Facing breast reconstruction?
You’re not alone.
Dr. Jason Roostaeian is proud to be a part of the outstanding breast cancer care team at UCLA.
Dr. Jason knows that the process of breast reconstruction involves much more than creating the most natural, comfortable appearance and feel – it’s about regaining the confidence that comes from looking like yourself again. Whether the result of a breast cancer diagnosis, or a prophylactic mastectomy procedure, each patient brings a unique perspective to the process. Dr. Jason understands the challenges – both physical and emotional – that this path often presents. He respects and recognizes that ultimately, the rebuilding of your breasts begins, and ends, with you.
No matter which option you choose, Dr. Jason will work closely with you and your team to ensure that you receive the best possible breast reconstruction experience.
Fortunately, Dr. Jason is now able to offer patients options to surgically recreate breasts that were unavailable as recently as a few years ago. Frequent practice of these innovative new techniques, combined with a UCLA Fellowship training in microsurgery (a highly precise, microscopic surgical technique), allows Dr. Jason to remain at the forefront of advanced breast reconstruction treatment offerings for patients.
Your breast reconstruction consultation
Navigating the breast reconstruction process can be daunting: should you undergo immediate or delayed reconstruction? Should you rebuild using your own tissue or opt for implants? Should your implants be placed under or over the muscle? The stress caused by a breast cancer diagnosis and/or a mastectomy is overwhelming enough – your reconstruction process doesn’t have to be. During your consultation, Dr. Jason will go over all of your options, patiently and carefully, ensuring that you have a thorough understanding of each potential procedure. You’ll feel comforted to be in the hands of a knowledgeable, expertly trained surgeon – and you’ll feel confident in being an educated, active participant in your treatment process.
All consultation fees may be credited to any subsequent service performed by Dr. Jason. To book a consultation, please complete the form and we will contact you within two business days.
Alternatively, you may call 310.825.8827 to speak with Lili to make an appointment.
What type of breast reconstruction is best for me?
There are two primary methods of breast reconstruction: those that rebuild the breasts using implants (silicone or saline), and those that use the patient’s own tissues (known as autologous tissue reconstruction, or “flap” procedures). Sometimes, a breast implant is used in conjunction with a flap procedure. Which option you choose is unique to your personal preferences, body type, and treatment plan, customized for you by Dr. Jason.
After determining the preferred reconstructive option, Dr. Jason will let you know if you’re a candidate for immediate reconstruction, or if you’ll need to delay the procedure to accommodate your treatment plan. Depending upon the patient, sometimes breast implants can be placed directly post-mastectomy; other patients may require the placement of tissue expanders to prepare the chest cavity for implants later. Flap procedures may be performed immediately, or at a later date, depending upon the situation.
Keep in mind that breast reconstruction is as much art as it is science. Several surgeries are sometimes required to achieve the most natural looking results – a process that Dr. Jason considers carefully and will explain to you thoroughly. Fat grafting (performed during surgery) and nipple/areola tattooing (performed after all surgeries are complete) will also help attain a more natural appearance.
IMPLANT VS. FLAP BREAST RECONSTRUCTION
During your breast reconstruction consultation, Dr. Roostaeian will thoroughly explain your options and answer all of your questions in detail. Many patients are curious about the difference between implant based breast reconstruction and analogous tissue, or flap based, breast reconstruction. Here is an overview:
|IMPLANT BASED||FLAP BASED|
BREAST RECONSTRUCTION USING IMPLANTS
Breast reconstruction using breast implants remains the most common form of reconstruction after a mastectomy. Dr. Jason is equally adept at placing breast implants either under the muscle (sub-pectorally) or over the muscle (pre-pectorally).
During your breast reconstruction consultation, Dr. Jason will determine which options are right for your unique situation and anatomy. He’ll guide you through the process to ensure that you have the most natural looking breast reconstruction possible.
AUTOLOGOUS TISSUE (OR FLAP) BREAST RECONSTRUCTION
Tissue flap procedures involve moving tissue from one part of the body (the “donor” site) to the chest to create a new breast mound. Flap types fall into one of two categories:
Pedicle: the flap is left attached to its original blood supply and tunneled under the skin to the chest.
