About Breast Reconstruction
Surgical breast reconstruction is performed to restore the chest to a normal appearance in shape and size after a mastectomy or lumpectomy. It is also an option to restore a breast damaged by trauma or a birth defect. Advanced technologies in breast reconstruction surgery make it possible for you to feel complete and attain natural-looking breasts even after they have been removed. This surgery can include a few procedures and various stages that can either be performed at the same time as your cancer treatment or delayed until a later date. New York plastic surgeon Dr. Michael Koch creates an individualized treatment plan and uses a compassionate approach as we work with you to restore your appearance and confidence at each of our three locations.
Breast Reconstruction Reviews
"A WONDERFUL DOCTOR - I have been coming to Dr. Koch for many years. He performed breast augmentation and then breast reconstruction on me when I was diagnosed with breast cancer. He is a wonderful doctor who is caring, friendly, compassionate and genuinely concerned about my progress and well being. Overall, my experience with Dr. Koch has been extremely positive and I would recommend him to anyone."- Anonymous / Vitals / May 20, 2011
"Professional and personable - As a patient in the midst of breast reconstruction due to cancer, Dr. Koch and his team have been so incredibly helpful from the start with drawing and notes that made it easier to understand during a very hard time. Dr. Koch helps to clarify at each step of the way and has been available to answer questions, respond to calls, and work through my confusion as the cancer process unfolded and the reconstruction work is now in progress. I am so grateful that he is my surgeon and absolutely recommended him."- Anonymous / Vitals / Apr 19, 2019
Breast reconstruction is a very personalized procedure. Every patient will have a thorough consultation with Dr. Koch to create their treatment plan based on their needs, concerns, and appropriate options. If you are planning to have breast reconstruction surgery, it is vital that you have realistic expectations. While Dr. Koch strives to create a natural appearance, your newly reconstructed breast(s) may not have the same feel, look, or sensation as your original breast(s). You should get approval from your oncology doctor to have surgery and tell Dr. Koch about any other factors that could impact healing.
There are a variety of techniques available today for breast reconstruction. There are also many factors that Dr. Koch considers when determining the technique that will produce your best results. Some of these factors include cancer diagnosis, reconstruction timing, whether you will use natural tissue or implants, and if nipple-sparing or nipple reconstruction is a part of the process. In order to rebuild the breast, there must be enough tissue to adequately cover the breast mound. Flap procedures accomplish this by using your own skin, fat, and muscle to create, cover, and build the mound. The most common flap techniques are:
- TAP/TDAP Flap
A TAP flap may be useful for small defects, such as in breast conservation and lumpectomy patients. The thoracodorsal artery perforator (TAP or TDAP) flap uses the tissue from the side of the breast and the back. Typically, a TAP flap is used to augment the volume of the breast and to create a more contoured effect.
- TRAM Flap
This method uses skin, fat, and muscle from your stomach to create the breast. The tissue used to create the new breast can be detached from the abdomen or it may remain attached to the donor location, maintaining the original blood supply.
- DIEP Flap
Like a TRAM Flap, a DIEP Flap removes fat, skin, and blood vessels from the lower stomach, but it doesn't take the muscle. The DIEP (deep inferior epigastric perforator) flap removes fat and skin from the belly to form the breast mound then uses microsurgery to attach the blood vessels to the chest.
- Latissimus Dorsi Flap
This method uses muscle, skin, and fat from your back. During this procedure, tissue is moved from the back to the mastectomy site through a surgically created tunnel and remains attached to the donor location, which leaves the original blood supply intact.
- PAP Flap
Another flap alternative is the PAP (profunda artery perforator). This technique takes skin, fat, and muscle tissue from your inner thigh to create your breast(s).
- LTP Flap
While the TRAM flap tends to be one of the more common methods used during reconstruction, sometimes there is not enough muscle, skin, and fat that can be taken from the abdominal area. In these situations, the LTP flap may be used, which takes tissue from the lateral thigh area.
