Reconstruction Do-Overs

Breast reconstructions may need to be redone years later.

BY KATHY LATOUR
PUBLISHED: JUNE 09, 2009
Canady says redoing reconstruction is where “the artistic” comes in and each has to be considered on a case-by-case basis. He urges women to consult with experienced plastic surgeons in well-established practices, where they will find board-certified, skilled surgeons who have done a surgery numerous times. And, Canady says, get more than one opinion. 

“It’s amazing to me how people will go to multiple places looking for a car but go to one doctor’s office when making a decision about something they will have to live with the rest of their lives.”

A RECONSTRUCTION REDO can happen immediately or years down the road—and for any number of reasons. The woman may dislike the outcome, or the breasts no longer match because of age, the power of gravity, an implant rupture, or infection.

My original plastic surgeon had retired, so I asked around before choosing William Carpenter, MD, at Baylor University Medical Center in Dallas. Carpenter says the majority of reconstruction redos he sees come from “implant malfunction,” meaning there is capsular contracture or the implant has ruptured.

“Another reason patients come in a long time after reconstruction,” Carpenter says, “is that the opposite breast has changed over the period of time, and they need some sort of a balancing procedure, either on the other side or on the cancer side where the reconstruction was done, or both.” He says he has had little trouble with insurance companies covering the redos.

Every case involves some customization, Carpenter explains, with some patients needing more skin, some needing more volume, some patients needing a bigger implant, others a smaller implant.

Carpenter examined my existing reconstruction and recommended a second back flap because it would give me the best match to the other breast. I also learned that the scar for this back flap would be about half the length of the first since I would be having a skin-sparing mastectomy, one of the advances that has allowed for a much better cosmetic result. 

Basically, the tissue was removed through a circular incision about the size of a silver dollar around the areola. After the surgeon removed the tissue, Carpenter cut a similar size piece of skin from my back that, still attached to the muscle, was then tunneled under the skin to my chest wall. Under the muscle he placed an expander sack that was filled with fluid over a hree-month period until the skin was stretched to accommodate the permanent implant.

During the second surgery, he put in the new implant on the left and opened the old reconstruction on the right, where he found that the old implant had ruptured and was “a mess.” He cleaned it out and replaced the old implant with the same type of implant he was using on the left. The teardrop shape would fill in the indentation that had bothered me for so long. The implants I chose were part of a clinical trial for a new cohesive silicone gel that one person described as having the consistency of a gummy bear, meaning that, unlike the old silicone gel implants, if it is cut, it doesn’t run like a liquid.

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