- Reconstructive Breast Surgery Options | Johns Hopkins Medicine in Baltimore, MD
- Simultaneous Reconstruction
- Why Choose Johns Hopkins Medicine?
- Staged Reconstruction
- Delayed Reconstruction
- DIEP, SIEA, SGAP Flaps
- TRAM flap
- Why Choose Johns Hopkins Medicine?
- Oncoplastic Surgery (Bilateral Breast Reduction or Lift Combined with Lumpectomy
- The Breast Reconstruction Guidebook
- Paying for Reconstruction Procedures
- Best Breast Reconstruction Baltimore, Maryland
- Types of Breast Reconstruction
- Implant Reconstruction
- Tissue Expansion
- Breast Implants
- Autologous or “Flap” Reconstruction
- TRAM Flap (Transverse Rectus Abdominis)
- Latissimus Dorsi Flap
- Nipple- or Areola-Sparing Mastectomy
- Dr. Wells Welcomes Your Questions
- Additional Resources
- Hopkins celebrates Breast Reconstruction Awareness Day
- Breast Reconstruction Options If You Have Lymphedema
- What are the treatment options for lymphedema?
- Could you explain the new options for women who have had cancer and now suffer from lymphedema?
- Who makes a good candidate for the TBAR procedure?
- What is the downtime after surgery?
- Do other surgical treatments for lymphedema exist?
Reconstructive Breast Surgery Options | Johns Hopkins Medicine in Baltimore, MD
Your breast surgeon and the breast plastic and reconstructive surgeon will help you decide which option is best for you:
Reconstruction of the breasts done at the same time as surgery to remove the cancer.
Pros: The patient wakes up with a breast mound already in place, having been spared the experience of seeing herself with no breast at all. The process is done in the shortest time possible and is not a series of complex surgeries over a length of time.
Cons: If there is a recurrence of the cancer, the reconstruction may need to be modified. If there are complications, post-surgery, women may need to have more surgeries. Small revision surgeries or matching procedures on the opposing breast may be required. Rarely, it is determined that a patient will need radiation, which can compromise reconstructed breast tissue.
Why Choose Johns Hopkins Medicine?
Ours is one of the few breast centers in the region to offer this number of reconstructive surgery options to women. Our surgeons perform skin sparing, nipple sparing and scar sparing mastectomy whenever possible, leading to better cosmetic and reconstructive results.
Our specialists are experienced in creative techniques, such as fat grafting, that can use fat from your body as a way to naturally shape the breast. Though revisions to your original procedure may need to be done over time, the end result is improved.
This reconstruction involves placing a temporary tissue expander either under or over the muscle at the time of your mastectomy. The expander gradually stretches the muscle and skin in preparation for either an implant or flap reconstruction.
Pros: The surgeon creates a natural pocket in which a permanent implant or a tissue flap may be placed. The overall result is more symmetric, natural and aesthetically pleasing. It allows a woman to complete radiation treatment while having a “placeholder” implanted. It allows enough time to make sure all of the cancer has been treated.
Cons: It takes longer to complete the breast cancer treatment process. During the time of temporary tissue expansion, the breasts do not look natural. Small revision surgeries or matching procedures on the opposing breast may be required.
Watch our video animation to learn more.
This reconstruction happens after all of the recommended treatment to treat the cancer is completed.
Pros: Some women aren’t comfortable weighing all the options at once when they are struggling with a diagnosis of cancer. Some women need time to come to terms with losing their breast(s). Some women who are overweight, smokers or have high blood pressure may be advised to wait. It allows enough time to make sure all of the cancer has been treated.
Cons: Longer time to “complete” the breast cancer treatment process. Women may not feel whole without their breast(s).
DIEP, SIEA, SGAP Flaps
The DIEP flap is the technique where skin and tissue (no muscle) is taken from the abdomen in order to recreate the breast. Other flap techniques, called the SIEA flap, the LSGAP flap and the SGAP flap, take tissue from the lower abdomen or lateral buttock regions.
Pros: Since the reconstruction involves using the patient’s own tissues, the risks of implant reconstruction are avoided, particularly in the case of radiation.
