Expertise
Our surgeons have years of experience in breast reconstruction and specialize in this area.
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.
Patients may need reconstruction in one or both breasts after cancer surgeries such as:
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:
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.
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.
Types of breast reconstruction surgery we offer include:
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.
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.
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.
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.
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
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.
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.
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.
In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:
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.
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.
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.
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 if you have the following signs/symptoms:
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.
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.
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.
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.