When considering Breast Reconstruction after cancer, I will guide you through the possibilities for creating the most natural, beautiful breasts. There are a couple of different types of surgery that you may want to familiarize yourself with beforehand. These are the kinds of Breast Reconstruction surgeries available through my office. Some options utilize the body’s own tissue taken from areas with a little extra, such as the abdomen or thighs, and the others use silicone or saline implants.

DIEP Flap Breast Reconstruction

DIEP stands for Deep Inferior Epigastric Perforator. This technique uses excess skin and fat from the lower abdominal area. The incision is similar to the one used for a Tummy Tuck and can be easily hidden by clothing or bathing suit. Another benefit to this surgery is that it flattens the abdomen for an overall beautiful body contour. It spares the abdominal muscle and there is significantly less pain in the shorter recovery process. Since the muscles are in tact, the abdominal wall strength is not affected.

Tram Flap Breast Reconstruction

This is another technique that uses the abdominal tissue to rebuild the breasts, however the difference from the DIEP is that it does use abdominal muscle in addition to the skin and fat. The incision will still be discreet and hidden by the clothing or bathing suit, but recovery will take longer due to harvesting muscle. I am skilled in offering options within this surgery, which are to take the tissue connected to a blood supply, which is called pedicled, or not attached to the original blood supply and requires connection to a new one, which is called free flap. Both of these methods require immense skill and unique challenges. For example the pedicled technique is to avoid muscle rotation, which can create an abdominal bulge, and the free flap technique is even more intricate of a surgery as it requires successful reconnection of arteries using microsurgery.

Gracilis Flap Breast Reconstruction

This surgical technique uses excess skin and fat from the inner thigh to reconstruct a natural appearing breast. This can be done without taking any muscle, which it would then be called the Transverse Upper Thigh Flap surgery. Sometimes the inner thigh flap requires a small amount of muscle in order to assure an adequate blood supply to the flap. The muscle that’s used to do this is the gracilis muscle, which is what the surgery is named after. Unlike missing a part of the abdomen muscle, the gracilis muscle is often not missed unless you do a lot of exercises or sports mostly depending on quick changes of going side to side. A side benefit of taking tissue from the inner thigh is that it often can reduce inner thigh friction.

Latissmus Flap Breast Reconstruction

This surgery reconstructs the breasts using a flap of skin and muscle from the back of the same side as the operated breast. This living tissue is used to recreate the breast mound. It is mostly used for women who don’t have enough abdominal tissue or have had previous abdominal incisions. There are usually no complications and the blood supply is highly dependable. The use of the latissmus flap can be combined with implants.

Breast Reconstruction with Implants

Because of the familiarity with implants for Breast Augmentation, this is an option chosen by thousands of women each year who undergo a mastectomy. It is also commonly used for women who are thin and don’t have extra tissue to use. A major benefit is that this can be done sequentially under the same anesthesia as the mastectomy surgery, called immediate reconstruction. This process still usually requires 2 or more surgeries, as we will have to navigate unique issues with the skin stretching (possible loss of elasticity due to radiation treatments) and addressing scar tissue.

You can rest assured that I am using the most cutting edge and advanced techniques along with my immense experience to help guide you to the right surgical options for your Breast Reconstruction. Please schedule a consultation to discuss what might be the best option for you, www.davinciplastic.com.

Sincerely,

Steven Davison M.D.

Board Certified Plastic/Reconstructive Surgeon

One of the many considerations of breast cancer that requires a mastectomy is Breast Reconstruction surgery. This can be a time of overwhelming choices and so my goal with each Breast Reconstruction patient is to provide compassionate care and the best natural looking results possible. This is a specialty I give the utmost attention to and have developed knowledge and skills that have provided beautiful results that have been very healing and satisfying to many clients.

Why Reconstruction?