Free: the flap is completely detached from the donor site and moved to the chest, where it is connected to a new blood supply using microsurgery
Microsurgery utilizes specialized instruments to detach and reconnect the donor tissue’s blood vessels under a microscope. Dr. Jason received advanced training in Microsurgery at UCLA and remains at the forefront of this innovative technology.
TISSUE FLAP PROCEDURES
TRAM (transverse rectus abdominis muscle) flap
Tissue used: skin, fat, blood vessels and muscle
Donor site: abdomen
Flap type: either pedicle or free
Scarring: breast, navel and abdomen, between hipbones
Residual effects: may tighten the lower belly (similar to a tummy tuck); may decrease abdominal strength
Candidates: women who have enough abdominal tissue to form a breast mound
DIEP (deep inferior epigastric perforator) flap
Tissue used: skin, fat, and blood vessels
Donor site: abdomen
Flap type: free
Scarring: breast, navel and abdomen, between hipbones
Residual effects: may tighten the lower belly (similar to a tummy tuck)
Candidates: women who have enough abdominal tissue to form a breast mound
LAT: Latissimus dorsi flap
Tissue used: skin, fat, muscle, blood vessels
Donor site: upper back
Flap type: pedicle
Scarring: breast, mid to upper back
Residual effects: may cause weakness in back, shoulder or arm
Candidates: women who desire a more natural breast than an implant alone can provide; women whose body cannot support an implant.
GAP (gluteal free) flap
Tissue used: skin, fat, blood vessels
Donor site: upper buttock
Flap type: free
Scarring: breast, upper buttock
Residual effects: may cause a lift in the donor side of the buttocks
Candidates: women who are too thin for a TRAM or DIEP flap; women who have undergone prior unsuccessful flap surgeries
TUG (inner thigh) flap
Tissue used: skin, fat, muscle and blood vessels
Donor site: inner thigh
Flap type: free
Scarring: breast, bottom fold of the buttock extending to inner thigh
Residual effects: slightly elevated risk of temporary healing complications
Candidates: women whose inner thighs touch (indicating excess tissue) and who desire small or medium sized breasts
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Dr. Jason and our staff at the UCLA Plastic & Reconstructive Surgery Suite are ready to get you started on your journey. Whether to answer questions, schedule a consultation, or simply to listen, we're ready when you are.
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Everything you need to know about breast reconstruction
Frequently Asked Questions (FAQs)
PREPARING FOR BREAST RECONSTRUCTION SURGERY
During your consultation, Dr. Roostaeian will listen to your goals, answer any questions, and help you determine the best treatment plan for you. Dr. Jason and his coordinator, Lili, will work with your care team to schedule your surgery. You’ll have a pre-op appointment to about a week or two prior to your surgery.
Dr. Jason’s staff will work with you and your breast surgeon to make this process as smooth as possible for you.
Am I a good candidate for a breast reconstruction?
Whether or not you’re a good candidate for breast reconstruction with Dr. Jason Roostaeian will depend on a number of factors. Dr. Jason will work closely with your breast care team to determine whether breast reconstruction is right for you.
How do I find the best breast reconstruction surgeon?
When searching for the best breast surgeon to perform your breast reconstruction, Dr. Roostaeian advises you to consider several key factors:
- Credentials and Certifications: Research your prospective breast surgeon online – not just on their website, but on industry credentialing sites such as www.surgery.org, which lists board certified plastic surgeons. Do not choose a cosmetic surgeon who is a member of the ABCS – they do not receive the extensive training and oversight that plastic surgeons do. Look for plastic/cosmetic surgeons like Dr. Roostaeian, who are ABPS and ASAPS members.
