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Breast Reconstruction

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Dr. Ching has a special interest in breast reconstruction and is deeply committed to providing women in Hawaii with the most current treatment in this field. He performs breast reconstruction surgery in Honolulu on women who have had a mastectomy (removal of the breast due to cancer or precancerous condition) or who have breast deformities. Many women feel very insecure or self-conscious about the appearance of their breasts following a mastectomy. For them a breast reconstruction is an excellent option for restoring confidence and wholeness.

Breast reconstruction allows your natural curves to be restored and can drastically improve your quality of life. Unusual congenital breast anomalies, including significant asymmetry and all varieties of tubular breast deformities, can also be significantly improved. The procedure is performed in a safe, caring environment with personal attention to your needs.

In the setting of mastectomy, breast reconstruction can be performed at the same time of mastectomy (immediate reconstruction) or some time after mastectomy is performed (delayed reconstruction). There are many benefits of immediate reconstruction. These include less surgical procedures for the patient as the mastectomy and reconstruction are completed in a single surgery. In appropriate cases, the skin and nipple of the breast can be preserved (skin sparing mastectomy) allowing for a reconstructed breast that is very close to a natural breast. This approach of reconstruction where the breast reconstruction is completed in one surgery is called “single stage reconstruction” or “direct to implant reconstruction”. Dr. Ching was the first in Hawaii to use this technique. This technique requires the use of a biologic implant called Alloderm which is used to create a sling to position the implant in the appropriate location on the chest. This technique is ideal in smaller breasts. We are often using this technique in prophylactic mastectomies, mastectomies that are performed before the presence of cancer. Often these patients may have the BRCA1/2 mutation, which strongly predisposes women with this gene mutation to developing breast cancer.

Women with larger breasts undergoing mastectomy or women who have had mastectomy some time ago will often have tissue expander reconstruction. In this type of surgery, a special implant called a tissue expander is used to slowly expand the remaining breast skin so that an appropriately sized implant can be placed. Once the expander is the right size, the expander is switched with a permanent implant. This technique requires two surgical procedures but can also provide excellent results.

In appropriate patients, the breast can be reconstructed with skin and fat from the abdomen or back. This type of surgery, called autologous breast reconstruction, borrows excess parts from another region of the body (termed “flaps”) to reconstruct the breast. The common flaps that are used are the TRAM flap or L.dorsi flap. Microsurgical techniques, where the flap is completely detatched from the body and transplated into the chest, such as the DIEP flap, are also offered by Dr. Ching.

Often, additional, smaller procedures can improve the result of reconstruction. Fat grafting to the breast can fill in thinner areas of skin or smaller defects. Strattice, a material similar to Alloderm is also being used to increase the thickness of breast skin to minimize the visibility of rippling from breast implants. These techniques can be necessary as the remaining skin of the breast can be very thin after all the breast tissue is removed during a mastectomy. These techniques are sometimes offered to patients that have started breast reconstruction with Dr. Ching to optimize their surgical results. We also often see patients seeking breast implant revision of their breast reconstruction that was performed elsewhere.

When the nipple and areola are absent from mastectomy, the nipple can be created from the skin of the breast. Small flaps of skin are folded and sutured together, in a fashion similar to the paper art of origami. After the nipple is reconstructed, Dr. Ching prefers to tattoo color for the nipple and areola. The result is a very natural appearance that restores the breast completely. Nipple and areolar reconstuction are usually the final stage of reconstruction.

Contact us today for a personal, confidential consultation with Dr. Ching about breast reconstruction in Honolulu, Hawaii.

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Shim Ching, MD