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Steps Through Reconstruction

This general overview of the steps through breast reconstruction is intended to help you understand the process and be more prepared for the time required during this journey. Please review the information below for details regarding each step along the way.

Initial Consultation

Dr. Spiegel will meet with you and assess your personal situation and medical history. Together, you and Dr. Spiegel will make a decision regarding the appropriate procedure for you. You will be required to complete new patient paperwork and send any medical records to the office, prior to your appointment. Photos will be taken during this appointment to be saved into your secure medical chart.

Secondary Consultation

You will return for a follow up consultation with Dr. Spiegel to answer any additional questions and review any particular health concerns brought up previously. A general timeframe will now be established for your surgery. You will meet with our surgical coordinator to discuss surgery timing and be given details regarding any necessary testing prior to surgery.

First Stage Surgery

The priority for the first stage of breast reconstruction is to preserve the natural shape and structure of the breast, referred to as the breast envelope, while the patient completes oncologic breast surgery, as well as any additional therapy required, such as radiation therapy.
During your initial consultation, Dr. Spiegel will work with you to develop a breast reconstruction plan that fits your needs and oncologic treatment plan.
If you are undergoing autologous flap reconstruction, you will recover in the hospital for 3 – 4 days. The first 48 hours are the most crucial for flap monitoring. If you undergo tissue expander/implant reconstruction as your first stage, your hospital recovery time will be one day. Please visit the Breast Reconstruction Overview page for more information regarding the options for breast reconstruction.

Follow Up Appointments

Generally you will have your first two visits the first and second week after surgery, followed by another visit approximately one month after surgery. At approximately 3 months, you will be scheduled for a consult to discuss results, symmetry, and second stage surgery with Dr. Spiegel.

Second Stage Consultation

Breast reconstruction is typically performed in two stages. The first stage is the technical stage with the priority being for the breast general surgeon to remove the breast tissue and any cancer, while the plastic surgeon focuses on maintaining your natural breast shape and contour. The second stage of breast reconstruction focuses on enhancing the breast and addresses any breast asymmetry present. A second stage procedure is not always necessary and this will be discussed in detail during your consultation with Dr. Spiegel.

Second Stage Surgery

The second stage surgery, or symmetry procedure, is typically an outpatient procedure. If a second stage procedure is indicated, Dr. Spiegel will determine appropriate timing. Typically, a second stage procedure is performed no earlier than 4 months after the first procedure. This allows the body adequate time to heal in between surgeries. If radiation is required, it is best to wait 6 months to 1 year after the completion of radiation therapy, prior to operating.

Nipple Reconstruction

If you had a mastectomy requiring your nipple to be removed, nipple reconstruction can be performed. Nipple reconstruction is either performed at the time of the second stage symmetry surgery or as an additional staged procedure in the office.

Nipple/Areola Tattooing

To complete your reconstruction, nipple and areola tattooing is performed. The tattooist uses a wide array of pigmented inks to match your existing nipple and/or to create natural appearing areolas. This can be done at 6 weeks after nipple reconstruction.

Final Follow Up Appointment

If you have nipple tattooing, we will have you return for a follow up two weeks after the tattoo. If you do not have nipple tattooing, follow up will be one year after your final procedure. Follow up is then performed on an annual basis. Of course, if at any time you have any questions, concerns or additional needs, you may contact us for another appointment. We are always here for you!

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