Category: Breast Reconstruction Surgery

BEAUTIFICATION…BALANCE…SYMMETRY….Stage III

The goal of all breast reconstruction (restoration) surgeries is to achieve symmetry and balance between both breasts and also for them to look “natural.”  Beautification is started several weeks or months after your reconstruction process is complete and you have healed nicely.  Beautification involves creating balance between the two breasts, breast contour, adjusting flaps if needed, and nipple/areolar reconstruction.  Sometimes, women choose this phase, of their breast restoration process, to include other breast procedures such as a Breast Lift or Breast Reduction.  My goal is that: “all  cosmetic surgery should be functional…and all reconstructive surgery should be aesthetic and look as natural as possible.”

My patients are living testaments to the benefits of having restorative procedures following mastectomy surgery.  Here are just a few of their comments:

“I love being able to wear off the rack clothing since you completed the beautification process and now my breasts are symmetrical and so natural looking.”

“My husband is so glad to see my level of self confidence and a sense of normal self restored again.”

“The breast reconstruction did more than restore normal looking breasts….it restored my self confidence and has allowed me to return to the lifestyle I love…and the love of my life!”

We will discuss your goals for Stage III Beautification in detail.  After decades of helping women through this process…I’ve been able to help them through the challenges…by removing fear and replacing it with knowledge and self empowerment.

STAGE IV…NIPPLE TATTO…this is just as it says…nipple tattooing to create a natural looking nipple and areola on the breast(s).  This process further beautifies the breast by defining the dark area of skin surrounding your nipple(s) and areola(s).

Regardless of when you begin the process of reconstruction/restoration…. I use the most advanced but safest methods along with finely honed techniques.  By combining my meticulous skill with my thorough understanding of the intricacies of the human anatomy, my patients enjoy amazing outcomes that are both functional and beautiful.  You can read more about this entire process at: www.davinciplastic.com

In review, I’ve quickly covered Stages I & II of Breast Restoration surgery. Now, let’s look at breast reconstruction using implants instead of your own body tissue.  Implants are chosen by hundreds of thousands of women every year to restore a natural looking figure with two breasts.  Some women choose to start this process immediately (Immediate Restoration) by having the surgeon place the tissue expanders at the time of the mastectomy…under the same anesthesia and using the same incision. Remember, the expanders are the precursor to the permanent implants. They slowly and gently expand the chest tissue to allow for the implants at a later date. Read more about this: https://www.davinciplastic.com/

BREAST IMPLANT SURGERY… When it’s time to place the saline or silicone implants…usually 3-4 months (I help you decide which is best for you), the surgery is scheduled to do the implant(s) placement.  This involves going through the same incision used to place the expanders, removing the expanders and precisely placing the correct implants. General anesthesia is used for this procedure. The incisions are closed and healing begins taking place.  Stage II is now complete. Healing for all surgeries takes times and varies with each individual.  Activities are restricted at first, but you gradually move back into full activities…looking and feeling great.

ABOUT IMPLANTS…Today’s implants are the most advanced and safest of all time.  You can choose from either saline or silicone filled implants (both are FDA approved) and both types come in a spectrum of sizes and shapes, and have either smooth or textured surfaces to meet the many individual needs of women today. Implants are not for everyone, but for those who choose them…they restore natural looking, contoured breasts, enhanced self confidence and return to a normal lifestyle.

ABOUT BOARD CERTIFICATION… I am a board certified reconstructive surgeon with specialization in breast reconstruction.  Board certification does not guarantee certain results, but it does ensure that you are working with a surgeon who has been trained by the experts, has had years of extra education and experience and vast knowledge to draw from.  I am ranked among the “Top Docs” in the Nation who perform reconstructive surgeries successfully everyday…not bragging…but you need to know some docs are highly skilled and trained…others are not.

Next time I’ll discuss Stage III breast Reconstruction…known as Beautification. Be sure to read the previous blogs if you missed them.

Stay Well,

Dr. Steven Davison

“At DAVinci…I combine the supreme elements of art and surgical science.”

