Breast Reconstructive Surgery

Now More Options for Women After Mastectomy

Indianapolis-FacilityThumb

86th Street/Naab Road, Indianapolis

Womens Center Facility thumb

Carmel Hospital & Women's Center


St. Vincent has a comprehensive Breast Care program including many breast reconstruction options. Breast Surgeons at both St. Vincent Breast Care Centers can arrange the consultation with a St. Vincent Plastic Surgeon Breast Reconstruction Specialist. For more information or to schedule an appointment call 317-338-4303.

St. Vincent now offers breast cancer survivors who have a mastectomy more breast reconstruction options. Your St. Vincent Cancer Care team includes a plastic surgeon that specializes in breast reconstruction, and along with the breast surgeon, will explain the different types of breast reconstruction. Many factors are considered including the stage and size of the breast cancer tumor; if the skin, nipple or chest wall is involved; whether radiation therapy is needed after surgery; and other risk factors such as diabetes and smoking history. This topic can be very emotional and in our experience, taking a holistic approach that balances the physical, mental and spiritual needs of each woman makes a difference in the long run. At St. Vincent educating all involved is a very important first step. Breast Reconstruction is life-changing for many women and their families, in a positive way, but it's not for everyone. Talk to our St. Vincent Breast Navigator to begin the conversation -- call 317-338-3900.


Dr. Robert Paul

St. Vincent Welcomes Dr. Robert Paul, Plastic Surgeon and Breast Reconstruction Specialist

Dr. Robert M. Paul, board-certified by the American Board of Surgery, is an experienced micro-surgeon. He received his training at the Indiana University School of Medicine with extensive experience doing all types of breast reconstruction procedures, including breast implants, local/regional muscle flap reconstruction, the DIEP flap procedure, SIEF, as well as, symmetry procedures and revisional surgery. He is part of the St. Vincent Physician Medical Group and supports St. Vincent's Comprehensive Breast Care Services in Indianapolis and Carmel. Dr. Paul works closely with all the St. Vincent breast surgeons, radiation oncologists and medical oncologists. His experience includes performing life-changing reconstructive and cosmetic procedures to help Indiana military veterans, breast cancer survivors and children with disabilities regain a healthier body image.

"As a surgeon, I specialize in micro-surgical procedures that are complex and involve the delicate dissection of tiny blood vessels from donor tissue and fine suturing techniques. As a problem solver, I tailor plastic surgery- breast reconstruction procedures for the individual needs of our patients. Today we have so many more options to give our patients, especially breast cancer survivors." -- Robert M. Paul, MD, a plastic surgeon specializing in breast reconstruction 


Plastic Surgery Breast Reconstruction Options

The timing of reconstruction varies -- one-stage, staged, or delayed reconstruction – based on the needs of each patient. In all cases, St. Vincent breast reconstruction surgery is a highly coordinated effort among all of the Cancer Care team members and is determined by your individualized cancer treatment plan. Some of these reconstruction options may also apply to women having prophylactic mastectomies as a result of high risk hereditary breast cancer and ovarian cancer.

One-stage reconstruction is a coordinated surgery that happens as part of the original breast surgery to remove the cancerous tumor. However if radiation therapy is recommended, reconstruction procedures are staged for a later time until the treatment plan is completed and the skin and tissue is healed.

Staged reconstruction is the most common type of reconstruction. At the time of the original breast surgery, a temporary tissue expander is placed under the chest wall to gently inflate and stretch the muscle and skin creating a natural pocket. This step prepares for a breast implant or breast tissue flap procedure.

Delayed reconstruction happens after the cancer treatment plan is completed. There may be several steps in the surgical process depending on the type of reconstruction.


Types of Breast Reconstruction

Breast implants are the most common type of reconstruction. This procedure is dependent on stretching the skin and muscle under the chest wall with tissue expanders before one of two types of implants, silicone or saline (salt-water), can be placed. Typically, it can take 3-6 months of gradually inflating the tissue expander before a suitable "pocket" is formed and the implants can be placed. Implants do have some long term risk factors and nationally approximately 30% of women with implants after mastectomy will need additional revisional-surgery.

DIEP Flap breast reconstruction - Dr. Paul is one of a handful of plastic surgeons in Indiana performing DIEP flap micro-surgery. The DIEP procedure may be done at the same time as the mastectomy if no radiation therapy is needed as part of the treatment plan or staged for a later time. The DIEP procedure does not involve tissue expanders, unlike the breast implant procedure. The DIEP flap is comprised of skin and fat tissue (not muscle) that is taken from a horizontal incision in the lower abdomen (near the bikini line) and used to reform a breast after mastectomy. The DIEP procedure is a more complicated surgery that lasts longer than other breast reconstruction surgeries because tiny blood vessels must be dissected in the tissue flap and then reattached with great precision. The result is a reconstructed breast that has a more natural look and feel. Since muscle is not removed, there a lower risk of developing hernias, bulges or weakness at the abdominal site where the flap is remove and the patient essentially gets a "tummy tuck" without sacrificing core muscle strength in the abdomen. After a one sided DIEP procedure, the plastic surgeon may also apply symmetry techniques so both the breasts are similar such as lifts or reductions in the unaffected breast. Women who are very fit and trim with a low BMI are generally not candidates for this procedure.

Regional muscle flap generally refers to the muscle and skin tissue that is taken from the back below the shoulder blades in order to form a breast mound. In a TRAM flap reconstruction the muscle is taken from the abdomen. These patients have decreased muscle strength in that area of the body which may decrease body function and increase the likelihood of developing a hernia post-operatively (from the TRAM procedure). These procedures are used regularly in breast reconstruction and are the most common flap procedures performed.

Fat grafting after reconstruction is common place and is often used to help contour the breast or fill in areas that require additional volumes. A newer technique is called Simultaneous Implant Exchange with Fat or SIEF procedure. In this procedure, the breast mound is recreated from the patient’s own fat that has been gently liposuctioned from the belly, thigh, or buttock and then injected into the breast flaps. As more fat is injected the tissue expander placed at the initial mastectomy surgery is gradually deflated. The SIEF procedure is outpatient and requires multiple operations (4-7) to create a larger breast mound. There is no long term SIEF data currently available; however, plastic surgery case studies have reported promising results.

Note: St. Vincent Surgeons and Plastic Surgeons make every effort to salvage the nipple and areola at the time of the original surgery if it is unaffected by the tumor. There are multiple nipple and areola reconstruction options that are available to patients that have lost these structures during the breast surgery process.


Plastic Surgery and Lumpectomy

Oncoplastic surgery may be appropriate for some patients at the time of a lumpectomy. Plastic surgery techniques are used to reshape the breast and give it a "lift."

Fat grafting as described in the SIEF procedure is also applicable to some lumpectomy cases to fill in the resection defects.


Other St. Vincent Resources

Most health insurance programs provide coverage for breast reconstruction as a result of mastectomy or lumpectomy due to breast cancer. The St. Vincent Financial Counselor can verify benefits and answer questions about these surgical options. Call 1-800-582-8258 or 317-338-8035.

St. Vincent Cancer Care provides educational programs and support group activities that address breast reconstruction. To learn more, contact a St. Vincent Cancer Care Survivorship Navigator at 317-338-3551.