Procedures

Breast cancer reconstruction procedures.

Procedures

Breast cancer reconstruction procedures.

Procedures

Breast cancer reconstruction procedures.

Procedures

Breast cancer reconstruction procedures.

"DR. LIU AND HIS STAFF PUT ME AT EASE RIGHT AWAY AND TOOK GREAT CARE OF ME" - Kim S.

Plastic surgeons have become very adept at breast reconstruction techniques to recreate breasts that women may have lost as a result of breast cancer surgery.

There are many surgical options Dr. Liu may consider for your procedure based on your aesthetic goals and medical history. The process and stages of your reconstruction vary depending on the surgical plan you choose.

Beverly Hills breast reconstruction specialist, Dr. Perry Liu, will review your breast reconstruction options with you in detail during your consultation and together you will decide which method is best for you. Feel free to ask as many questions as you would like as Dr. Liu wants to make sure you are comfortable with the procedure you choose.

Two types of reconstruction

I. Implant Reconstruction

Breast reconstruction following cancer surgery can be accomplished using the same silicone implants that are used for cosmetic breast augmentation procedures.

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VS.
II. Autologus Reconstruction

In autologous breast reconstruction, Dr. Liu uses excess tissue (skin, fat, or muscle) located elsewhere on the body to create a breast.

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BREAST RECONSTRUCTION PROCEDURES

  • I. IMPLANT OPTIONS

    • NON-AUTOLOGOUS OVERVIEW

      Beautiful breast enhancement using implants

      After a mastectomy, the breasts can be reconstructed using a variety of techniques. Dr. Liu can explain each of these to you in depth during you confidential Los Angeles consultation, so you will be able to choose the best approach for your needs.

      One common method of reconstruction involves the use of implants, and is not unlike a regular breast augmentation procedure for increasing one’s cup size. Dr. Liu offers the very latest in breast implant styles, including the form stable silicone Gummy Bear, known for its highly natural look and feel.

      Using implants for a reconstruction is slightly challenging, because typically there is less native breast tissue to help camouflage the implants. However, Dr. Liu has a variety of solutions for this problem, including the use of a tissue expander to help grow new breast tissue.

      During the procedure, your implant is placed underneath the pectoralis major muscle, which can significantly help to hide its appearance. Dr. Liu may also choose to cover the implant using a piece of acellular dermis that helps with the camouflaging process.

      Reconstructions are typically performed in two stages. First, a tissue expander is placed to recruit more of your own tissue for the reconstruction. During the second stage, the expanders are exchanged out for silicone implants. Some patients may be good candidates for a single-staged procedure, without the need for the tissue expander.

      What is Alloderm?

      Alloderm is a bio matrix that is made by using cadaver skin that has had all the cells taken out of it, leaving behind the collagen.  Your body uses your own blood vessels and tissue to fuse with the transferred collagen. It can be used as a hammock to assist in holding the breast implant in place, and in creating a more natural looking breast implant reconstruction.

    • ONE-STAGE IMPLANT RECONSTRUCTION

      When a patient has breast cancer, it can be devastating to wake up from a mastectomy and find the chest cavity vacant. With the one-stage breast reconstruction process, Dr. Liu is able to provide immediate implant surgery directly after the mastectomy, so that clients awake from their surgery with a fully reconstructed breast profile. He will recreate the breasts using the acellular dermal matrix and either saline or silicone implants.

      In addition to its aesthetic and emotional benefits, the one-stage surgical process lowers the risk of complications, infection and discomfort. Patients typically stay two nights in the hospital after surgery.

      Unfortunately, not every client is a match for this type of procedure, which requires adequate tissue on the chest wall to camouflage the implants. In the case that radiation or surgery has eliminated the possibility of a single-stage treatment, Dr. Liu will propose an equally outstanding method of reconstruction to spare the patient from unwanted complications.

      The following constitute the steps of the one-stage breast reconstruction procedure:

      Step 1

      Immediate breast reconstruction is performed at the time of mastectomy using a silicone or saline implant and Alloderm.

      Step 2

      Oftentimes the reconstructed breast will appear rejuvenated while the normal breast looks saggy. To counter this condition, a breast lift is performed to ensure symmetry in the chest.

      Step 3

      Dr. Liu will perform nipple reconstruction for the breast mound.

      Step 4

      Dr. Liu will use a tattoo to restore the correct color balance to the reconstructed areolar complex.

    • TWO-STAGE IMPLANT RECONSTRUCTION

      Dr. Liu understands how important it is to clients that their breasts be beautifully reconstructed as soon as possible after a mastectomy. However, there is not always enough tissue in the chest wall to adequately house the implants.

      In these cases, Dr. Liu will need to perform a two-part process, first harvesting additional cellular material using a tissue expander, and then placing the breast implants so they are well camouflaged.

