Wichita women who have had or who are planning to have a mastectomy often follow up the surgery with breast reconstruction. By recreating the breast(s), the procedure restores a patient’s natural figure and eliminates the need for an external prosthesis.
The timing of your breast reconstruction surgery will depend on several factors, including your desired outcome and the scope of your cancer treatment. Some women have reconstructive surgery at the same time as their mastectomy. Others have breast reconstruction months or years later.
As an experienced plastic surgeon, Dr. Voge can develop a personalized surgical plan to meet your aesthetic goals and to give you back a sense of physical wholeness. Learn more about treatment, and view “Frequently Asked Questions” at the bottom of the page.
Why Patients Choose Dr. Voge for Breast Reconstruction
Dr. Voge’s primary goal is helping patients become their very best selves. As a board-certified plastic surgeon, she has performed thousands of procedures for women in the Wichita area. Through her specialized residency training, she developed skills in the full spectrum of cosmetic and reconstructive techniques and studied under a number of nationally recognized practitioners. As a patient, you can expect Dr. Voge to:
- Apply current findings in the field of breast cancer research to achieve attractive and natural-looking outcomes.
- Provide individualized care and personal attention.
- Coordinate with your breast cancer team to support your treatment while ensuring that your aesthetic goals are met.
Your Initial Consultation at Plastic Surgical Specialists
When you visit our practice in Wichita, our all-female staff will welcome you to the office and help you feel comfortable and at ease in your treatment. Our clinical specialist will let you know what to expect and remain available to you as a guide through the entire process.
During your consultation with Dr. Voge, she will take the time to discuss your concerns and learn about your aesthetic goals. Her foremost concern is your health and well-being. She will be in continuous contact with your oncology team so that your breast reconstruction plan is in harmony with your treatment.
There are a number of factors that determine the timing and technique for breast reconstruction. More details can be found in the “Frequently Asked Questions” section below.
Dr. Voge can often start reconstructing your breast(s) after your breast cancer surgeon completes the mastectomy in the same surgical session. In some cases, patients have enough tissue and skin left over after a mastectomy that Dr. Voge can place the implants during the same surgery.
Other patients will not have enough skin for the immediate placement of an implant. Dr. Voge may use abdominal tissue to fashion the new breasts, or she may use tissue expanders. Expanders allow Wichita patients to slowly stretch their tissues over time until their body is ready to support implants. This approach requires a follow-up surgery.
If you will be receiving chemotherapy, you can still begin the reconstructive process at the time of your mastectomy. If tissue expanders are placed, they can still be stretched during chemotherapy, albeit at a slower rate. The second surgery to replace your tissue expanders with implants can take place one month after the completion of chemotherapy. This delay conforms to medical guidelines and enables the best cosmetic outcome without compromising your breast cancer treatment.
Radiation treatments will affect the timing and approach of your breast reconstruction. Dr. Voge may be able to perform the procedure between chemotherapy and radiation. Alternatively, she may recommend waiting for six months after your final radiation treatment.
Your Experience With Breast Reconstruction Surgery
On the Day of Your Procedure
Dr. Voge will perform your breast reconstruction at a Wichita-area surgical center or hospital. You will receive general anesthesia and be asleep during surgery. When you wake up, you can expect to:
- Be wearing a specialized supportive bra that aids in healing.
- Receive pain medication to help you manage discomfort.
- Have drains in place to limit swelling.
- Receive detailed instructions from your medical team about how to take care of your surgical dressings.
Recovery and Follow-Up
You will likely be sore for several days following surgery. To promote healing, avoid pushing, pulling, lifting, and all forms of exercise for six weeks.
Dr. Voge’s breast reconstruction patients return to her Wichita office about a week after their procedure for a follow-up appointment. She will check that your surgical sites are healing properly, evaluate your drains, and provide instructions for ongoing care.
If you had your breast implants placed on the same day as your mastectomy, you will return to the office once your drains are removed, in about five weeks from surgery. You can expect to see your final results within three months. Alternatively, if you had tissue expanders placed:
- You will return to the office for weekly appointments. During your visits, Dr. Voge will increase the volume of your expanders until you reach your preferred size.
- This process takes 1-3 months. Once it is complete, you can schedule your implant placement surgery.
Many mastectomy procedures require removing a patient’s nipple. Plastic Surgical Specialists offers cosmetic solutions to restore this feature. Two typical approaches available to Wichita patients are:
- Three months after the placement of your implants, you may choose to have a nipple tattooed onto your skin. This is an in-office procedure that creates the realistic illusion of a three-dimensional nipple without any additional surgery.
- Skin fold. Dr. Voge can create a new nipple with the existing breast skin. You can opt to leave this newly created nipple as is or to have it tattooed for a more natural appearance.
Whether you are planning to have a mastectomy or are just now considering restoring breasts removed years ago, you may benefit from care with Dr. Voge and her staff. Together, we can develop a treatment plan to help you regain your physical identity.
Frequently Asked Questions About Breast Reconstruction
What is a mastectomy?
