One of the most meaningful aspects of Dr. Holcombe's work is being able to walk alongside patients who have been diagnosed with breast cancer. He is passionate about helping women recover in a way that they can feel themselves again.
While breast augmentation is relatively easy and has few complications, breast reconstruction can be a difficult process with higher possibilities for complications. Dr. Holcombe has experience in working with thousands of women for breast reconstruction, and he will spend time with you to review your options and partner with you along each step of this journey.
The best option for breast reconstruction will depend on a variety of factors which include your medical history, previous surgical history, the treatments you required for breast cancer and your desired results. Dr. Holcombe will discuss your options in your initial consultation and make a recommendation based on your specific needs.
EXPANDER TO IMPLANT RECONSTRUCTION
Reconstruction using breast implants is done in stages. In the first stage, we place a tissue expander behind the muscle. The expander has a built-in port that we can access using a magnet after surgery and slowly fill the device with salt water in the office to stretch out the skin. We continue expanding the device until you are at the size you would like to be, and then we wait a few months to let your body get used to the size of the expander. At that point, we can then exchange your expander for implants. You will need to pick either saline implants or gel implants, and we can review the key differences during your consultation.
If you require radiation for the treatment of breast cancer, this makes it more difficult to heal your breast reconstruction. When healthy tissue is needed in order to perform an expander to implant reconstruction, we can use a latissimus flap procedure. The latissimus flap surgery uses donor skin from your back and rotates it forward to your breasts. The latissimus flap can be used at the time of expander placement, or it can be used at a later time if you have any delays in healing with an expander placement.
TRAM FLAP RECONSTRUCTION
In TRAM flap reconstruction, we use lower abdominal tissues to recreate breast mounds. In other words, we do a tummy tuck but instead of throwing away that lower belly skin and fat we would keep it attached to the muscle and vessels and move it up to your chest to reconstruct the breasts. Dr. Holcombe trained at Emory with the surgeon who invented the TRAM flap operation and has done many of these operations over the years.
DIEP FLAP RECONSTRUCTION
The DIEP flap is an alternative to the TRAM flap reconstruction which uses the lower abdominal tissues but maintains more core strength, as only the skin and fat are taken to create breast mounds. This is considered a "free flap" operation, meaning that your surgeon will completely remove tissue from your body and do microsurgery to reconnect the blood supply when the flap is moved to its intended location. Dr. Holcombe does not perform the DIEP flap operation, but if he determines that this would be the best fit for you, he will refer you to colleagues at the Mayo Clinic or St. Joseph Hospital for consultation.
We most often operate at St. Joseph Outpatient Surgery Center. If you have high risk medical conditions or if your reconstruction surgery is more extensive, St. Joseph Hospital is another location where we operate. We will let you know the location of your surgery on the day of your consultation.
Please be prepared to check into the surgery location at least one hour before your scheduled surgery time.
You will need to be fasting for at least 8 hours prior to the surgery, and some medications may require you to fast up to 12 hours prior to surgery. You will receive specific instructions prior to your procedure date.
Please provide us with a complete list of your medications during your initial consultation, and please let us know if you have any changes to your medication prior to surgery. This will allow us to give you the best instructions to prepare for surgery and recovery.
You will wake up from breast surgery in an ACE wrap, and we will ask you to continue using that compression dressing for the first week following your operation. At your one week follow up, you can usually transition into a sports bra with gentle compression until you are one month out from your surgery. If Dr. Holcombe decides that you will need surgical drains then we will give you detailed instructions for caring for the drains and we will see you regularly until the drains can be removed. You will need to avoid strenuous activities, including exercise and heavy lifting, for the first month after surgery.
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