      Two-stage reconstruction is more time-consuming than a one-stage procedure, however, Dr. Liu will be able to create outstanding results for you in either situation.

      Upon insertion, tissue expanders may initially feel tight, so patients generally require about three weeks to adjust before Dr. Liu begins to add the saline solution. The filling process requires multiple visits to our office so that the expanders may be inflated to patients’ desired size. The expander is usually inflated by 50-100ml weekly, which gradually stretches the skin.

      Eventually, the tissue expander stretches the breast skin envelope so it may accommodate an implant. Once the desired size is achieved, surgery is scheduled and expanders are exchanged for saline or silicone implants. The entire process usually takes 4-6 months. After reconstruction, the new breasts often look as though a cosmetic breast lift or breast augmentation was performed.

      Patients may prefer this option if they are unsure of what size they would like their breasts to be or if they plan to undergo post-operative chemotherapy following their mastectomy. Expanders may be deflated during radiation to make radiotherapy easier to administer. Patients typically stay two nights in the hospital after surgery.

      Dr. Liu will take the following steps to perform a two-stage breast reconstruction with implants:

      Step 1
      Dr. Liu will perform an immediate breast reconstruction at the time of the mastectomy using a tissue expander and Alloderm.

      Step 2

      Dr. Liu will perform staged tissue expansion in the office (if necessary), beginning 4 weeks post-operatively. Often times, tissue expansion may not be necessary for immediate staged reconstructions.

      Step 3

      Dr. Liu will exchange the tissue expander for silicone or saline implants, or perform flap reconstruction using the client’s own tissue.

      Step 4

      Dr. Liu will perform a contra-lateral breast lift to match the reconstructed breasts. Oftentimes the reconstructed breast will appear rejuvenated while the normal breast appears to sag.

      Step 5

      Dr. Liu will perform nipple reconstruction for the breast mound.

      Step 6

      Dr. Liu will perform tattoo restoration to color correct the reconstructed areolar complex.

  • II. AUTOLOGUS

    • Autologus Overview

      Stunning breast augmentation results without the use of implants

      If you are a woman seeking modest breast enhancement, but are not sold on the idea of surgical implants, a fat grafting procedure may be ideal for your needs. Fat grafting, also called autologous fat transfer, meaning “from your own body”, is a safe, effective method of taking unwanted fat from one region of the torso, purifying it, and then injecting into an area that requires more volume, such as the lips, face, breast or buttocks.

      Dr. Liu performs fat transfer for his breast augmentation patients by using liposuction on the hips, thighs or belly, harvesting the desired fat content and then surgically grafting it inside the breast pocket to create a fuller, more voluptuous breast profile.

      It’s important to note that typically, only 70% of the fat survives the harvesting process, with the remaining 30% getting reabsorbed by the body. Because of this, clients may need to undergo multiple sessions with Dr. Liu in order to organically build the breast mound to the desired cup size.

      Dr. Perry Liu in Beverly Hills is a consummate leader in the field of breast augmentation with autologous fat grafting for breast reconstruction.  He will discuss all of your options with you in detail during your confidential consultation, answering any questions you may have so that you can make an educated choice regarding your breast reconstruction options.

    • FREE FLAP RECONSTRUCTION

      After a mastectomy, clients desire the most natural and feminine-looking reconstruction results possible. In an effort to create such organic outcomes, plastic surgeons have turned away from implants and towards the harvesting of the patient’s own fatty tissue to recreate a full and sensual breast mound.

      In free flap reconstruction, a large section of tissue is separated from its blood vessels and moved to the chest. This method is the most advanced and technically demanding option, requiring the expertise and prowess of a gifted board-certified surgeon such as Dr. Liu.

      During this process, Dr. Liu removes spare tissue from an area of the body with significant excess fat and utilizes it to construct a new breast. He then reconnects the blood vessels to ones in the chest. Free flap reconstruction works best for one-sided breast reconstruction because the resulting match to the non-treated breast is excellent.

      The most common free flap procedure Dr. Liu performs is known as a DIEP flap, which uses abdominal fat to create a new breast. The abdomen provides fat that very successfully imitates breast tissue and offers patients the benefit of a tummy tuck at the time as they undergo their breast reconstruction.

      Using perforator flaps, only skin and fat is removed from the donor site. Abdominal muscles are left intact so there is no resulting weakness in the abdominal wall. This is the best reconstructive option in terms of donor site recovery and the aesthetic appearance of the reconstructed breast. The one drawback to this procedure is its long scar, which may resemble the one associated with the tummy tuck.

      Breast reconstruction with free flaps will require a slightly longer hospital stay of several days following the procedure. The flap requires careful post-operative monitoring, as there is a risk of flap failure and possible need for revision surgery. Overall, free flap reconstruction procedures have a success rate of 95-98%.

