Whether a breast reconstruction is performed using an implant or the patient's own tissue ("autologous" flap), it usually takes more than one stage for the best results. A second procedure—referred to as the "revision stage" or "stage 2"—is designed to fine-tune the reconstructed breast(s) in order to improve the overall cosmetic appearance.
Stage 2 breast reconstruction is typically performed about 3 months after the initial reconstruction as a day surgery (outpatient).
For implant-based reconstructions, stage 2 usually involves exchange of the tissue expander for the permanent implant, and fat grafting to improve the soft tissue contour and "padding" over the implant. Direct-to-implant ("one-stage") reconstructions can also require revision surgery, usually fat grafting. For autologous (flap) breast reconstruction, revision surgery usually involves scar revisions, fat grafting, and shaping of the reconstructed breast(s).
If the reconstruction was performed as a unilateral (one-sided) procedure, stage 2 usually also involves symmetry surgery on the other breast to match the breasts as closely as possible if this was not performed at the first surgery.
Revision surgery is also an option for patients unhappy with the results of reconstruction performed elsewhere.
The exact details of the revision surgery required will depend on the type of breast reconstruction the patient had initially.
Autologous Tissue Breast (Flap) Reconstruction
Flap revision involves shaping the breast(s) and making them as symmetric as possible in terms of size and shape. Fat grafting can be used to address contour irregularities and size discrepancies. The donor site scar (the scar from where the tissue was taken) is also revised to minimize its appearance as much as possible and improve the contour of the donor site. Nipple reconstruction is also performed at this stage whenever possible if the patient did not have a nipple-sparing mastectomy.
2-Stage Implant Breast Reconstruction
Once tissue expanders are adequately filled they are exchanged for permanent breast implants. This is usually done about 3 months after the initial surgery. Two types of breast implants are available to patients: Saline and Silicone. We advise that you speak with your plastic surgeon to decide which implant is best for you. The implant pocket(s) can be adjusted if needed to improve the overall breast shape and symmetry. Fat grafting can also be performed at this stage to improve the overall contour and make the results as natural as possible.
Direct-to-Implant Breast Reconstruction
Direct to Implant breast reconstruction involves placing the final breast implant at the same time as the mastectomy. Unlike traditional 2-stage implant reconstruction using expanders, the reconstruction is completed in one surgery. The direct-to-implant procedure is also sometimes referred to as "single-stage" or "one-step" breast reconstruction. These terms can be misleading as a revision procedure, usually involving fat grafting, is often needed for the best cosmetic results. Fat grafting helps fill in contour defects created by the mastectomy and thickens the fatty layer under the skin. A thicker tissue layer over the implant decreases the visible waves in the implant shell, known as "rippling", and greatly improves the final cosmetic results.
Revision of Breast Reconstruction Performed Elsewhere
The PRMA surgeons also frequently perform revision surgery on patients who are unhappy with their results from surgery performed at other institutions. This can involve anything from fine tuning to a complete "re-do" reconstruction depending on the specific situation. These procedures are also typically covered by insurance.
Revision surgery is designed to fine-tune the reconstructed breast(s) and donor site
It is typically performed about 3 months after the initial reconstruction as an outpatient surgery
The revision stage will differ depending on the initial type of reconstruction and the patient's goals
PRMA frequently performs revision surgery on women with unsatisfactory reconstruction results from surgery performed elsewhere. To schedule a consultation, please contact us here or call us on (800) 692-5565.
Dr. Ochoa said I was a candidate for DIEP flap reconstruction. I wanted it done at the time of the mastectomy. I spent the next month reading everything I could about DIEP flap and early stage cancer and watching the patient testimonials, while getting used to the no caffeine or chocolate before surgery.
On September 4, 2012, I underwent the DIEP Flap reconstruction. The results are better than I’d expected. I feel good about myself, especially knowing that it’s all me. No artificial implants. I like to say that PRMA gave me back what Cancer stole from me.
I had my bilateral mastectomy and immediate DIEP flap the day before my birthday in September of 2010. I told the hospital staff that this was my birthday present; getting rid of cancer, getting a breast reduction and getting a tummy tuck. I thought I would be terrified, but everyone had told me how great Dr. Ledoux was and how wonderful the hospital staff was, so after Dr. Ledoux prayed with me, I was ready to go.
To those of you who may be reading these stories and facing the same diagnosis as I and other women on this page have confronted, have faith in God’s healing powers through the work of His faithful servants like Dr. Ledoux.
I think for anyone considering this surgery, you have to feel good about your doctor and confident in their abilities. Complications happen, even with the best of doctors, but doing your research and knowing how often your doctor does DIEP flap reconstruction, what their failure rates are, what kinds of complications they typically see, how long they expect your surgery to be, what the backup plan is in case of a failed reconstruction etc. are really important details. I made my choice in doctors based on the answers I received to all my questions, and how comfortable I felt in person with my doctor. I knew immediately after meeting him the first time that it was the right choice for me.
PRMA was highly recommended by many, and after meeting with my surgeon, we called PRMA to set an appointment. Dr. Ochoa said I was a candidate for DIEP flap reconstruction. I wanted it done at the time of the mastectomy. I spent the next month reading everything I could about DIEP flap and early stage cancer and watching the patient testimonials, while getting used to the no caffeine or chocolate before surgery.