- Composite Flap
Also known as a composite stacked flap, this method combines flaps from different areas on your body to reconstruct the breast.
While flap procedures are usually successful and a common method used in breast reconstruction, you may be able to rebuild your breast(s) with tissue expansion. This involves placing a tissue expander under the breast wall and then slowly filling it with saline over the course of 4 – 6 months until the skin is properly stretched. After a flap has been created or the skin is stretched through an expander, you can then decide whether you want to use a natural fat transfer or breast implants to create the volume and shape of the breast(s). After your breast reconstruction surgery, you may want to improve the appearance with nipple and areola reconstruction. There are numerous techniques to restore the nipple-areola complex so that it looks more attractive.
Dr. Koch also utilizes Alloderm during implant-based breast reconstructions when necessary. Alloderm is a regenerative tissue matrix and acts as support and reinforcement for the breast. It is placed in the breast pocket and attached to the chest wall, and can help stabilize the implant and reduce the risk of implant migration.
What to Expect
Breast reconstruction surgery is performed in various stages. During certain phases (such as creating a flap, inserting an expander, or placing implants), general anesthesia is often used. Some patients will require an overnight stay — this is dependent on the current phase of treatment. Once the final step has been completed in the breast reconstruction process, you will wear a compression bra for the chest and you will be given medication by Dr. Koch to control bleeding, discomfort, and swelling. Over time, the breast(s) will look normal so you can feel more confident. Ongoing monitoring with mammograms and breast exams are important and recommended for long-term health.
Frequently Asked Questions
How much does breast reconstruction surgery cost?
Breast reconstruction is a complex surgery, so to get great results, you should concentrate on choosing a plastic surgeon with years of experience like Dr. Koch over the lowest price. During your initial consultation, Dr. Koch will listen to your needs and goals before crafting your custom reconstruction plan. Once this is done, a member of our team can talk to you about cost estimates, payment methods, and low-interest financing.
Does insurance cover my surgery?
The WHCRA (Women's Health and Cancer Rights Act) of 1998 requires insurance plans that cover mastectomies to also cover breast reconstruction surgery. If you have insurance, someone from our practice will help you understand your policy and coverage. We will also help you submit needed information and paperwork to your insurance.
Which technique should I choose?
There is no single technique that is right for everyone. The best technique for you will depend on your needs, goals, and body. During your consultation, Dr. Koch can go over your options, including both implants and flaps, so you understand the benefits and challenges before you decide on your treatment plan. Whether you decide on implants or a flap for reconstruction, Dr. Koch will do his best to give you natural-looking results.
What about nipple reconstruction?
Reconstruction of the nipple-areola complex is usually performed with cosmetic tattooing. If you are interested in having your nipple-areola complex tattooed onto your reconstructed breast(s), you should tell Dr. Koch during your consultation. He will go over your options, so you can decide if you want 3D tattooing of the nipple and areola to be a part of your treatment plan.
Should I have reconstruction with my mastectomy or wait?
When you choose to have breast reconstruction is based on several factors. Some patients choose to have their reconstruction procedure performed at the same time as their mastectomy, while some patients prefer to wait. Dr. Koch recommends you schedule a consultation after your cancer diagnosis so you can begin learning about your options and when you may want reconstruction surgery. If you decide to have a reconstruction procedure at the same time as your mastectomy, Dr. Koch can collaborate with your oncologist to plan your surgery.
Plan Your Procedure
Reclaim Your Self-Confidence
While the breast reconstruction process can be lengthy, it is considered one of the most worthwhile cosmetic surgeries for our New York patients. It can help decrease the emotional and physical impact of a mastectomy while also allowing you to boost your self-confidence and figure. If you have been diagnosed with breast cancer, have had trauma to the chest, or were born with a defect that affects the shape of your breasts, we invite you to call one of our three New York locations and schedule your consultation with Dr. Koch.