- Before and After Photos: The doctor you choose to perform your breast reconstruction should be happy to show you an extensive array of standardized before and after photographs. Scrutinize them carefully, making sure the lighting is consistent and the various views are shown with detail. View enough breast reconstruction pictures to determine whether or not the work is of high quality, with an aesthetic that matches your personal goals. Dr. Jason strives to provide patients with the highest quality of standardized breast surgery photographs so you can feel confident in your choice. Click here to view Dr. Jason’s gallery of before and after breast reconstruction photos. [LINK]
- Office and Surgery Facility: Before choosing a reconstructive surgeon to perform your breast surgery, closely evaluate the office staff, as well as the surgery facility. All of the staff should be helpful and friendly, and pleased to provide you with detailed information about their operating rooms and equipment. Dr. Jason and his staff are proud to be affiliated with UCLA, world renowned for state-of-the-art surgical facilities and patient care. Click to learn more about our top-ranked hospital.[LINK]
- Personal Connection: Seeing eye to eye with your breast reconstruction surgeon is just as important as assessing their operating skills. Plastic surgery is a very personal endeavor, and Dr. Jason strongly believes in creating a connection with all of his patients prior to heading into the OR.
Click to read Dr. Jason’s blog post How to Find the Best Plastic Surgeon.
How much does breast reconstruction cost?
The exact price for breast reconstruction will vary depending upon the type of reconstruction that works best for you. Breast reconstruction with Dr. Jason Roostaeian may be covered by your insurance. Please contact Lili in our office, 310-825-8827, to learn more.
What type of breast implants are best for breast reconstruction?
What's the difference between silicone and saline implants?
When planning your breast reconstruction with Dr. Jason Roostaeian, he’ll help you decide what type of implant to choose. Both silicone and saline implants are considered safe and are available in similar shapes, sizes, and textures.
Silicone implants are made of a silicone rubber shell filled with silicone gel. Silicone implants feel more similar to natural breasts and are less likely to ripple due to its consistency.
Saline implants are also made of a silicone rubber shell, however they are filled with a sterile saline solution. Saline is a salt water solution and therefore feels relatively firm and is more likely to cause rippling.
Another major difference between saline and silicone implants is in the detection of a rupture. If a saline implant ruptures, it is easily detected as the salt water is soon absorbed by the body leaving the breast deflated. Silicone implants on the other hand can be difficult to detect ruptures and often require imaging of the breast to do so.
|Feel Soft||Feel More Firm|
|Less Rippling||More Rippling|
|Incision Size: Increases with larger Implant||Incision Size: 3-4 cm regardless of size|
|Implant Shell: Silicone Rubber||Implant Shell: Silicone Rubber|
|Cost More||Cost Less|
|Complication Rate: Minimal||Complication Rate: Minimal|
|Capsular Contracture: ~1-2%/year||Capsular Contracture: ~2%/year|
|Detecting Rare Ruptures: Often requires MRI or Ultrasound (~1-2%/yr)||Detecting Rare Ruptures: Implant Deflates (~2-4%)|
What's the difference between smooth and textured implants?
What size breast implants should I get during my reconstruction?
During your initial consultation, Dr. Jason Roostaeian will work with you to determine the right size and shape of implants for your body type. Dr. Jason specializes in natural looking breast reconstruction.
It is important to remember that while Dr. Jason will strive to achieve your aesthetic reconstruction goals, your breast reconstruction is dependent upon your anatomy and your individual treatment concerns.
Will my breast reconstruction with implants be over or under the muscle?
During your breast reconstruction planning, Dr. Jason will help you decide where to place the implant. Breast implants can be placed either behind the mastectomy flap tissue but in front of the pectoral muscle, or behind the muscle.
Placing an implant behind the mastectomy flap tissue and in front of the muscle is referred to as prepectoral placement. Placing an implant partially behind the pectoralis muscle, wherein the lower portion of the implant is not completely covered by the muscle, is referred to as subpectoral or dual plane placement. Partial muscular coverage is ideal for many post-mastectomy patients because the muscle helps hide the implant and provides a more natural look.
Dr. Jason will help patients who desire pre-pectoral implant placement to determine whether this is a feasible option for their breast reconstruction.
Can you use my own tissue to create my breast reconstruction?
Yes – Dr. Jason Roostaeian is fellowship trained in microsurgery, which allows him to use a patient’s own tissue to create a new breast mound. Tissue is taken from a donor site (most typically the abdomen) and essentially transplanted to the chest, where it is reconnected and shaped into a breast that looks and feels more like a natural breast than an implant would.
During your breast reconstruction consultation, Dr. Jason will help you determine whether this flap-based type of reconstruction is right for you.
Where will my breast reconstruction incisions be?
