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Birmingham, Alabama Plastic & Reconstructive Surgery

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Breast Reconstruction after Mastectomy

“Dr.  Moor talked to me about my surgery before and after. So that I understood my surgery. I feel that I like my body after the surgery. He does help me at any time over all these years. I know that he will be there when I need his help. He is the best doctor I have ever had!!“
   - (TRAM FLAP Breast Reconstruction Patient)

Dr. Moor has an emphatic understanding of what effect the diagnosis of breast cancer has on the patient.  As your Plastic Surgeon, he is a member of a team that will help, advise and treat you.  The staff at Alabama Plastic Surgery will make an appointment for you with Dr. Moor as soon as possible so that you can get more answers. He will discuss your reconstructive options.  Dr. Moor feels that the breast cancer patient should be as informed about reconstruction as she desires to be and as soon as she wishes.  The better and sooner the patient is informed, the better the patient can make an informed decision about Breast Reconstruction. 

Dr. Moor takes great pride in the service and care the staff at Alabama Plastic Surgery offers to his breast cancer patients. Breast Reconstruction is a Whole Team Approach: Dr. Moor works very closely with your oncological surgeon, your hematologist-oncologist and your radiation therapist. Most all women who have mastectomies are candidates for reconstruction. 

Reconstructive surgery recreates a breast contour, eliminates the need for wearing a prosthesis, replaces breast volume, restores cleavage, provides more variety in the type of clothes that can be worn, and helps restore femininity and whole body image. If you are uncomfortable about more surgery or not sure about the type of procedure, then the reconstructive procedure should be delayed.  Dr. Moor prefers to start Breast Reconstruction at the time of the mastectomy.  (‘Immediate Reconstruction’) because the tissues are still softer and therefor there is a better chance of reconstructing a more natural mound, better aesthetic result and fewer surgeries.  It also may be psychologically more beneficial to start the reconstruction as soon as possible. The timing of a breast reconstruction is not only dependent on your decision but the timing is also dependent on the advice of your treatment team, based on your individual situation and overall treatment plan. Your cancer treatment team may feel that delayed reconstruction is preferred until after the other modes of treatment are completed, i.e. chemotherapy and radiation therapy.  Once you have decided to have breast reconstruction, and have chosen when to have the reconstruction, you need to decide on the type of reconstruction.  The type of reconstruction available to you depends upon your medical situation, reasonable weight to height ratio, breast shape and size, general health, life style, recovery time, goals and unilateral versus bilateral reconstruction. 

There are three basic reconstructive techniques that we  perform at Alabama Plastic Surgery.  1) The Prosthetic Reconstruction utilizing a breast implant either saline or silicone. (‘gummy bear’ and other silicone implants)  2) The Tissue Flap (TRAM flap) technique means that Dr. Gene Moor uses your own tissues. A third technique is a Combination Technique utilizing an implant covered by a tissue flap.

The Prosthetic Reconstruction is at least a two-staged procedure, the first stage in hospital (inpatient) and the second stage is an outpatient procedure.  The initial stage is usually at the time of the mastectomy.  A tissue expander, which is an inflatable balloon-like device, is inserted under the chest muscle.  Over the subsequent weeks or months the device is inflated to the ultimate desired size.  The second stage is to replace the expander with either a permanent silicone implant or a permanent saline implant.  Patients like this procedure because of the shorter recovery time.  After a prosthetic reconstruction some patients prefer to go bra-less.

Bilateral Expanders

The Tissue Flap technique for breast reconstruction moves the skin, fat, and muscle from one area of the body to another.  The procedure that we use at Alabama Plastic Surgery is the TRAM Flap which utilizes abdominal tissue to reconstruct the breast mound.  Breast reconstruction patients frequently come to Dr. Gene Moor requesting “the tummy tuck operation”, (which is the TRAM flap procedure. The TRAM flap reconstruction surgery requires a longer hospital stay and a longer recovery time.  An advantage of the TRAM Flap is, that it can create a more natural looking breast and does feel better to the touch. This procedure is considered the gold standard of breast reconstruction.

Bilateral Tram Flap

Unilateral Tram Flap

The combination procedure that Dr. Gene Moor uses is the Latissimus Dorsi Flap (tissue from your back) to your chest to reconstruct a breast.  If there is not enough back tissue to reconstruct a breast, a silicone implant is incorporated.

After the completion of the reconstructed breast, many patients want nipple reconstruction.

Dr. Moor utilizes two techniques after he has completed the breast mound reconstruction. Some patients may prefer to have a tattoo for a nipple/areolar instead of a surgical procedure. If the patient wants nipple projection this can be created by numerous local skin flaps.

Dr. Moor is experienced in breast reconstruction revision and utilizes fat grafting techniques to help obtain a better contour of the breast mound or fill depressions in lumpectomy sites.

Dr. Gene Moor, at ALABAMA PLASTIC SURGERY, has a large experience in Nipple Sparing Mastectomies. This procedure is growing in popularity because of the aesthetic benefits. The decision to utilize the nipple sparing mastectomy is up to the oncological surgeon and is based on tumor size and location. The ideal patient is relatively small breasted, little or no sag, under going bilateral risk-reducing mastectomies for prophylaxis or for small peripherally located tumors.

Nipple Sparing Mastectomy

During your consultation Dr. Gene Moor discusses reconstruction with you in detail, and makes it easy for you to fully understand the surgical procedures, the risks and benefits of each choice you have.

He will discuss if you are a candidate for reconstruction and make suggestions as to which procedure he thinks best suits your situation.  The reconstructive process may involve more than one surgical procedure in order to achieve the final satisfactory result.  The goal is to provide symmetry between the breasts when you are wearing a bra.  Occasionally it is necessary to surgically address the uninvolved breast to achieve symmetry.  The  opposite breast may be treated with an augmentation, Mastopexy or Reduction. This may be covered by your insurance company. 

(Medicare does not cover the opposite breast unless you have had a bilateral mastectomy.)

Breast reconstructive patients and their family should be realistic about what to expect from reconstruction.  Dr. Gene Moor will discuss your decision with your entire breast cancer treatment team as well. 

It is our goal to make your reconstructive process as pleasant as possible.