Breast Reconstruction

Dr. Gabriel’s experience in all types of breast reconstruction gives women in the Vancouver, WA and Portland-metro area more choices when looking to restore their breasts after mastectomy. It also means that Dr. Gabriel can help you select the breast reconstruction technique that best fits your anatomy and personal circumstances.

Dr. Gabriel Pioneers the Use of Botox for Pain Reduction in Breast Reconstruction

Dr. Gabriel has demonstrated in a small but hypothesis-driven randomized clinical trial that botulinum (Botox) effectively addresses the sources of severe pain associated with silicone implant breast reconstruction following mastectomy. He presented the following findings at the International Society of Aesthetic Plastic Surgery 20th Biennial Congress on August 17, 2010.

Silicone breast implantation often involves the positioning of a temporary expander implant between layers of the pectoralis majorchest muscle, which is filled with water serially to create a pocket where a permanent implant will reside. The muscle often contracts and spasms in response to the expansion, causing pain, Dr. Gabriel noted. 
He and collaborator G. Patrick Maxwell, MD, who practices at Loma Linda, theorized that injections of botulinum could offer relief by temporarily paralyzing the muscle, causing it to remain flaccid. That way, fewer spasms would occur and less pain would arise. 
Thirty consecutive breast cancer patients scheduled for mastectomy with silicone gel implant breast reconstruction were randomly assigned to 1 of 2 groups: 40 units of botulinum injected into each pectoralis major through 4 serial injections in 0.5 cc increments; or the same routine procedure using saline solution as a placebo.

The women who received the botulinum injections were far more comfortable after surgery than those who received placebo, Dr. Gabriel explained. Patient responses were measured at three time points during and after the procedure with a 10-point visual analog scoring (VAS) test, where a score of 1 signified an absence of pain and 10 was associated with unbearable pain. According to Dr. Gabriel, the mean VAS score at the 3 time points for the botulinum group was about 4, and was significantly lower than the mean VAS score of 7 seen in the placebo group. No notable differences in the use of narcotic, muscle relaxants, or anti-inflammatory drugs were observed for the two groups in the first three days after surgery. However, from days 7 to 45 of recovery, the botulinum group used significantly fewer doses of narcotics and muscle.

Additionally, Drs. Gabriel and Maxwell found a statistically significant increase in the volume of expansion per office visit, leading to full expansion more quickly in the botulinum group than in the placebo group.

Call us at 360.514.1010 to learn more about how Botox can significantly reducing the postoperative pain associated with silicone implant breast reconstruction following mastectomy. Read the entire press release for this story, which is getting national and international attention

You Have Options

If you have not yet had a mastectomy, we can educate you on your reconstruction options prior to mastectomy surgery and work with you to develop a reconstruction plan that’s best for you. Our affiliation with the Southwest’s Kearney Breast Center and Southwest Medical Group Surgical Specialists enables us to collaborate with every member of a mastectomy patient’s treatment plan, delivering the optimal results throughout the process. This seamless collaboration along with increased access to reconstruction options is instrumental in helping patients better deal with their diagnoses and treatment. We are happy to go over all your options with you and help you decide what will be best for you.

Breast Reconstruction Techniques

Breast reconstruction is an extremely personal choice. Whether you choose to proceed with reconstruction immediately following your mastectomy or wait until you’re more comfortable moving forward, the Southwest Medical Group Plastic Surgery team will be there to help you along the way. We will also help you choose the reconstruction technique that is best for you. We offer:

TRAM Breast Reconstruction

TRAM flap (Transverse Rectus Abdominis Myocutaneous) reconstruction procedure uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound. This breast reconstruction technique is beneficial because the tissue and skin transferred from the abdomen is very similar in softness and look to the breast. Additionally, due to the removal of abdominal skin and tissue, the patient will also receive a tummy tuck, resulting in a tighter stomach.

You are a good candidate for TRAM if:

• Healthy non-obese patient who is a non-smoker with enough lower abdominal tissue to make a breast. (This is best determined by your doctor, as it often takes less tissue than patients realize)
• Patients who have had prior radiation therapy can still have a TRAM flap

You are a NOT good candidate for TRAM if:

• You have a serious medical problem like diabetes, obesity, emphysema, heart disease, or connective tissue diseases
• You have had previous abdominoplasty
• You are a smoker

DIEP Breast Reconstruction

DIEP (Deep Inferior Epigastric Perforator) reconstruction is a refined version of the TRAM flap, in that the DIEP utilizes only the blood vessels, fat and skin from the abdomen. The rectus abdominal muscle is left intact. Though DIEP can be performed many years post mastectomy, it is also commonly performed immediately after mastectomy.

You are a good candidate for DIEP if:

• You are healthy and physically active
• You have excess skin and tissue in the tummy area (in fact, one benefit to DIEP is that you end up with a tummy tuck as well)
• You have had or will have radiation
• You are a non-smoker

You are a NOT good candidate for DIEP if:

• You are a smoker
• You have diabetes or blood clotting problems
• You have had previous abdominoplasty
• You have very low body fat

SIEA Breast Reconstruction

SIEA (Superficial Inferior Epigastric Artery) breast reconstruction is a procedure in which abdominal skin and fat is removed and used to reconstruct a breast. This same tissue is discarded in patients that undergo cosmetic surgery for a 'tummy tuck'. Although the abdominal tissue used is the same as the DIEP, the SIEA relies on a distinctive blood supply and requires less surgical dissection than the DIEP. Whether the SIEA flap or DIEP flap can be used for reconstruction depends on intraoperative findings related to vessel size and blood flow. The decision between DIEP and SIEA is usually an intraoperative decision based on blood supply. If Dr. Gabriel determines you have appropriate blood supply for an SIEA breast reconstruction procedure, benefits include less post-operative pain and speedier recovery.

You are a NOT good candidate for SIEA if:

• You do not have enough tummy fat and skin
• You are an active smoker -- your abdominal scar will heal slowly, and your fat tissue is more likely to turn into scar tissue

SGAP Breast Reconstruction

SGAP (Superior Gluteal Artery Perforator) reconstruction can be an excellent option for patients who do not have sufficient abdominal tissue to donate to the reconstructed breast. During a SGAP flap reconstruction, skin and fat is moved from the upper buttock up to the chest, and used to create a breast mound. One advantage of SGAP is that no muscle is moved, so recovery time will be less than it would for a TRAM flap.

You’re not a good candidate for SGAP if:

• You have previously had upper buttock skin and fat removed
• You have had liposuction on your upper buttock
• You smoke – your buttock scar will take a long time to heal, and your fat tissue is more apt to develop into scar tissue

Implant Breast Reconstruction

A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction.

Your surgeon will help you decide what is best for you. Reconstruction with an implant alone usually requires tissue expansion. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process.

It requires many office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin.

A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.