      The free flap reconstructive options Dr. Liu offers include:

      DIEP Flap (Deep Inferior Epigastric Perforator Flap – fat is taken from the abdomen)
      SIEA Flap (Superficial Inferior Epigastric Artery Flap – fat is taken from the abdomen)
      TUG Flap (Transverse Upper Gracilis Flap – fat is taken from the inner thigh)
      SGAP/IGAP Flap (Superior Gluteal Artery Perforator Flap/Inferior Gluteal Artery Perforator Flap – fat is taken from the buttocks)
      ALT Flap (AnteroLateral Thigh Flap – fat is taken from the outer thigh)

      Dr. Liu will take the following steps during the free flap procedure:

      Step 1

      Dr. Liu will harvest the free flap at the time of the mastectomy or during a separate surgery following recovery from mastectomy.

      Step 2

      Dr. Liu will perform a contra-lateral breast lift to match the reconstructed breast mound, and a revision of the reconstructed breast mound, if necessary.

      Step 3

      Dr. Liu will reconstruct or revise the areolar complex.

      Step 4

      Dr. Liu will perform a tattoo restoration to color correct the reconstructed areolar complex.

    • PEDICLES FLAP

      As surgeons learned to use a woman’s own body to reconstruct her breasts, they perfected the technique of transferring a flap of living tissue from either the back or the belly to the chest without detaching it from the blood supply. This type of living tissue transfer is called a pedicle flap.

      The most common types of pedicle flaps are the TRAM (Transverse Rectus Abdominus Myocutaneous Flap), and the Latissimus Dorsi flap. With these procedures, both skin and muscle is transferred from the donor area to rebuild the breast mound.

      TRAM flaps take the fatty tissue, skin and muscle from the abdomen and use it to create a new breast profile. This type of breast reconstruction is highly popular in Los Angeles and beyond due to its side benefit of contouring the patient’s belly. Who doesn’t want a built-in tummy tuck with their breast reconstruction procedure? Most clients are pleased to lose some of their excess fat in the mid-torso, while also building a beautifully enhanced breast appearance.

      Latissimus Dorsi flaps are muscle-skin flaps taken from the back area and are used to reconstruct the breasts for a fuller, more feminine aesthetic. These flaps often lack the volume to create a full-sized breast and are used in conjunction with breast implants.

      Breast implant procedures with an LD flap will often appear more natural-looking than those performed with Alloderm (cadaveric human skin) because in this case you will have access to both fat and muscle to camouflage the implant.

      Unlike implant-based reconstructions where you are able to go home the same day of your surgery, pedicle flap reconstructions require a slightly longer post-operative recovery period, with a stay in the hospital from 4-7 days on average. While you may experience moderate pain during recovery from pedicle flap surgery, your pain will be well-controlled and we will assure that you remain comfortable at all times.

    • PEDICALED FLAP RECONSTRUCTION

      As surgical methods of reconstructing the breasts after a mastectomy have evolved, doctors found that using a client’s own fatty tissue to recreate the breast mound provided the most realistic and natural-looking outcomes. They created a method of transferring a flap of living tissue to the chest area with its blood supply still intact. This is called a pedicle flap, and it is a method of reconstruction that Dr. Liu uses to excellent effect.

      Two of the most common and popular types of pedicle flaps are the TRAM flap, harvested from the abdomen, and the Latissimus Dorsi flap, harvested from the back.

      Patients undergoing pedicled flap reconstruction are usually required to stay in the hospital several days to recover. Any discomfort is immediately treated with pain medications, keeping you relaxed throughout your recuperation.

    • LATISSIMUS DORSI FLAPS

      Today’s highly advanced methods of breast reconstruction ensure that the client will enjoy the most natural-looking results possible, helping to boost self-confidence and restore quality of life. By using the client’s own fatty tissue to help recreate the breast mounds, Dr. Liu is able to create the illusion of organic breasts that have never undergone surgery.

      With the Latissimus Dorsi flap method, skin, fat and muscle is harvested from an area of the back beneath the shoulder blades. It is then tunneled under the skin with its blood supply still intact and used to create a stunning new breast profile.

      Latissimus Dorsi flaps tend to lack the volume needed to create full-sized breasts by themselves, so they are typically used in conjunction with tissue expanders and breast implants to provide an aesthetically pleasing result.

      By combining muscle-skin flaps with implants, Dr. Liu is able to beautifully camouflage the implant and create a breast that looks and feels more natural than with a purely implant-based reconstruction. The only drawback to this procedure is the long incision on the mid-back region below the shoulder blade, however Dr. Liu will do his best to minimize the scarring.

      The following steps are taken during breast reconstruction with an LD flap:

      Step 1: A pedicled TRAM flap is harvested at the time of the mastectomy or during a separate surgery following recovery from a mastectomy.

      Step 2: Dr. Liu may perform a contra-lateral breast lift with augmentation to match the reconstructed breast mound, and a revision of the reconstructed breast mound if necessary.