Most patients have less postoperative pain than after a TRAM flap and are therefore able to leave the hospital sooner, and return to normal activities quicker than after a TRAM flap.
Because the abdominal muscle is not removed as in the TRAM flap, patients have much less risk of developing hernias, bulges and core weakness at the site where the flap is removed than patients who have had a TRAM flap. This advantage is much greater in bilateral (both sides) reconstruction.
It is typically easier to match the contralateral natural breast with the patient’s own tissue when compared to implant reconstruction. Patients essentially end up with a “tummy tuck,” “bottom lift” or other cosmetic benefits at the same time as the breast reconstruction.
Cons: DIEP/SIEA/SGAP flap reconstruction generally requires a longer and more challenging surgery at the first stage when compared with implants or TRAM flaps. Patients will have a scar across the lower abdomen or the upper part of the buttock where the flap is obtained. However, this does not differ from the TRAM flap as the abdominal scars are equivalent.
Small revision surgeries or matching procedures on the opposing breast or donor site may be required. Patients who smoke, are obese or have diabetes are not ideal candidates for this type of surgery.In the short term, implants can become infected or mal-positioned and require surgery to correct these problems.
Implant-based reconstruction is not generally recommended if patients require radiation, due to the risk of complications. In the longer term, implants can develop capsular contracture (tightening of the soft tissues around the implant), implant mal-position, and implant rupture.
If there are complications, secondary procedures may be required.
Why Choose Johns Hopkins Medicine?
Our Breast Center surgeons perform more types of flap procedures than other breast centers in the area. Common procedures include bi-lateral SGAP flaps, LSGAP “cushion” flaps, and transverse upper gracilis (TUG) flaps. Our specialists pay particular attention to blood vessel mapping and nerve preservation, which improves results and minimizes anesthesia time for patients.
Many patients who are good candidates for surgery can have excellent results with these procedures. At our Breast Center the success rate is 97 to 99 percent.
Our specialists are experienced at creative techniques, such as fat grafting which can use fat from your body as a way to naturally shape the breast.
Though revisions to your original procedure may need to be done over time, the end result is improved.
In a pedicle TRAM flap, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant. The free TRAM flap involves less muscle.
Pros:Shorter and less complex surgery than the other flap procdedures.
Cons:This was state-of–the-art decades ago and has since been replaced by other, more advanced procedures. The patient may have more postoperative pain and longer hospital stays. There is a risk of abdominal bulge or hernias, and as a result, there might be a limit to how much weight you can lift. Other newer procedures may offer more natural results.
Why Choose Johns Hopkins Medicine?
Surgeons at Johns Hopkins Medicine no longer perform or recommend the TRAM flap. We offer many newer and more advanced options for reconstruction, including free tissue transfer procedures. Not all plastic surgeons can perform these newer procedures.Patients who had complications from TRAM flap procedures come to our Breast Center for revision procedures.
Oncoplastic Surgery (Bilateral Breast Reduction or Lift Combined with Lumpectomy
This surgery combines the latest plastic surgery techniques with a lumpectomy. When a large lumpectomy is required (which will leave the breast distorted), the remaining tissue can be sculpted to restore natural appearance to the breast. The opposing breast will also be reduced to create symmetry.
Pros: Only involves one surgery. Surgery is completed prior to radiation and does not pose the risks associated with wound healing.
Tissue surrounding the tumor is carefully analyzed for the presence of cancer—once when the surgical oncologist removes the tumor, and again when the plastic surgeon operates. Breasts are symmetrical. In the case of a breast reduction, if symptoms of large breasts were a problem before, these symptoms can be alleviated.
Cons: There is a risk of losing nipple sensation on the breast where the cancer is removed and the possibility for a free nipple graft.
The Breast Reconstruction Guidebook
The following is an excerpt from Kathy Steligo's The Breast Reconstruction Guidebook, now in its fourth edition.
If you’re facing mastectomy to treat or prevent breast cancer, you have a lot of decisions before you.
Will you keep a flat chest after surgery, wear temporary breast prostheses, or have your breasts reconstructed? If you do want to have breast reconstruction, is your priority to have the shortest procedure with the quickest recovery or to pursue a method that will give you the most natural breasts possible? Does keeping your own nipples and areolae appeal to you? Do you have quite a bit of excess fat that you’d to be rid of in the process?