The reasons women choose to have restorative breast procedures are well stated in these quotes …

“I need to feel whole again,” –  “You have given me back what cancer took away,” – “The reconstruction of my breasts made me feel restored…not reconstructed,”  –  “I want to look as good as I feel,”  –  “I want to look and feel sexy again…and want my husband to see me as sexy.” 

These are but a few of many thousands of thoughts from women who wanted to fully recover from their breast cancer…with a whole body.

Today, I review Flap Procedures (Stage II Breast Reconstruction/Restoration).  There are a variety of Flap Procedures used to restore breasts…not every type is right for every woman, but we determine this after careful and thorough evaluation of your needs and goals.  I tailor each flap procedure to achieve beautiful natural looking breasts. There are four muscle flap techniques as follows:

1) Latissimus Dorsi Flap uses a flap of skin and muscle from the back on the same side as the operated breast.  This is transferred forward to form a breast mound that will look and feel natural since it is your own living tissue.

2) TRAM Flap is the most common form of living tissue  breast restorative techniques used today.  It creates a natural looking, soft, warm breast.  TRAM Flap involves either free flap or pedicled flap techniques.  Pedicled flap means the tissue remains attached to its blood supply.  TRAM Flap procedures employ skin, fat and muscle removed from the lower abdomen and transferred to the chest.

3) DIEP Flap reconstruction employs excess skin and fat from the lower abdominal area, through an incision similar to that used for Tummy Tucks. This is a “perforator flap” technique that is muscle sparing…meaning no muscle function is sacrificed, but warm living tissue is used instead.

4) Gracilis Flap harvests excess skin and fat from the inner thigh to restore natural looking, soft, warm breasts.  This may be a TUT Flap (without muscle) which is referred to as a Transverse Upper Thigh Flap. When a small amount of muscle is required…a TUG Flap is employed.  Either flap can be harvested so the donor scar is discretely hidden inside the upper thigh.

This is a brief overview of the 4 Flap techniques used for restorative breast reconstructions.  Each of them has it’s own virtues… and all offer beautiful, natural looking and feeling breasts.  I have guided many women through making the right choices so as to ensure optimum results.

GOALS of RESTORATIVE BREAST PROCEDURES

Goals are critical to good outcomes.  You must have yours…here are mine: “all cosmetic surgery should be functional & all reconstructive surgery should be aesthetic & look as natural as possible.”  

ADVICE TO MY PATIENTS

Always ask me questions; ask to see pictures of my patients, gather information and consults with trusted mentors, make your decision.   There are NO wrong decisions. Choose a qualified, Board Certified surgeon with specialized training and expertise in reconstructive surgeries.

Next blog will cover Implant Breast Restoration.

Dr. Steven Davison

“At DAVinci…we combine the supreme elements of art & surgical science.”

STAGE TWO BREAST RECONSTRUCTION

From previous blogs you know that Stage I involves placement of the Tissue Expander…often placed under the same anesthesia as your mastectomy surgery… and called Immediate Breast Reconstruction.  Delayed Reconstruction means you choose to wait a few weeks or months before starting the restoration process.

Here are the steps leading up to Stage II Reconstruction:

During the mastectomy skin and breast tissue are removed, leaving the chest tissue flat and tight.  The “expander” is inserted under the chest muscle and skin to serve as a “space saver.” The expander is slowly filled with saline solution (over many weeks) to stretch the remaining skin and muscle to allow for the future breast implant.

Expander surgery is done under the same anesthesia as the mastectomy surgery.  (Immediate Reconstruction)  Healing takes 4-6 months

NOW Stage II begins: The new Breast Implant is placed when Dr. Davison determines the space is sufficient and then the expander is removed.  This is done through the original incision.

Stages III & IV …Begin about 3 months later and Involves A new nipple and areola…with additional breast beautification.

I become your primary care physician during this entire process…generally about a year.

