Breast Reconstruction

The goal of breast reconstruction is to restore or maintain natural looking breasts after breast cancer surgery. The surgeons at Hill Country Plastic Surgery are experienced in a variety of different reconstructive techniques and procedures to fit the patient’s goals, body, and lifestyle. We offer implant reconstruction, oncoplastic reconstruction, and revisional breast surgeries and will work with your breast cancer team to achieve optimal outcomes.

About Breast Reconstruction Surgery

Patients may need reconstruction in one or both breasts after cancer surgeries such as:

Lumpectomy (removal of a portion of the breast)
Mastectomy (removal of the entire breast)

Reconstructive surgery can be done at the time of mastectomy or lumpectomy or after completion of the cancer treatment. There are multiple factors that influence the type and timing of reconstruction such as:

Cancer treatment plan, including if radiation is required
Your overall health
Your body type and shape and size of the breasts
Your lifestyle

The surgeons at Hill Country Plastic Surgery employ the newest techniques to achieve optimal outcomes. Your surgeons will work closely with your breast cancer team of doctors. They have many years of prior experience at an NCI-designated cancer center and are dedicated to comprehensive, multi-disciplinary care.

If you are interested in breast reconstruction or want to see if you are a candidate, discuss this with your breast cancer doctors. With a referral from your physician, you can talk to the surgeons at Hill Country Plastic Surgery to learn about what reconstructive options we can offer you.

What does Hill Country Plastic Surgery do differently?

Expertise
Our surgeons have years of experience in breast reconstruction and specialize in this area.
Collaboration
Dr. Shah and Dr. Farber are experienced in complex surgeries and working with multidisciplinary teams. They are dedicated to ensuring that your cancer reconstruction is well coordinated with your cancer team.
Female breast reconstruction surgeon
Dr. Shah is one of the few female breast reconstruction surgeons in the San Antonio area. This gives her a unique perspective when evaluating patients, offering recommendations, and helping patients through recovery.
Innovation
Our goal is to offer the newest techniques for your reconstruction. Dr. Shah is a trained surgeon-scientist and has conducted research in the field of breast reconstruction and biomaterials

Options for Breast Reconstruction Surgery

Many women have breast reconstruction during the same procedure as their cancer surgery. First, breast surgeons remove the cancer then our plastic and reconstructive surgeons create new breasts during the same surgery. This is called “immediate” reconstruction. Sometimes it is necessary to have the reconstruction after you have healed from the first cancer surgery. This is called “delayed” reconstruction. You may still be a candidate for reconstruction even if you have had a lumpectomy or mastectomy done many years ago without reconstruction.

Reconstruction is major surgery and can require weeks of recovery afterwards. For some procedures, patients can be discharged the same day. For others, you may be in the hospital for multiple days. We work to minimize discomfort and keep your care moving forward with our enhanced recovery from surgery protocols. After surgery, our team stays in regular contact with you through clinic visits, phone calls, or through the patient portal so we can detect potential complications early.

Breast reconstruction surgery after mastectomy

Types of breast reconstruction surgery we offer include:

Implant-based reconstruction
This is done either in one or two surgeries. The traditional method is in two stages where an expandable implant is placed under the skin either on top or under the chest muscle. The implant is then expanded in clinic using salt water until the desired size is achieved. Next, the expandable implant is removed and replaced with a permanent saline or silicone implant. In a one stage surgery, also known as “direct to implant” or DTI, the implant is placed at the time of the mastectomy either over or under the muscle. This option is available to patients that have not overly large breasts and have a breast size and shape that they are happy with. Read about the differences between saline or silicone implants here.
Flap reconstruction
We create a new breast using a flap of skin, fat and muscle from another part of your body. Because this option does not use muscle tissue, most women have a quicker, more comfortable recovery than those that require part of the muscle. Women usually stay for 3-4 days after surgery in the hospital for monitoring of the reconstruction. Because this is a more involved surgery than with implant-based surgery, total recovery may take longer than for implant-based reconstruction, but the results last longer since it is only using your own tissue.
Flap + implant reconstruction
For patients that have had failed prior implant reconstruction or have poor skin quality due to radiation, you may be a candidate for a latissimus flap and implant reconstruction. This procedure involves taking skin and muscle from the back and using it to bring healthy skin and muscle to the chest. An expandable implant is placed under the flap and once it is expanded to size, it is replaced with a permanent implant.
No implant, no flap reconstruction
For patients that are not good candidates for implant reconstruction or if those options aren’t just right, reconstruction using the remaining skin to create a new breast can be done. This is sometimes referred to as a “Goldilocks” reconstruction. This is an option for patients with large breasts who want and will be satisfied with smaller breasts. This type of reconstruction is done at the time of mastectomy. It is important that this is done with a breast surgeon comfortable with this technique since the incisions are not traditional mastectomy incisions.