While considering being in surgery again most certainly is not appealing after going through cancer treatments, I have found that it does help empower women to regain their feelings of femininity and sense of normalcy. Most times I’m helping to rebuild a breast mound after lumpectomy or mastectomy surgery, however I can also correct previous breast surgeries and nipple replacement.

Deciding on the Surgeon

Through my many years of experience and artistry, as well as using the most sophisticated and cutting edge techniques, I can help to create natural looking breasts to enhance body shape. Breast reconstruction surgery requires a thorough understanding of the intricacies of the human anatomy, as this is not the same process as the standard Breast Augmentation. I have extensive experience and years of specialized training in Breast Reconstruction surgeries to provide my patients with the most beautiful, natural looking results possible.

Making Decisions

Working alongside your oncologist, we will patiently and thoroughly discuss your options regarding Breast Reconstruction surgery. We will cover many topics, such as the possibility of performing Breast Reconstruction at the same time as the cancer removal under the same anesthetic, or if we should wait until after other treatments.

You also have options as to what you’d like to replace the breast tissue with, including your own living tissue from an area with some extra to spare, such as your inner thigh, or implants made of silicone or saline. All of these can be used to create beautiful, natural looking breasts. The best choice differs for each individual based on many factors so we will discuss this extensively. Some of these factors are (but not limited to):

• cancer type
• stage of breast cancer
• your personal preferences
• overall health

If you’re considering Breast Reconstruction after cancer, and you’re looking for compassionate and expert care for the best results possible, please visit our website to schedule a consultation at www.davinciplastic.com.

Sincerely,

Steven Davison M.D.

Board Certified Plastic/Reconstructive Surgeon

Angelina Jolie’s double mastectomy is big news right now...and is a timely reminder for women around the world…about the risk of developing breast cancer when a person is BRCA1 positive and/or has a strong family history of breast/ovarian cancers. Angelina chose to have a double mastectomy (removal of both breasts) for several reasons….these 3 being the highest priority:

1) Angelina’s double mastectomy (surgical removal of both breasts) greatly reduced her changes of getting breast cancer by 87%.  For people who test positive for BRCA 1…the breast removal surgery reduces the risk of ever getting cancer…significantly.

2) The mastectomy surgery reduced her risk of getting ovarian cancer by 50%.  This is the disease that killed her mother (after fighting it for 10 years) at age 56.

3) Having the double mastectomy reduced her risk of breast cancer down to less than 5%…so she could tell her children: “They don’t need to fear they lose me to breast cancer.”    Her big why was her kids.  Living a long life to be there with and for them.  I didn’t want to leave them or for them to lose me at a young age the way I lost my Mom.  Angelina, age 37, and Brad Pitt have 6 children. Three are her own natural born and three are adopted.

Angelina chose to tell us all about her double mastectomy to encourage other women to:  get gene tested and to raise awareness of the options available to those at risk.

Angelina’s surgery was done in February…but she kept it private until now.  Even her own father, Actor/Celebrity John Voight didn’t know about it until recently at a family birthday party for one of the kids…and was very surprised because she has been very active and looked (looks) perfectly normal and healthy.

Brad Pitt and their 6 children were totally involved in the entire process…and even set up a little post-op recovery area at home so they could help mommy and be part of her recovery.  Brad is thankful and relieved for the clean bill of health….and for the fact that the cloud has been removed!

About BRCA1...BRCA1 is a gene mutation that men and women can carry and pass down to children.  This mutation makes people at risk for breast, ovarian, pancreatic and prostate cancers.  Genetic counseling followed by gene testing (blood tests) allow mutations to be found either BRCA1 or BRCA2…and empowers other family members to get tested also.  See: www.davinciplastic.com

Angelina said:

“This was not an easy decision….but one I’m glad I made! Now I want to encourage other women to get tested…especially those with a strong family history of cancers! ” She encourages us to seek out the information and the experts…learn about all the options…and those who can help you through this aspect of your life…make informed choices and become empowered!