Stage II Breast Reconstruction involves rebuilding a new breast mound by using what is called a Flap Procedure.  There are several options for flap procedures that I will cover in my next blog.

Every year the numbers increase of women who choose breast reconstruction.  Vast experience enables me to gently guide you through the process to eliminate frustration and confusion, until you eventually see the tremendous benefits of your choices.  During the consultation you will come to understand your options and be able to choose a course of action that restores both form and self confidence.

All we do…we do sensitively, expertly and with outstanding results to improve your health and wellbeing. The results of all surgeries should be both…functional and beautiful.

Dr. Steven Davison

At DAVinci…we combine the supreme elements of art & surgical science.

Well, here’s my chance to “shine” a bit. I don’t usually hang out or post my “brag sheet”…but being recognized among the top doctors of the nation can make a guy feel proud.  In case you’re not aware…I’ve been named as a “Top Doctor” of the Year by the Washingtonian,  the Northern Virginia Magazine, and others, for Reconstructive Breast Surgeries.  Along with that award, top docs must assume great responsibility.  First let me explain the selection process.

Castle Connolly Medical Ltd. is America’s trusted source for identifying top doctors and the best in American medicine.  Their system for selection is rigorous and includes ascertaining critical information about doctors such as: exceptional training, experience and how they are regarded by their peers etc. etc. Top Doctors can have an enormous impact on healthcare for patients and their families….a “Top Doc” can mean the difference between receiving first class medical care and substandard care.  Top Docs rank among the top 10% in the Nation.

The Washingtonian and Northern Virginia Magazine also use these rigorous guidelines for selecting “Top Doctors”…or “Top” anything e.g. restaurants.  Education (not all schools are equal), experience can make a major difference in outcomes, and most important of all…life changing procedural results that patients are happy with, along with peer recognition (being recommended by other doctors)…comes only from years of growing and honing skills while keeping up with advancements.  This is the stuff Top Docs are made of.

 I love what I do, and the greatest reward is always seeing positive outcomes for my patients.  

I am honored and blessed to be able to serve the population in and around Washington, D.C. and I thank each of you for your  years of trust, confidence and support you’ve shown to me and my family.  I look forward to many more years of helping each of you, and your family and friends…and to enjoying the friendships that grow as a result.

Thank You, Stay Well and may God richly bless each of you.

Steven Davison, M.D.

At DAVinci…we combine the supreme elements of art & surgical science.

STAGE I – Mastectomy & Expander

Breast Reconstruction usually occurs as a two-stage procedure – starting with the placement of a breast tissue expander – which is replaced several months later with a breast implant. Dr. Davison will place the tissue expander under the same anesthesia as your mastectomy surgery if possible. This is called immediate reconstruction since the process is started at the time of your mastectomy.  You may choose to “delay” the start of reconstruction and wait for a few weeks or months.  This is called delayed breast reconstruction.

Here are the steps involved in mastectomy with expanders:

1.  During the mastectomy your breast surgeon removes skin and breast tissue – leaving the chest tissue flat and tight.  An expander (balloon type expandable device) is put into place under the chest muscle and skin – to serve as a space saver – into which a breast implant is later placed.  The expander is gradually filled with saline solution – over several weeks – and slowly stretches the remaining chest skin and muscle to allow for the future breast implant.
2.  Expander surgery is performed under general anesthesia in an operating room. Often a Biologic tissue barrier is used to create an inner Bra to cradle the expander.
3.  The incision used to perform your mastectomy is used for the expander placement
4.  After placement – the incision is closed
5.  Drains are left in place – and are removed when only 30cc fluid comes up
6.  Healing takes 4-6 months – the surgery takes several hours and is done under one anesthesia.  If delayed expander placement is done – surgery takes 1-2 hours.
7.  Breast implant is placed when Dr. Davison determines the space is sufficient and the expander is removed.  The same incision is used to do implant placement.
8.  A nipple and areola is created typically 3 months later – with additional beautification for both breasts.
9.  Dr. Davison becomes your primary care physician over the next year during this entire process.