Breast reconstruction surgery after lumpectomy

For patients who are candidates for lumpectomy and want to keep as much of their natural breast tissue as possible, we offer “oncoplastic reconstruction”. For those who have had a lumpectomy in the past and are not satisfied with the appearance of the breasts, we also are able to do revisions.

Oncoplastic Reconstruction
This is done at the time of the lumpectomy and before radiation. For women with large heavy breasts that would benefit from breast reduction, we can perform breast reduction on both sides at the time of the lumpectomy. If you have a body shape that would not do well with a mastectomy or you want to have the reconstruction done at the time of the cancer surgery, this is also an option for you. It is important to talk to your breast surgeon about having this type of reconstruction done prior to any surgery since many procedures cannot be done after radiation has been done.
Revision after lumpectomy
For women who desire a more symmetric result or if there is collapse or dimpling of the treated breast, we offer reconstructive options ranging from fat grafting to flap reconstruction. If the breast has undergone radiation, we typically do not perform extensive reductions or augmentations but can adjust the other breast so you have more symmetry between the breasts.

Fat Grafting

Fat Grafting
Fat grafting is using fat from other parts of the body and injecting it in the breast to increase the size of the reconstructed breasts. This procedure can be combined with any of the breast reconstruction techniques described. The fat is collected through the liposuction procedure. The liposuction is performed in the same way that cosmetic liposuction is performed but the fat is saved instead of being thrown away. Also, the amount of fat that is collected is not as much as when patients are having cosmetic liposuction.

Areola and nipple reconstruction

After healing from any type of breast reconstruction surgery, you may want to have a nipple and areola reconstructed. This can be done in different ways to get the best result. The reconstructed nipple does not have feeling or erectile function like a natural nipple.

Tattoo only
The nipple and areola are tattooed directly onto the skin. There is no nipple that sticks out, but using 3D techniques, the nipple appears real
Nipple reconstruction
A nipple that sticks out can be created by performing a surgery where the skin on the breast is folded to form a nipple. After healing, the nipple and areola can be tattooed to get the appropriate coloring.
Areola reconstruction
If tattooing of the areola is not desired, it can be reconstructed by using the skin of the inner thigh as a skin graft to the breast.

Breast reconstruction matching (symmetry) surgery for the other side

If reconstruction is done only on one side, it may be necessary to adjust the other side to match. The procedures that are done are the same as what is done for cosmetic breast surgery. Read about breast lift, breast augmentation and breast reduction surgeries to learn more about these procedures that can be used for your reconstruction.

Breast reconstruction revision surgery

Sometimes revisions are needed. The surgeons at Hill Country Plastic Surgery can help correct problems that occur after breast reconstruction surgery because of infections, scar tissue, or if the breasts are uneven. Breast reconstruction is not the same as cosmetic breast surgery so during your consultation, your surgeons will discuss with you what is and is not possible to achieve.

Why Should You Choose the Surgeons at Hill Country Plastic Surgery?

Both Dr. Farber and Dr. Shah were fellowship-trained at the most prestigious institutions and their techniques for delivering patient results and satisfaction set the standard for plastic surgeons in the field. They use the most advanced techniques and consistently achieve superior results. Their warm demeanor, genuine care, and dedication to their patients are second to none. Ultimately however, patients choose Dr. Farber and Dr. Shah for the results. Their patients look and feel their best, and so can you. Discover the difference here in San Antonio!

What to Expect During Your Consultation Visit

During your appointment with us, we will learn more about you and offer personalized recommendations for treatment. There are many different techniques for reconstruction and our job is to help you decide what is best for you. Prior to your appointment, we will review your cancer history, mammograms and other studies, biopsies, and treatments. Based on this information we will be able to determine what procedures you are a candidate for and discuss with you the pros and cons of each procedure.

We will perform a physical examination which will consist of a breast examination and measurements. We may also take photographs if you will be having surgery done soon.

During your consultation, we will discuss many options and help determine the best course of treatment for you. You will receive the consultation notes and recommendations, plus other resources that can help you be informed and prepared for your upcoming surgery. The information we provide you is based on the latest research and our years of personal experience with patients who have undergone breast reconstruction.

Breast reconstruction is often covered by insurance. For patients that are undergoing cancer surgery on one side, insurance will often cover a procedure for the other side to match the reconstructed side.We will assist you in determining how your plan covers the procedure and if you will have out-of-pocket expenses.

After your consultation, you will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you. If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.

Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.

How to Prepare for Your Surgery

Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. You will also be provided with a post-operative appointment for follow up after your surgery.

Before the Day of Surgery

Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.

Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.

Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.

Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.

You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.

The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.

Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.

Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.

Do not eat or drink anything after midnight the night before your surgery.

Please call our office if you have an infection of any kind prior to your surgery.

Day of Surgery

On the day of surgery do not take the following blood pressure medications before your surgery:

Medications with generic names that end in “-pril”, “-sartan”. If you are on metformin, you will be asked to not take it on the day of surgery.