A mastectomy is a surgery that removes all of the breast tissue, which is one of several layers of tissue in the human body. From outside to inside, these layers include the skin, the fat, the breast tissue, the pectoralis muscle, and the rib bones.
An analogy using oranges may help in illustrating a mastectomy. The breast tissue is taken away from the outer peel of fatty tissue and skin. This process leaves the skin and a layer of fat behind, as both are safe for the patient to keep.
What is breast reconstruction?
Breast reconstruction is a surgery to try to replace what is lost when a portion or all of a woman’s breast tissue is removed to treat or prevent cancer.
Typically, Wichita women have breast reconstruction when they have a mastectomy. Patients may also have the procedure as part of a lumpectomy, which is a surgery that removes only a portion of the breast. Women who have a lumpectomy may choose to have breast reconstruction to reduce the size of their breasts or to address a significant loss of tissue.
The types of breast reconstruction that Dr. Voge performs for Wichita patients varies based on:
- The surgery used to treat the cancer.
- Other treatments used on the cancer.
- The patient’s breast shape and size.
- The patient’s personal preferences.
What are the types of mastectomy?
Total mastectomy. Surgeons use this approach when reconstruction does not occur at the same time. The nipple is removed, and excess skin is removed so that the skin lays flat on the chest.
Skin sparing mastectomy. This approach removes the nipple but preserves excess skin to aid in the breast reconstruction. The resulting scar depends on the size and shape of the patient’s breast. The scar may go horizontally across the breast or form a “T” shape. Dr. Voge’s patients know the location of their scars prior to surgery.
Nipple sparing mastectomy. This type of mastectomy preserves both the nipple and the skin. When having a nipple sparing mastectomy, nipple sensation will be lost. The nipples will not have their previous sexual function or sexual sensation. They may or may not be numb, but any feeling will be comparable to how one’s arm skin feels when one touches it after having slept on it too long. The benefit of this approach is the cosmetic appearance of the nipples and scar location at the inframammary fold (the crease at the bottom of the breast).
With breast reconstruction, either a skin sparing or a nipple sparing mastectomy is performed. For patients to have a nipple sparing procedure, the nipple cannot be located too low, and the breast cannot be very large. For those Wichita patients with cancer, the cancer has to be small and located far away from the nipple. The breast cancer surgeon determines if the patient is an appropriate candidate for a nipple preserving mastectomy.
Is breast reconstruction with implants the same as breast augmentation?
No, this is not the case. They are two very different procedures with the only similarity being the implants. Some of the biggest differences follow:
- When Dr. Voge performs breast reconstruction procedures for Wichita patients, she is recreating the shape of the breast. Breast augmentation focuses on increasing their size.
- After a mastectomy or a lumpectomy, there is less breast tissue, which means that implant imperfections may be more noticeable.
- Removing breast tissue takes away blood supply to the skin. This leads to higher complication rates and more limitations on what can be done at the time of mastectomy compared to what a breast augmentation can do.
Can I have larger or smaller breasts than I do now?
Breasts can often be reconstructed smaller or larger than their original size. However, there are limitations to how large the breast size can be.
Commonly, Dr. Voge will use a tissue expander to create larger breasts as part of breast reconstruction. Some patients have breast skin that has been previously stretched out due to weight change or pregnancy. These patients can have their breasts minimally enlarged in a single surgery. The size limitation in this approach depends on the health of the skin at the time of the mastectomy.
What is a tissue expander?
A tissue expander is a medical device with properties similar to a water balloon. Once it is placed through surgery, Wichita patients visit Dr. Voge’s office to have the tissue expander filled with saline (salt water). This enlarges the device, stretches out the tissue, and, over time, creates space for an implant.
Typically, patients have fluid added to the tissue expander once a week or according to any time frame that the patient’s schedule allows (no more than once a week). Patients can still have fluid filled if they are being treated with chemotherapy, though the timing will be adjusted to fit the chemotherapy schedule.
Dr. Voge’s office stops adding fluid to the expander when:
- The patient decides that she is happy with her breast size.
- The patient’s skin will not safely stretch any further.
- The patient has reached the largest size of implant.
The expansion process is rarely associated with significant pain. Patients often describe it as a dull muscle ache, tightness, or pressure that lasts less than 48 hours. Dr. Voge helps prevent the discomfort that can occur if too much fluid is put in by carefully guiding patients in the process. Note that tissue expanders feel quite hard beneath the skin — like rocks or coconut shells. The implants that replace the expanders feel much softer.
What are the types of reconstruction that can be performed with a mastectomy?
There are two main types of reconstruction: implant-based and using the patient’s own tissue. Implant-based reconstruction is how approximately 80 percent of reconstructions are performed in the United States, and these can be divided into two categories:
A one-stage reconstruction is also called direct-to-implant reconstruction. Doctors can use this approach with a nipple sparing mastectomy since skin is not being removed. At the time of the mastectomy, Dr. Voge places an implant to restore the shape and appearance of the breast.