Plastic surgeons have been recreating breasts for decades. Technological innovation and surgical improvements in the 15 years since The Breast Reconstruction Guidebook was first published now make reconstructive results with breast implants or your own tissue better than ever.
If you’re interested in breast implants, you might choose cohesive silicone gel “gummy bears” that retain their shape and feel more breast tissue.
If you’d to avoid the traditional method of tissue expansion that creates a space to hold your implant, you might be a candidate for nipple-sparing mastectomy with a direct-to-implant procedure, which completes in a single visit to the operating room what reconstruction with tissue expanders takes months to accomplish.
(Solid data show that nipple-sparing mastectomy, considered to be unwise just a few years ago, is safe for most women, even many who are treated for breast cancer.) If your reconstruction is done with tissue expanders, perhaps you’ll prefer to control the speed of your expansion at home, avoiding routine office visits and shortening the overall reconstruction process.
“Flaps” of your own excess fat can also be sculpted into new breasts. Plastic surgeons continue to push the reconstructive envelope, developing better flap techniques and procedures that provide more predictable results and shorten recovery.
Some tissue flaps use muscle along with skin and fat to rebuild the breast, but other more sophisticated options spare the muscle, preserving function and making for less intense recovery.
These micro surgical tissue flaps, including DIEP (deep inferior epigastric perforator), GAP (gluteal artery perforator), TUG (transverse upper gracilis), and others, are no longer considered weird or experimental, and options for rebuilding your breasts with excess fat from your abdomen, back, buttocks, thighs, or hips are numerous.
And flap reconstruction comes with a bonus: new breasts and a slimmer donor area. Methods of nipple reconstruction have also improved. Or a growing number of women, you may prefer to have three-dimensional nipples tattooed onto your reconstructed breast, giving a life illusion of having nipples where there aren’t any.
One of the most exciting reconstructive innovations is fat grafting— liposuctioning your own excess fat and carefully injecting small amounts into your reconstructed breast. Although fat grafting has been used for many years, recent improvements make it far more practical and successful, ensuring that more fat stays in the breast.
Adding fat to the new breast can refine shape, increase volume, and improve contour with minimal downtime, making a good reconstruction even better. Perhaps the most important change is the increasing number of plastic surgeons who now routinely offer breast reconstruction, translating to more accessible experience, skill, and choice.
One thing that hasn’t changed in 15 years is that women who consider breast reconstruction share a common dilemma: “What is the best option for me?” Because no single procedure is right for all women, the wisest approach is to first carefully consider the alternatives; consult with two or three experienced, skilled surgeons; and then determine which reconstructive method, if any, matches your personal preferences and priorities. Fortunately, mastectomy and reconstruction are no longer one-size-fits-all. You have options, but that also means you need to make decisions. You may not be a candidate for all procedures. If you’ve undergone radiation for breast cancer, for example, that poses some reconstructive limitations. Some choices may not be available in your area or within your health insurance network. Others may not interest you, because of the investment in time or recovery. With you in the driver’s seat, you’re less ly to have regrets about how your reconstruction is done, and you’ll know what to expect in the hospital and at home during recovery.
its preceding versions, this edition of The Breast Reconstruction Guidebook was written to answer your questions, demystify confusing terms and concepts, and help you go from confused to confident. The text is deliberately objective. It doesn’t favor or recommend one procedure or another, because that’s up to you to decide.
What’s most important, particularly if you’re feeling that you’ll never be the same, is that after mastectomy, you can have symmetrical, soft, rounded breasts. They won’t feel the same as your natural breasts, but many women find that their new breasts look as good or better. Reconstruction isn’t perfect, and it isn’t always easy.
It can’t undo everything mastectomy takes away or replace lost sensation or the ability to breastfeed.
But it can restore your post-mastectomy profile and profoundly affect your self-image and peace of mind, so that you can get on with your life, while you wear all the clothes you wore before your mastectomy and look natural again without your clothes.
As someone who has twice confronted breast cancer and twice had reconstruction, I understand just how you feel. I know firsthand that sorting through the various reconstructive options can be a confusing, time intensive, and frustrating experience.