Whenever possible, Dr. Jason Roostaeian will place your breast reconstruction implant incisions using your existing mastectomy incision sites to minimize scarring.
Incisions for flap based reconstruction procedures are determined by the donor site and the extent of the flap.
How do I prepare for breast reconstruction surgery?
When preparing for a breast reconstruction procedure, follow all instructions issued by Dr. Roostaeian, his office, your breast surgery team, and the staff at the UCLA. These guidelines include, but are not limited to:
- No food or drink prior to surgery
- Shower/cleanse the area with Hibiclens prior to coming in for surgery
- Avoid certain drugs and supplements before and after surgery
- Arrange transportation
- Ensure you will have help around the house for the first few days
- Obtain prescription and non-prescription medications ahead of time, including pain meds
- Choose to wear loose, comfortable clothing
- Plan out sleeping and resting arrangements (Which side of the bed is easiest to navigate to/from? Do I have enough pillows to make sleep/rest comfortable?)
- Have frequently used items handy – you won’t be able to lift or strain right away
Your exact instructions will depend upon your unique treatment plan.
undergoing breast reconstruction surgery
When you arrive for your breast surgery, UCLA nurses will prepare you for your operation. Dr. Roostaeian will stop in to answer any remaining questions you may have, and to make surgical markings for the OR.
Once you have received the anesthesia and are comfortably sleeping, Dr. Jason will perform the breast reconstruction as discussed during your previous meetings.
Dr. Jason will explain to you during your consultation that sometimes, a surgical plan may need to be slightly amended depending upon what is revealed in the operating room. He will make adjustments as needed in order to achieve the results that you’ve agreed upon.
Will I have local or general anesthesia during my breast reconstruction?
Typically, Dr. Roostaeian performs breast reconstruction surgery using general anesthesia. Local anesthesia with IV sedation is also possible. During your pre-operative appointment, Dr. Jason will review your options and help you decide on an whether to use local vs general anesthesia to best suit your needs.
Is breast reconstruction an outpatient procedure?
Whether or not your breast reconstruction with Dr. Jason Roostaeian requires an overnight stay depends on your individual treatment plan.
Some breast reconstruction procedures are outpatient, meaning you will not need to stay overnight in the hospital. Once you’re cleared by the UCLA Surgery Center recovery team (usually after a few hours), you may go home or to your aftercare location.
Other breast reconstruction procedures, including those involving microsurgical flaps, require a stay in the hospital for observation and monitoring.
During your consultation and pre-op appointments, Dr. Jason will go over your surgery plan in great detail.
How long does breast reconstruction surgery take?
The duration of breast reconstruction surgery with Dr. Jason Roostaeian depends upon the type of breast reconstruction procedure. Typically, reconstruction using breast implants takes about 2-3 hours.
Autologous tissue flap procedures, which require intricate microsurgery, generally take between 5-7 hours.
During your consultation and pre-op appointments, Dr. Jason will go over your surgery plan in detail.
Can I combine a breast reconstruction with other procedures?
Yes, it is possible to combine a breast reconstruction with other procedures. Many women choose to take advantage of their time in the operating room to make changes that help them look and feel their best.
What are the main breast reconstruction surgery risks?
Serious complications following breast reconstruction, while possible, are unlikely. Some potential complications can be avoided by carefully following instructions. In addition to the usual risks associated with anesthesia, other risks include:
- Capsular Contracture: when the normal fibrous capsule that your body forms around your implant becomes excessive to the point it distorts its appearance or causes pain. The risk of this occurring is approximately 2% of patients/year.
- Hematoma: Is a collection of blood beneath the skin and can be treated without compromising result, occurs in about 1%.
- Nipple Problems: Changes in sensation, this is generally temporary unless due to mastectomy.
- Rippling: more common in saline.
Is breast reconstruction painful?
As with any surgery, there is some discomfort following a breast reconstruction. Dr. Jason will inform and prepare you for any pain that can be expected following your breast operation.
Breast reconstruction recovery
Prior to your breast reconstruction procedure, Dr. Roostaeian will go over what you can expect after your surgery and answer any questions you may have. Before being discharged from the UCLA Surgery Center, you will receive detailed post-op instructions from the staff, as well as information about your follow-up appointment with Dr. Jason. If at any time you have a question or concern after your surgery, our staff is available to assist you. Dr. Jason cares deeply about providing the highest standard of care for his patients, and will closely monitor your healing process.
