Dr. Mahabir - Finding the Right Surgery For You

The diagnosis of breast cancer is a devastating blow. Add to that your thoughts racing ahead to the possibility of needing a mastectomy and breast reconstruction as part of your treatment plan and it can be overwhelming. However, just as each cancer is unique, so are you and your options for breast reconstruction. There are several methods of breast reconstruction and your breast surgeon and plastic surgeon will work with you to determine which is best for you.

A mastectomy implies that the vast majority of the breast tissue is removed along with the cancer. Depending on the location of the cancer and your personal preference, you may be a candidate for a nipple sparing mastectomy where the nipple and areola are spared. Traditionally, the plastic surgeon would insert a tissue expander or breast implant under the muscle as a first stage in the reconstruction. Tissue expanders gradually stretch the skin and tissues to recreate the breast. This dated technique had several downsides however. First, it’s often a painful process because the chest muscle is stretched at the same time. Next, the final reconstructions tended to look somewhat less projecting and unnatural since the implant is under the muscle. Finally, every time they use their chest muscles the implant shows visible distortion as the muscle is directly under the skin. This is referred to as an animation deformity and is similar to watching a body-builder flex their chest. Not infrequently this traditional expander reconstruction can also result in chronic discomfort for patients for years following their procedure.

These disadvantages leave an opening for a more advanced, innovative option: pre-pectoral breast reconstruction. In our endless quest to improve patient outcomes, minimize downtime, and speed up recovery following breast reconstruction, Drs. Raman Mahabir and Bryan Gawley, have perfected this new and exciting technique in which the implant is placed above the muscle.

We use the latest innovations and advancements in surgical technique and technology: collaboration with the breast cancer surgeons and advancements in mastectomy technique allow for greater skin and nipple preservation, SPY Florescence Imaging enhances our ability to assess blood supply to the tissues, cohesive implants allow for less rippling and visibility, and fat grafting allows for optimization of the results. Combining these advances allows us to place the implant, in one operation, in front of the pectoral muscle. The benefits are numerous: less pain and tightness; faster recovery; minimal deformity muscle contraction, and most importantly a more natural appearing breast for the patient.

Pre-pectoral reconstruction eliminates the need to elevate/cut the muscle and therefore there is little to no muscle deformity or pain associated with the procedure. We can create stable outcomes with less pain, quicker recoveries and it is great for patients who exercise regularly, do yoga or pilates or are physically active and wish to return to their regular routines following their operation.

Patients requiring significant skin reduction at the time of mastectomy may also be good candidates for prepectoral reconstruction. Drs. Mahabir and Gawley have also perfected several techniques to reduce the skin envelope without significantly compromising mastectomy skin flap vascularity. The nipple and areola can be reconstructed later with either a minor surgery or 3-D tattooing.

Finally, the role and benefits of autologous fat grafting (using the patients own fat from one area they do not want it) cannot be understated. Autologous fat grafting provides additional soft-tissue coverage by thickening the tissues. It improves the aesthetic result by camouflaging the upper pole, reducing implant visibility and increasing overall breast volume.

Not everyone is a candidate for Prepectoral reconstruction. We work closely with your breast cancer team to ensure your reconstruction matches the needs of the breast cancer surgeon and your particular breast cancer. Complications, while rare, do exist and will be discussed during your consultation. This is a key step in the shared decision making process and helps you understand and evaluate this technique.

Finding the Right Surgery For You