By the time you’ve read through this book, you’ll feel more confident in your choices and understanding of mastectomy and reconstruction. You may decide to go ahead with reconstruction. You may not. Either way, you’ll know what to expect.
And even if you decide that reconstruction is not for you, after reading through different parts of the book, you’ll have a good understanding of breast cancer, mastectomy without reconstruction, and what to expect from your surgery and recovery.
How will the next 15 years change mastectomy and breast reconstruction? I hope that science is driving us toward a time when mastectomy will be archaic, and this book will be obsolete. But discovery isn’t easy, and the development process isn’t quick.
Sooner or later, scientists will discover how to repair defective genes that cause disease. Women diagnosed with breast cancer may undergo gene therapy without needing chemotherapy or radiation. We’ll move breast cancer to the list of diseases we no longer need to fear, and mastectomy will no longer be needed.
Until then, reconstruction is our best antidote for replacing lost breasts.
Kathy Steligo is the editor-at-large for Facing Our Risk of Cancer Empowered (FORCE). She is the co-author of Confronting Hereditary Breast and Ovarian Cancer: Identify Your Risk, Understand Your Options, Change Your Destiny and Confronting Chronic Pain: A Pain Doctor's Guide to Relief.
Paying for Reconstruction Procedures
Breast reconstruction procedures should be covered by your health insurance plan, whether they are done right away, soon after mastectomy/lumpectomy, or many years later. This includes procedures that may be needed over time to refine the reconstructed breast and/or to create symmetry (balance) between the two breasts.
The Women’s Health and Cancer Rights Act of 1998 requires all group health plans that pay for mastectomy to also cover prostheses and reconstructive procedures.
In addition, Medicare covers breast reconstruction, while Medicaid coverage can vary from state to state.
Government- and church-sponsored plans are not necessarily required to cover reconstruction, so you may need to check with your plan administrator.
Even if you’re covered, it’s still possible to run into problems, especially in certain situations: for example, maybe you’ve chosen a newer type of reconstructive procedure, you’re having surgery to create a more balanced appearance, or you need a complete correction of a past reconstruction. Coverage also can be an issue if you want to use a plastic surgeon who is outside your health insurance plan’s network.
It’s always best to communicate with your health insurance provider up front and check on what exactly is covered so you can avoid the work of trying to get payment later.
You also can work with the administrator in your plastic surgeon’s office who handles insurance claims.
Another potential resource is your state health insurance agency and commissioner, as some states have passed additional laws requiring coverage for breast reconstruction.
These are some questions you can use to guide these initial conversations with your insurance plan and plastic surgeon’s office:
- Does my plan cover mastectomy? (If the answer is yes, it must cover reconstruction.)
- How many “second” opinions are covered?
- How should I obtain preauthorization for my surgery?
- Am I limited to in-network surgeons and services?
- If I travel to another surgeon who specializes in a particular technique not available within my network, what expenses will be covered?
- What are my total out-of-pocket costs if I go to an out-of-network surgeon?
- Is there a limit to the amount of coverage provided?
- Is my hospital stay covered? If so, for how many days?
- Are the other healthcare professionals involved in my surgery covered?
- Will all payments be made directly to providers?
Source: Kathy Steligo,The Breast Reconstruction Guidebook (Baltimore: The Johns Hopkins University Press, 2017), p. 207-208.
Remember that you’ll still be responsible for your deductible and co-pays, so make sure you understand how much you’ll be paying pocket.
If you’re responsible for a portion of the treatment cost, this might influence your decisions about what type of reconstruction to have. Costs can vary widely, but implant procedures generally do cost less than tissue flaps.
However, they’re more ly to require adjustment in the future, so the overall cost may even out.
How your plastic surgeon’s office communicates with the insurance company about your surgery can make a major difference, too, says Frank J. DellaCroce, M.D., FACS, plastic surgeon and co-founder of the Center for Restorative Breast Surgery.
The office must use language that clearly indicates it is medically necessary, not just cosmetic.
“If you’re fixing a reconstructed breast that has become misshapen, for example, or bringing the two breasts into balance, there is a potential for the insurance plan to deny coverage right away and say, ‘Well, that’s cosmetic.
