helpful. He is all of those and and professional. Having a bilateral mastectomy is an emotional and traumatic experience, they had experience and were very understanding ”
Breast Reconstruction
“ I highly recommended Dr. Albright to anyone looking for a caring, dedication Doctor. He has helped me get through some of the toughest times in my life with Breast Cancer. My surgery and reconstruction went very well with no complications. He is compassionate with his patients and truly cares about how we feel. His staff always made sure I understood what was going to happen and answered any questions or concerns that I had. ”
“ Dr. Albright was a great surgeon. He was very thorough at every appointment. Explained every step along the way, took time to answer my questions in terminology I could understand. I would highly recommend him to anyone that needs reconstruction!! His office staff is very personal and friendly and helped me with insurance processing. ”
Sue Menson
Breast Reconstruction
“ Dr. Albright came highly recommended and I knew immediately after meeting him he was the surgeon for me. He is kind, professional, knowledgeable and his office staff is fantastic!  I had a double mastectomy with reconstruction, no infection or rippling and Dr. Albright was able to do everything in one surgery so no expanders or "touch-ups" later.  I had a double mastectomy with reconstruction, no infection or rippling and Dr. Albright was able to do everything in one surgery so no expanders or "touch-ups" later ”
Breast Reconstruction
“ Dr. Albright and his staff were excellent in their care for me. He delivered a cancer diagnosis to us & took as much time as we needed to discuss the options. When preparing for a 2nd surgery, he again talked through the options & what decisions we needed to make dependent on the work of the surgical oncologist since I would be under anesthesia. For what seemed like the end of the world to us, he treated us with compassion, answered all our questions and respected our wishes. He ROCKS! ”
Breast Reconstruction
“ I saw Dr. Albright after being diagnosed for the second time with breast cancer. My worst nightmare came true, I had to have a masectomy. I don't know what I would of done without Dr. Alright. He did an amazing job. He is very thorough and very compassionate. As I cried before surgery he held my hand and promised me it would be alright...and it was. The staff is amazing, Nicole is very helpful with the insurance. The results exceeded my expectations. I would choose him again in a heartbeat. ”
Breast Reconstruction
“ Excellent job with post-mastectomy reconstruction. Very satisfied with the results. Also, Dr. Albright and his amazingly supportive staff helped me throughout the entire cancer recovery process--all of the emotions, decisions, and confusion. They were never impatient; they always took whatever time I needed and genuinely helped me. Thank you to all of them for making a horrible illness bearable! ”
Alamo Plastic Surgery San Antonio TX | Team - Dr. Albright, Franchesca Espinosa, Juli Albright
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