On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon will make some preoperative markings and will perform extensive checks with careful attention to detail, ensuring high quality care and safety. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.

During the plastic surgery procedure, our plastic surgeons pay meticulous attention to detail and work as a highly experienced team to ensure a great result. Your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.

Aftercare

In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:

Prepare a sleeping area that is easy to get to. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.
You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.
If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.
Review your post-surgery instructions given to you at your pre-operative appointment

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.

When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.

Medications:

After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for a pain medication. If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day.. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.

Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.

You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day. Take ibuprofen with food to protect your stomach from irritation.

If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.

Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Surgical Site Care:

You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze or ointment over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery. More specific instructions will be provided during your pre-operative visit.

Drain Care:

Sometimes it is necessary to place a drain after surgery. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.

Please Call Immediately if:

Please call if you have the following signs/symptoms:

temperature greater than 100.5 F
bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes
increasing pain that is not controlled on oral pain medications
increasing redness or size at the surgical site
your drain is not holding suction
if your incisions come apart
Any other concerns

For non-emergency questions:

During business hours (8 AM – 4:30 PM): call (210) 658-3555.

After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.

If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity restrictions:

No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment. Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move.

Clinic appointment:

Your clinic appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.

Breast reconstruction is not the same as cosmetic breast surgery so during your consultation, your surgeons will discuss with you what is and is not possible to achieve. Prior to your appointment, we will review your medical history and your cancer evaluation from your doctors to determine your risks. Radiation therapy is a major factor in the quality of skin and wound healing after surgery. Risks can include, pain, bleeding, infection, loss of implants, loss of flaps, need for additional surgery, and asymmetry. The risks and potential for complications are different for all people and we will discuss this with you at your consultation.

The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.

Breast Reconstruction FAQs

How do I choose a breast reconstruction surgeon?

The breast reconstruction process can take up to a full year in some cases. It is important that you feel comfortable with and trust your surgeon to be able to meet your reconstruction goals. You will be able to meet and talk with your surgeon to determine if he or she is the right person for you.

What if I’m having or had radiation?

Radiation affects the healing of skin, the color, the ability for it to stretch and can make the skin harder and firmer. While radiation does not exclude you from reconstruction, it can increase the risks. Not all patients respond to radiation in the same way so we will evaluate you, your skin, and your treatment to determine which reconstructive procedures are right for you.

Will my insurance cover my reconstruction?

The Women’s Health and Cancer Rights Act of 1998 guarantees reconstruction after mastectomy or lumpectomy for women with insurance. While reconstruction is covered, there are many differences between insurances and not all reconstructive procedures may be covered. We will work with your insurance carrier to determine your benefits.

Do you do surgery to fix lymphedema after breast cancer surgery?

We currently do not do surgery to correct lymphedema after breast cancer surgery. However, we do procedures to treat lymphedema and lipedema on other parts of the body.

When should I see a breast reconstruction surgeon?

It is recommended that you see us before any surgery is done. That way, we can determine the best timing for your reconstruction.

Interested?

Are you interested in learning more about this procedure? To schedule a consultation, please contact us. Hill Country Plastic Surgery is the premier plastic surgery center in the San Antonio and our friendly team members are here to help you and will reach out promptly.

References

Meet Our Surgeons

Dr. Amita Shah

Dr. Amita Shah is a double-boarded Plastic and Reconstructive Surgeon. She specializes in breast and body aesthetic and reconstructive surgeries including microsurgical procedures such as the DIEP flap. She is also a general plastic surgeon that operates from head to toe for aesthetic procedures and cancer and trauma reconstructions. Dr. Amita Shah is known for her innovative approach to plastic surgery, incorporating the latest techniques and approaches to achieve the desired outcomes for her patients.

Professional affiliations:
Membership in American Society of Plastic Surgeons
American Medical Association
American Burn Association
American College of Surgeons, Fellow
Texas Medical Association and Bexar County Medical Society
Plastic Surgery Research Council
Candidate member of the American Society of Aesthetic Plastic Surgeons

Learn More About Dr. Shah »

Dr. Scott J. Farber

Dr. Scott J Farber is a board certified, fellowship-trained Plastic and Reconstructive Surgeon with a sub-specialty in Cranio-Maxillofacial aesthetic and reconstructive plastic surgery. He is one of only two surgeons in the San Antonio area with this specialized fellowship training. Besides having impeccable surgical acumen and technical skill, Dr. Scott J Farber has a natural eye for beauty and balance — an instinctual talent that cannot be taught.

Professional Affiliations:
American Society of Plastic Surgeons
American Society of Aesthetic Plastic Surgeons
American College of Surgeons
Association of Military Surgeons of the United States
Texas Medical Association and Bexar County Medical Society

Learn More About Dr. Farber »