’ Instead we might have to say, ‘Acquired asymmetry in the breast after mastectomy that was causing a cup size difference that gives difficulty in clothing and function, and she has an overall imbalance that is producing a deformity with respect to symmetry.’ When you lay it out that, then they have a harder time saying well, too bad. It becomes more real.”
Dr. DellaCroce offers these other tips:
- Make sure the office is using the language specified in the ICD-9 (soon to be ICD-10) code, which is the standard classification system that all insurance plans follow.
- Be persistent. If coverage is denied, you and your physician’s office can revise the description and send a non-identifying photo (your chest only, not your face) to illustrate the problem area(s).
- Keep complete print records of every communication as you push forward with your case.
“We usually have success, but the way that the physician’s office communicates the issue to the insurer will either guarantee success in terms of coverage or will guarantee denial,” Dr. DellaCroce adds.
For more detailed information about how to make an appeal to your insurance provider, we recommend chapter 19 of Kathy Steligo’s book, The Breast Reconstruction Guidebook.
This chapter offers great tips about how to go about this process.
To learn more about your rights under the Women’s Health and Cancer Rights Act, check out the American Cancer Society’s helpful Women's Health and Cancer Rights Act page, including the questions and answers.
You can also read our blog, Reconstruction Coverage Under the Women’s Health and Cancer Rights Act.
For additional tips about managing your health insurance and treatment-related costs, visit Breastcancer.org’s section on Paying for Your Care. This section focuses more on breast cancer treatments, but some of the advice still may be helpful to you.
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Best Breast Reconstruction Baltimore, Maryland
Women considering breast reconstruction in the Baltimore area will find a concerned, empathetic, and experienced specialist in Dr. Alyson Wells of Valley Plastic Surgery.
A double-board-certified plastic surgeon, Dr. Wells has the elite level of training and experience necessary to restore the breasts following treatment for breast cancer, including mastectomy and lumpectomy.
The loss of one or both breasts can be traumatic, both physically and emotionally. The goal of breast reconstruction is to help restore the shape, symmetry and appearance of the breasts and, thereby, assist women in regaining some of what was lost to cancer, including their confidence and femininity.
Rest assured that Dr. Alyson Wells has many patients who feel their breasts are even more beautiful following total reconstruction.
Federal and Maryland state laws mandate that insurance providers cover breast reconstruction, including surgery on the other, uninvolved breast to create symmetry. Contact Valley Plastic Surgery to inquire about using insurance to cover the costs for breast reconstruction.
Experiencing mastectomy and subsequent treatment for breast cancer can be a very difficult time in your life. It is important that you have a medical team by your side that is ready and willing to answer your questions and address your concerns.
During your private consultation with Dr. Alyson Wells, you will have the opportunity to not only ask questions, but also discuss your goals for breast reconstruction surgery. Dr. Wells will inquire about your health and medical history, conduct a physical examination of your breasts, and discuss the available breast reconstruction options with you.1
Dr. Wells will explain the details of the decided upon breast reconstruction procedure and will discuss your customized treatment plan with you.
If you are ready to discuss breast reconstruction surgery options with a compassionate, highly skilled surgeon, contact Valley Plastic Surgery today to schedule your personal consultation with Dr. Alyson Wells.
Types of Breast Reconstruction
There are a variety of techniques used for reconstruction of the breasts following mastectomy or lumpectomy.2 Your ideal method depends on the type of cancer treatment, anatomical considerations, and whether reconstruction is performed at the time of the mastectomy (immediate reconstruction) or some time following mastectomy (delayed reconstruction).
Dr. Wells may recommend a combination of techniques in order to create the most beautiful, natural appearance.
There are several benefits of choosing an implant reconstruction. If you would prefer a shorter surgery and recovery time, implant reconstruction following mastectomy or lumpectomy could be beneficial for you and your goals.
Candidates for an implant reconstruction are women who do not need to have radiation therapy and who do not desire extra incisions in other areas of the body to excise skin and muscle flaps.
Also, these patients may be willing to alter their opposite breast in order to make it more symmetrical to the breast with the implant.
There are several considerations when making a decision to move forward with an implant reconstruction after mastectomy or lumpectomy.