      Step 3: Dr. Liu will reconstruct or revise the areolar complex.

      Step 4: Dr. Liu will perform a tattoo restoration to color correct the reconstructed areolar complex.

    • FAT GRAFTING

      Fat grafting is a safe and effective breast reconstruction option that helps improve breast symmetry, contour, and volume. Fat grafting is a popular option for women who desire the results of a conservative breast augmentation without placement of an implant. The best candidates for fat grafting are those with excess unwanted fat elsewhere in their bodies. The most common donor sites from which fat is harvested are the abdomen, flanks (love handles), and thighs.

      During fat grafting procedures, Dr. Liu first performs liposuction to remove fat from unwanted areas. The liposuctioned fat is then harvested and then injected into the breast. Fat grafting may require more than one session until the desired breast size is achieved. Typically, 30% of the injected fat does not survive and is reabsorbed by your body. It is possible for this fat to form scar tissue that may require surgery to remove.

      Advantages of fat grafting include minimal scarring, (liposuction scars are well-hidden and not usually longer than 3mm), a slimmer figure in the liposuctioned area, and a natural-looking breast. The best candidates for fat grafting have naturally small breasts, desire liposuction, and want to avoid having breast implants or a significant increase in their breast size.

      Grafted fat may also be enhanced with autologous stem cells. In this process, Dr. Liu combines liposuctioned fat with stem cells to produce a concentrated supply of fatty cells and stem cells. Angiogenic growth factors produced during this process improve the chances of fat survival. Concentrated stem cells may also be used to restore the health and viability of damaged, radiated skin.

      Prior to fat grafting, a BRAVA device may be used to expand the breast envelope. BRAVA consists of plastic domes mounted on a gel rim that adheres to the skin around the breast and is worn by patients for an extended period of time. The device generates a negative pressure on the breast, which gradually stretches the breast tissue, similar to tissue expanders. BRAVA increases available space in the breast envelope, allowing larger volumes of fat to be injected into the breast during a single fat grafting session.

    • TRAM Flap Breast Reconstruction

      Using the patient’s own fatty tissue to recreate a breast mound often achieves a more natural appearance than when reconstruction is performed with implants.

      The most common donor area for a tissue flap is the belly, as it often has a surplus of fat that will benefit from being contoured. This belly-derived tissue is called a TRAM (Transverse Rectus Abdominus Myocutaneous) flap and its blood supply remains intact during the transfer process. The flap is ferried beneath the skin up to the chest area where it is then used to refashion a more feminine-looking bust.

      The only drawback to this procedure is that by transferring skin and fat as well as muscle to the chest cavity, a weakened abdominal wall may result, along with an increased risk of hernia. For this reason, the TRAM flap procedure may not be right for every patient. Dr. Liu will discuss the best options for your needs during your confidential consultation in Los Angeles.

  • III. OTHER OPTIONS

    • Breast reconstruction using a tissue expander

      After a woman has undergone a mastectomy, the goal is to restore the feminine appearance of the breasts as soon as possible. Yet when the patient lacks the adequate amount of skin required to camouflage a breast implant, a device known as a tissue expander may be required to first stretch the out the skin and muscle in the chest wall.

      Breast reconstruction using a tissue expander is performed by inserting a temporary inflatable implant under the skin and the large pectoralis chest muscle. Over the course of several months, the expander is filled with a saline solution, stretching the muscle and causing new skin to grow so as to make room for a permanent breast implant.

      Dr. Liu is among the leading breast reconstruction surgeons in Los Angeles. Using tissue expander therapy, he has had the deep privilege of restoring beauty and confidence to hundreds of patients.

      Understanding the tissue expander procedure

      Once the mastectomy part of breast cancer surgery is completed, Dr. Liu immediately places the tissue expander beneath the skin and the large pectoralis muscle. This is the first stage of breast reconstruction.

      The expander is similar to an empty breast implant but more like a balloon. It is equipped with a tiny self-sealing valve that is placed just under the skin so it can be accessed easily when adding saline solution.

      Once the incisions have healed, which typically takes 3-4 weeks, a limited amount of a saline solution is injected into the tissue expander over the course of several months.

      Each time saline is injected the patient may experience a temporary feeling of tightness or pressure. Most women tolerate this very well; however, over-the-counter pain medication can be used as needed following each increase in size.

      Once the reconstructed breast is slightly larger than the unaffected breast, the saline injections are discontinued. The skin and muscles are then left to recuperate for 6-8 weeks before reconstruction surgery begins.

      Chemotherapy and radiation

      If the treatment plan includes chemotherapy or radiation therapy, tissue expansion will be postponed approximately 4-8 weeks until this stage is completed. If radiation therapy is planned, the valve used must be plastic rather than metal to avoid damaging the skin during treatment.

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