A two-stage reconstruction is a more common approach and the one Dr. Voge uses for most of her Wichita patients. It involves placing a tissue expander during the same surgical session as the mastectomy (the first stage). The tissue expander enlarges the tissues over time, and then, in a follow-up surgery, the tissue expander is exchanged for an implant (the second stage).
How long does two-stage reconstruction take?
The time involved depends on multiple factors:
- The date when patients begin to have fluid added to their tissue expander. Patients can start this process as soon as two weeks following mastectomy surgery.
- The length of time between office visits. Most women have fluid added every week or two.
- How large the patient wants her breasts to be. A larger size requires more filling sessions.
Surgery to replace tissue expanders with implants can occur one month after the last expansion appointment and at least three months following the initial surgery. On average, women have implants placed four months after their first surgery.
If one of Dr. Voge’s Wichita patients requires chemotherapy for cancer treatment, the patient can have her tissue expanders filled during chemotherapy, though at a slower rate. The surgery to place the implants can occur one month after she completes chemotherapy or any time after.
Will I be completely flat-chested after mastectomy with tissue expander reconstruction?
The answer is, “Not necessarily.” Dr. Voge can add saline to the tissue expander at the time she places it. The amount of fluid she adds to the expander — and how large a patient’s breast will be right after surgery — depends on how much healthy extra skin the patient has.
What do sub-muscular placement and pre-pectoral placement of the tissue expander or implant mean?
These are terms used to describe the layer of the body in which the tissue expander or implant is placed. In sub-muscular placement, it is placed under the muscle. Pre-pectoral placement means that it is placed on top of the muscle.
Should my tissue expanders and implants be placed sub-muscular or pre-pectoral?
There are multiple factors to consider with placement, including a woman’s initial breast size, her goals with surgery, the thickness of the fatty layer beneath her skin, and the skin’s health at the time of surgery.
Sub-muscular is the traditional approach, and it offers several advantages to Wichita patients:
- The muscle gives another layer of protection to hide the implant’s imperfections.
- Sub-muscular decreases the risk of an implant appearing through the skin.
- This approach decreases infection if the skin heals poorly.
The downside to placing the implant under the muscle is that patients tend to experience more pain as they heal. Results may also cause animation deformity: movement of the implant when the patient flexes her pectoralis muscle. Some patients will get significant animation deformity and others not much at all. Doctors cannot predict prior to surgery the likelihood of this risk.
Over the last few years, some surgeons began opting for pre-pectoral placement. This approach reduces pain in recovery, and animation deformity does not occur. However:
- More of the implant’s imperfections will be visible.
- In thin patients, the skin may be too thin, and they can get abnormal scarring of the skin to the implant.
- The implant is more likely to be exposed if the skin does not remain healthy. This can result in a follow-up surgery to remove the implant.
Dr. Voge recommends that Wichita patients who have pre-pectoral placement receive fat transfer and an acellular dermal matrix.
What is acellular dermal matrix / acellular dermis?
It is a portion of human cadaver skin that has been processed to take out the parts that the body could react to or reject. An acellular dermal matrix is utilized in the majority of implant-based breast reconstructions. Women who receive one cannot see or notice it beneath the skin.
Dr. Voge uses an acellular dermal matrix to create a “hammock” that supports a tissue expander or implant. If the tissue expander or implant is placed in a pre-pectoral position, she may also use this technique to cover them from above.
What is fat transfer / fat injections?
Fat transfer is a procedure that takes excess fat from one part of the body and moves it to another part of the body. As part of the process, Dr. Voge liposuctions the fat, purifies it, and injects it underneath the breast skin.
The benefit of fat transfer to Wichita patients is that it provides additional coverage over an implant and creates a smoother-looking result. At this time, breast reconstruction cannot be performed by fat transfer alone.
Are there other breast reconstruction options?
Wichita patients may be able to have their breasts reconstructed using their own tissue if they have enough excess tissue available. Common donor sites are the abdomen, buttocks, thighs, and back.
What happens if I need chemotherapy to treat my cancer?
Even if patients will be receiving chemotherapy, they can often have breast reconstruction at the time of their mastectomy:
- Chemotherapy usually begins 4-8 weeks after surgery and can take 3-6 months to complete.
- Prior to starting chemotherapy, a patient’s tissue expanders can be filled on a weekly basis. Once chemotherapy begins, Dr. Voge spreads out the time between visits to stretch the tissue at a slower rate.
- Patients can have surgery to replace the tissue expanders with implants one month or more after they complete chemotherapy.
Can I still have reconstruction if I need radiation to treat my breast cancer?
Dr. Voge can still perform breast reconstruction if a patient needs radiation to treat breast cancer. However, radiation may affect the options and timing for surgery, and the patient may require additional surgeries. Treating the cancer always comes first; Dr. Voge can alter the reconstruction process to adapt to each patient’s needs.
*Individual patient results will vary.
To schedule a breast reconstruction consultation with Dr. Voge, call our Wichita office at (316) 263-0234 or fill out our online form.