The availability of breast tissue to accommodate the implant, the type of implant to use, and maintenance of the breast implants should be carefully regarded.
It is important to note that during a mastectomy, skin and breast tissue will be removed from the breast, possibly giving the breast a flattened appearance.
With implant breast reconstruction, an expander is inserted under the skin and the pectoralis major muscle that remains after the mastectomy.
It is gradually filled with saline (a sterile saltwater solution) at short intervals to stretch the skin to accommodate the implant that will be placed in the breast.3 Once fully expanded to the desired size, and the skin has adjusted, the expander is replaced by a breast implant.
Breast implants may be used with either tissue expansion or autologous reconstruction.4 There are many details to keep in mind when deciding on which implants would be best for you. The outer material, filler, texture, shape, profile, and size are all variables to choose from.
- Saline implants contain a silicone outer shell and are filled with a sterile saline (saltwater) solution. Saline implants are available in a round shape and smooth texture. This is because the shifting of the implant within the breast pocket does not alter the outward appearance of the breast.
- Silicone breast implants contain a silicone outer shell and a silicone gel fills the interior. Silicone implants may come round in shape or in an anatomical/“teardrop” shape. They also may have a smooth or textured outer shell. Some implants are textured because the rough outer shell reduces risk of the breast implant changing orientation within the implant pocket.
- Gummy bear implants are effectively anatomical, textured, silicone implants. The only difference between the traditional teardrop implants and the Gummy Bear implant is the fact that the Gummy breast implant is filled with a cohesive silicone gel. In case of a breast implant rupture with gummy bear implants, the gel will keep its shape within the breast pocket.
Learn more about saline vs. silicone breast implants.
Autologous or “Flap” Reconstruction
In an autologous or “flap” reconstruction, tissue from your own body (autologous) is used to create a new breast envelope. There are many available flap procedures for breast reconstruction after mastectomy. Dr. Alyson Wells uses her precise surgical skill to provide you with a comfortable reconstructive surgery and recovery.
TRAM Flap (Transverse Rectus Abdominis)
TRAM, the transverse rectus abdominis, is a muscle in the lower abdomen that is the namesake of a flap technique to reconstruct the breast.5 Skin, muscle, and fat is taken from the TRAM and is transferred to the chest to form the breast envelope. TRAM tissue is similar to breast tissue, making TRAM flaps the most common in breast reconstruction.
- Free TRAM Flap: In this technique, Dr. Wells will excise the skin, fat, muscle, and blood vessels of the TRAM and carefully incorporate it with the existing breast tissue.
- Muscle-Sparing Free TRAM Flap: The muscle-sparing TRAM flap technique utilizes the same concept as the free TRAM, however, Dr. Wells would remove less of the muscle from the abdomen. Quicker patient recovery has been reported with this technique, compared to the free TRAM flap.
- Pedicled (attached) TRAM flap: This technique is used to preserve the blood supply of the TRAM donor tissue. The TRAM is separated from the abdomen with the blood vessels still attached. The donor TRAM is then transferred to the chest from underneath the skin of the torso to reconstruct the breast. Because this technique is “muscle-heavy,” it is considered a muscle-transfer flap.
Latissimus Dorsi Flap
Sometimes, tissue is taken from the latissimus dorsi muscle of the upper back and brought around to create the breast envelope in breast reconstruction following a mastectomy.
6 As in the pedicled TRAM flap, the latissimus dorsi tissue maintains its original blood supply. The donor tissue is moved around towards the breast from under the skin of the torso.
the pedicled TRAM flap, the latissimus dorsi flap is also a muscle-transfer flap.
Choosing a breast reconstruction method should be be made together with your reconstructive surgeon.
Dr. Alyson Wells can provide you with detailed information regarding your options when it comes to breast reconstruction. Dr. Wells’ surgical skill, attention to detail, and empathic approach can provide you with a sense of partnership during this time in your life.
Contact Valley Plastic Surgery today to schedule your private breast reconstruction surgery consultation with Dr. Alyson Wells.
Nipple- or Areola-Sparing Mastectomy
A nipple- or areola-sparing mastectomy is combined with immediate breast reconstruction.