As with any surgical procedure, recovery from a breast reconstruction proceeds in stages. While everyone’s healing process is different, you may expect the immediate recovery period to take about one to two weeks, followed by an activity restriction. Full healing and results will be apparent around the 3-4 month mark, while your scar and swelling will continue to improve over time.
When will I see my final breast reconstruction results?
Although you will be able to notice your reconstructed breasts immediately after surgery with Dr. Jason, the final result will emerge after the implants have settled (if applicable) and the swelling has completely subsided. The scars from your incisions will typically fade to thin, slightly discolored lines over several months. It is important to realize that your breasts will continue to change shape over time as they normally would.
When can I exercise or work out after a breast reconstruction?
For the first 2 weeks following your breast reconstruction surgery, Dr. Jason wants you to avoid getting your blood pressure or heart rate up as it can lead to bleeding and the development of a “hematoma” (a collection of blood that requires surgical drainage). After 2 weeks, it is important to avoid motions that lead to excessive strain or stress on your incisions to get the best scar possible. By 3 months, your incisions are strong enough to handle most strenuous activities.
What does a breast reconstruction scar look like?
Dr. Jason is very meticulous about his incision placement and suturing. Whenever possible, he uses existing mastectomy incisions to minimize scarring.
The number and placement of your breast reconstruction scars will depend on the type of reconstruction you choose: tissue flap reconstruction produces more scars than implant reconstruction, as there is an incision at both the reconstruction and the donor sites.
Your scars will typically fade to very thin lines over several months.
Please visit Dr. Jason’s breast reconstruction gallery to view examples of breast reconstruction scars.
What is breast reconstruction recovery like?
If you opt for implant reconstruction with Dr. Roostaeian, you should be ready to go home the same day (usually within two to four hours after surgery). Before you leave the operating room we dress you with a support bra that you can remove after 2 days. You can take a shower at that point but baths, swimming, or soaking of your incisions should be avoided for 4 weeks.
There is no significant downtime after breast reconstruction with implants. Most patients do not require very much if any prescription narcotics, but we prescribe them just in case your pain is greater than expected. Often only Motrin is necessary for pain control. You can drive if you’re not taking prescription narcotics and most feel up for it within a few days after surgery. You can return to work within a few days as long as it doesn’t require any significant physical activity or lifting.
Breast reconstruction using tissue flaps requires a longer hospital stay, so that Dr. Jason and his team can monitor the health of the flap. Downtime is also increased, because flap reconstruction requires multiple incision sites.
How much time off work should I take after a breast reconstruction?
While everyone heals at a different pace, there are general guidelines to help determine how much work or school you’ll miss after a nose job. To promote proper healing, Dr. Roostaeian recommends taking a few days off after breast reconstruction with implants.
Tissue flap reconstruction patients should plan to take off about two weeks from work.
After being discharged, most patients are able to work from home or do homework after a few days of rest. If your work requires significant physical activity you want to wait at least 14 days to prevent any increases in your blood pressure that can lead to bleeding while your breasts are still in the early stages of healing.
How long do breast implants last?
Implants do not need to be changed or altered unless a problem occurs. On average, 50% of implants are exchanged or removed for various reasons by 10 years. A patients’ desire for a size change, or switching from saline to silicone are some of the more common reasons. With the newest generation of implants, ruptures are more rare. Capsular Contracture, the formation of a tight or painful capsule around the implant, is one of the most common complications that can require removal or exchange of your implant. The risk of capsular contracture developing, on average, is approximately 2%/year based on the latest FDA data.
Breast Reconstruction Patient Testimonials
Dr. Jason is incredibly skilled
When you’re diagnosed with breast cancer, it’s not just your body that seems to be falling apart – it’s your whole world. If you’re lucky, you’ll find a surgeon like Dr. Jason, who is not only incredibly skilled, but thoughtful and compassionate. He has a unique ability to put your body back together again, so that you can begin to do the same for yourself.
– Anonymous Patient
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