Other Celebs who’ve had double mastectomies include:  Sharon Osbourne and Sheryl Crow.          November, 2012….Sharon disclosed the facts about her breast removal surgery  after a genetic test revealed she was a carrier of BRCA1 genes.  She knew immediately that the odds were not in her favor….she’s had cancer before and did not want to live under that cloud again.

The critical message here is:  if you have a strong family history of cancer….get tested.  Let’s talk about….I’m specialized in all breast procedures including reconstruction options.

Best to you and yours.

Steven Davison M.D.

Every brides’ goal is to have picture perfect, flawless and glowing skin on her wedding day.  Grooms want to have a clear complexion and be fit and trim with a great upper torso and much more. Today’s couples plan and do more together than ever before…especially for their wedding.  So in order to accomplish these goals, you must start a few weeks before your wedding date.  

Brides and Grooms Skin Care plan looks like this:

• Use only trusted skin care products…such as Obagi for beautiful, healthy  skin
• Perform your skin care regimen daily without fail
• Avoid shell fish, limit alcohol, stop smoking and avoid extractions (they inflame the skin) and tanning beds….there is no safe tan!
• Dietary:  eat lots of fresh, raw fruits and vegetables,  cut back on or eliminate fried foods, sugar, excess salt, processed foods
• Sugar molecules attach to collagen fibers and cause sagging skin and wrinkles
• Alcohol causes blotchiness and swollen skin
• Excess salt causes puffiness
• EAT lots of foods loaded with antioxidants (raw fruits and vegies….must be fresh)
• Pure Water….drink lots of it to stay well hydrated and detoxed
• Skin Care Regimen…must be daily routine and include:  cleansing, toning, moisturizing.    Exfoliate 1 time per month prior to your wedding.
• Sleep…the body heals and renews only during sleep.  Get 7 to 8 hours a night.
• Deep Breathing….stop and deep breath several times everyday
• Crying…avoid crying the week before your wedding to avoid red eyes and puffiness
• Lighter Makeup…Brides …lighten up on makeup and let your skin breathe
• Facial….get one a few days before your wedding day…focus on smoothing, exfoliation and hydration
• Wedding Day gel mask….lots of water….lots of deep breathing! (apply a gel mask that morning to clarify and smooth your skin….drink plenty of pure water and breathe deeply.

Beautifying Procedures Brides and Grooms Love!

Many brides and grooms want to look their absolute best on their wedding day…for those perfect photos, lasting impressions…and cherished memories.  The most popular procedures they choose include:  Tummy tucks, Facial Fillers, Lipo/Abs sculpting, Spa procedures to help transform troubled, aging skin to look and be more youthful,  Lip augmentation to get beautiful, sexy lips….Nose Jobs, Breast Augmentation or Reduction and others.

Today’s Couples Stay Younger Together…

Men and women arrive together to tailor their age defying programs!  The days of women showing up alone, having a breast procedure or facial rejuvenation treatments and then hoping no one notices right away….those days are long gone.  This is a new day! Husbands and wives, brides and grooms are scheduling appointments together and planning their age defying, beautifying treatments….together.  It’s lots of fun for all of us and so rewarding.

Society demands it…Men and Women want it!

Health and wellness that achieves wonderful youthful results incorporated with small procedures, started early enough to reverse early signs of aging.  We now thoroughly understand the aging process and the timetable at which visible signs of aging will occur.  In response to that, we can do small things early on and absolutely reverse and slow down the process.  Treatments like injectable facial fillers such as Juvederm, Botox, Obagi skincare products that work from the cellular level to create healthy skin from the inside out and other options.

Lots of Options for everyone…

These are just a few of the many ways you can prepare for your big day…but you must start now.  Come on in and let’s get to work on your personalized plan so you’ll be ready.  Visit my website for ideas and procedure overviews: https://www.davinciplastic.com

Helping people be their healthiest and most youthful is what I do best!

Steven Davison, M.D.

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

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

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.

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.