This approach to mastectomy can provide natural-looking results during reconstruction due to the preservation of the nipple and/or areola and the breast skin envelope.
Compared to conventional mastectomy where most or all of the breast tissue is surgically removed, women opting for nipple- or areola-sparing mastectomy reported more psychological satisfaction and greater quality of life.7
Dr. Wells will work closely with your oncologist to provide you with a team approach to your treatment. This will ensure that you receive the care you deserve and desire. Women appreciate Dr.
Wells’ compassion, her feminine perspective and her extensive medical knowledge. Dr. Wells and her caring staff look forward to answering your questions and supporting you through the breast reconstruction process.
Dr. Wells Welcomes Your Questions
Individuals interested in plastic surgery look to Dr. Wells for her kind, patient-centered disposition, her experience and her exceptional results. She will take the time to address your concerns so you can confidently make the choice to proceed with your breast reduction or other treatments.
Alyson Wells, M.D., F.A.C.S.
Her rare combination of impeccable training, keen aesthetic sensibilities, technical skill and precision in plastic surgery sets this Baltimore surgeon apart from the rest.
Request A ConsultationMeet The Doctor
If you are facing the possibility of a mastectomy or lumpectomy, or you have already undergone the procedure, Dr. Wells and her compassionate medical team can help you to become physically and emotionally whole again. Request a consultation online or call (410) 628-8200.
- American Society of Plastic Surgeons. (2019). Breast Reconstruction Consultation. Retrieved from https://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction/consultation
- American Cancer Society. (2019). Breast Reconstruction Options. Retrieved from https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options.html
- Johns Hopkins Medicine. (n.d.). Tissue Expanders. Retrieved from https://www.hopkinsmedicine.org/breast_center/treatments_services/reconstructive_breast_surgery/tissue_expanders.html
- American Society of Plastic Surgeons. (2019). Types of Breast Implants. Retrieved from https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/implants
- Breastcancer.org. (2019). TRAM Flap. Retrieved from https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/tram
- Breastcancer.org. (2019). Latissimus Dorsi Flap. Retrieved from https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/lat-dorsi
- Mota, B. S., Riera, R., Ricci, M. D., Barrett, J., de Castria, T. B., Atallah, Á. N., & Bevilacqua, J. L. (2016). Nipple- and areola-sparing mastectomy for the treatment of breast cancer. The Cochrane database of systematic reviews, 11(11), CD008932. doi:10.1002/14651858.CD008932.pub3
Hopkins celebrates Breast Reconstruction Awareness Day
BALTIMORE — One in eight women will be diagnosed with breast cancer, and of those, 80 percent will have no idea of what options they may have for reconstructive work, according to officials at Johns Hopkins Hospital in Baltimore.
“Everyone should take notice, chances are we all know someone who has been touched by breast cancer, whether it’s a neighbor, friend, co-worker or a loved one,” said Laura Gavin, a registered nurse practitioner in the Plastic, Reconstructive and Aesthetic Surgery Department at Johns Hopkins.
The hospital’s University School of Medicine and the Plastic, Reconstructive and Aesthetic Surgery Department helped to spread the word about breast cancer and the options patients have during Breast Reconstruction Awareness Day on Wednesday, October 16, 2013, with activities promoting education, awareness and care related to post-mastectomy breast reconstruction.
Nearly two dozen participants, wearing pink shirts, met between the Armstrong Medical Education Building on McElderry Street and the Johns Hopkins Outpatient Clinic on North Caroline Street to form a human pink ribbon, the international symbol of breast cancer awareness.
“This [was] followed by a dancing and singing routine to help draw attention to BRA Day,” said spokesman John M. Lazarou.
The event marked the fourth consecutive year that the iconic dome atop the Johns Hopkins Hospital’s historic building on Broadway had been lit in pink as a reminder of breast cancer awareness month and to remind women and their loved ones about breast and health issues, according to Lazarou.
Hospital officials say breast cancer is the second-most common cause of cancer death in American women. It is estimated that this year in the United States, 233,000 women will be diagnosed with breast cancer, and approximately 40,000 will die from the disease.
If detected early, treatment can save thousands of lives. Throughout the month of October, physicians and public health officials are encouraging women who are 40 and older (under age 40 for African Americans) to speak with their doctors about breast cancer, and the benefits and risks of screening.
“The goal is for women to become to become educated about breast reconstruction options. Technology has advanced and there are many reconstructions choices including autologous (cells or tissues transferred from the same individual), and fat grafting, it is no longer only implants,” Gavin said, adding that breast reconstruction can be done at anytime.
“Even if the mastectomy surgery was done 30 years ago, there are options,” she said. “There are even breast reconstruction options for patients having lumpectomies. In general, women need to be educated about all the options available to them.”
In a further effort to encourage all women, BRA Day included testimonies from those who have enjoyed success with the various options now available.
“I began exercising and getting healthy right away and that helped me through everything that I did,” said Pam Vierra, a mother of three from Central Pennsylvania who was diagnosed with breast cancer and decided to visit Johns Hopkins for a second opinion.
“When I was first diagnosed it was the worst nightmare, I was terrified by what I would have to go through and whether or not I would survive. I acted quickly and spoke with a local surgeon and she was thorough and compassionate but I went to Johns Hopkins for a second opinion and I decided that was the route I wanted to take.”
Vierra chose a procedure in which tissue was taken from her abdomen and transplanted to her chest to recreate breasts. “The outcome was natural and beautiful and I feel very comfortable,” she said. “It changed my life.”
While there are millions of cancer survivors, there are scores more living with cancer, some with metastatic cancer that has spread beyond its original site to other parts of the body.
The hospital’s team has developed a novel retreat program for women facing metastatic disease, in which they and their spouses or partners spend a weekend discussing and learning how to cope with incurable cancer.
“If you are not being told, then feel empowered to ask. Breast reconstruction is extremely important for quality of life,” Gavin said.
Breast Reconstruction Options If You Have Lymphedema
Your body has faced a lot of challenges. You have been treated for breast cancer, which probably included a mastectomy and other treatments such as chemotherapy or radiation therapy. And the mastectomy may have led to lymphedema, a swelling of the lymph vessels. As a result, you may have a swollen arm.
If you were considering breast reconstruction as part of your recovery, but lymphedema is now a concern, there are several options to consider. Michele Manahan, associate professor of plastic and reconstructive surgery, answers questions about innovations in reconstruction from breast cancer treatment that also address lymphedema.
What are the treatment options for lymphedema?
The first step in treating lymphedema is compression and elevation, but your symptoms your doctor may recommend surgical options. Talk to your doctor about your specific symptoms so that he or she can create a treatment plan that best fits your needs.
Could you explain the new options for women who have had cancer and now suffer from lymphedema?
The good news is that you can now treat your lymphedema and reconstruct your breast(s) at the same time.
Total breast autologous reconstruction (TBAR) is a technique where a surgeon uses your own body tissue, usually from your abdominal wall (the “donor site”), to reconstruct a new breast. The transferred tissue includes some of your own lymph nodes from your abdominal wall.
When moved to your breast, these lymph nodes will help drain lymph fluid and treat lymphedema caused by a mastectomy. In the operating room, the surgeon will confirm that these lymph nodes do not drain lymphatic fluid to your legs, which could cause lymphedema of the legs.
There are also other options for breast reconstruction to discuss with a plastic surgeon.
Who makes a good candidate for the TBAR procedure?
Because the procedure includes breast reconstruction with your own tissue, good candidates have not previously had this type of reconstruction. Patients who have previously had no reconstruction, failed reconstruction or had implant-based reconstruction may be able to consider converting to this type of reconstruction to help treat lymphedema.
What is the downtime after surgery?
You can expect to stay in the hospital for a few days following this type of surgery. When you go home, you will ly feel engaging in most activities of daily living, but we recommend you avoid strenuous activity for two to three months following the surgery. You may feel more tired and sore for several weeks after the procedure.
Do other surgical treatments for lymphedema exist?
Some patients may be better candidates for other types of surgeries to try to treat lymphedema. These often involve outpatient surgery. Options include:
- Using a microscope and several small incisions in the arm with lymphedema to connect small veins to lymphatic vessels to help reroute the lymphatic fluid.
- Using liposuction to perform minimally invasive tissue extraction of fatty tissue that has accumulated in the arms and legs.