Breast Resources of Arizona

We are all very excited about the upcoming start of Breast Resources of Arizona - our non-profit organization looks forward to educating and supporting those patients in need who have been diagnosed with breast cancer in various manners, with the funds donated by several of our very generous donors.  This opportunity will hopefully assist those in need and help to increase public awareness of breast cancer.  More information regarding this truly exciting charity to come once it is completed!

We also look forward to providing all women diagnosed with breast cancer the opportunity to obtain an additional opinion regarding breast reconstruction options prior to the surgery or provide opinions regarding revisions of reconstructions already done.  Utilizing the vast experience of our surgeons, who have completed advanced fellowship training in breast reconstruction at some of the most renowned institutions internationally, we hope to offer our opinions and provide all options to women, including implant-based and the newest flap-based reconstruction options, such as the DIEP flap and other microsurgical perforator flap breast reconstructions.

Phoenix/Scottsdale Breast Reconstruction Center

The Breast Reconstruction Center @ Advanced Aesthetic Associates is pleased to welcome Robert Bajnrauh, M.D. as the newest associate.  He has just completed his advanced fellowship training in breast reconstruction/microsurgery at the internationally-renowned Memorial Sloan Kettering in New York, NY.  Prior to that, he completed another year of fellowship training with Operation Smile and is proficient in pediatric plastic surgery, clefts, and cranio/maxillofacial surgery as well.

His wealth of experience will add a tremendous amount to the Phoenix Breast Reconstruction Center.  His expertise in microsurgery, including DIEP flaps and others, will add to the already highly skilled techniques at our Center.  His overall knowledge in breast reconstruction will add another level of care to our continually growing Center.  We look forward to the opportunity to assist and support all patients in any way that we can.

Fat grafting for contour deformity

Fat grafting has become a popular procedure to improve aesthetic outcome following breast reconstruction or for improvement of contour after lumpectomy.  Much of the newest research has investigated the properties of fat, in terms of its stem cell properties and associated advantages.

At our Breast Reconstruction Center, we have utilizing this technique almost routinely to maximize the aesthetic outcomes after lumpectomy or mastectomy.  We have refined the micro-fat grafting technique, and have been obtaining maximal fat graft survival into the breast.  After harvesting of the fat from areas with excess fat, usually the belly, hips, or thighs, the fat is processed and injected back into the breast using the aforementioned techniques.  Our patients have been very happy with the results as well as the areas where the liposuction was performed.  Contour has been much improved using the micro-fat grafting technique, and the downtime is minimal.

Fat grafting has become a mainstay in breast reconstruction and has added another edge to breast reconstruction for aesthetics with minimal morbidity and complications.

DIEP candidate with previous abdominal procedures

There have been much interest in a woman's candidacy for abdominal flap procedures if previous abdominal surgery has been done.  Especially with c-sections, many women have been told that they are not candidates for the DIEP flap.  Often times with low-transverse incisions (Pfannenstiel) incisions, the Superior Inferior Epigastric Artery (SIEA) has been transected. 

A recent study has looked at DIEP flaps being performed after such incisions.  While, if in fact the SIEA has been cut, it has actually improved circulation to the Deep Inferior Epigastric Artery Perforator (DIEP) system and augmented its vascularity and survival rate.  Unfortunately, there are rare instances that the DIEP artery system has also been transected, such as in the aforementioned cases, appendectomy, hysterectomy, exploratory laparatomy, cholecystectomy, etc.  These should be assessed on an individual basis and discussion/tests performed prior in order to speak abou the DIEP flap.  Physical examination, Doppler ultrasound, and CT angiograms can help to visualize the vascularity of the abdominal flaps prior.

All in all, abdominal procedures are not a contraindication to abdominal flap breast reconstructions such as the DIEP, but should be assessed by a skilled surgeon in such flaps.  "Flaps raised from these abdomens are not only safe, but may be better vascularized".

Breast Reconstruction with Fat Grafting/Transfer

One of the newest techniques for breast reconstruction involve utilization of the exciting benefits of fat grafting. Much research has been put forth into plastic surgery for harvesting of fat and its potential as stem cells. Fat grafting and transfer has been utilized both for breast augmentation but also in breast reconstruction for contouring of the breast after implant-based and flap-based reconstruction with excellent results.

After a lumpectomy or mastectomy, an innovative technique which has been implemented is performing this fat grafting and transfer technique to completely reconstruct a breast. This would involve no other scars or incisions, no foreign bodies or implants, and no complex flap procedures. Plus, additional benefits to the breast reconstruction include as close to normal sensation of the breasts along with the benefit of liposuction to harvest the fat from wherever there is spare fat!

Working with your breast surgeon during the oncologic procedure for your breast, some fat is harvested during the same surgery, which in turn is placed back into the breast area. This will give a small breast mound immediately after the procedure. An external expander device is then used for several weeks after the initial procedure while you are sleeping. The expander will have the same benefits as the internal tissue expander, however it is simply worn on the outside as a vest, without having an implanted prosthetic.  It has been shown to increase vascualrity, increase blood supply (important for radiated breasts especially), as well as expand the breast framework for which the fat will be placed in the future.

Once adequate expansion has been obtained after several weeks of wearing the external expander vest, a simple outpatient procedure will be performed in which liposuction will be performed from areas where you have excess fat. Instead of wasting this fat, it will be harvested, washed, and then transferred back directly into the breast to give the additional volume to reconstruct the breast. The liposuction may be performed from the abdomen, flanks, hips, thighs, buttocks, etc., until enough fat has been obtained to give adequate volume for your reconstructed breast. Multiple micro-fat grafts will then be placed throughout the expanded breast framework within its well-vascularized bed. Sometimes this will take a few small outpatient procedures, separated by several weeks, to obtain the results. Fat grafting allows precise placement of where the fat should go in order to perfectly contour the breast shape.

The newly-reconstructed breast mound has now been recreated with the use of only your own fat via liposuction with the hopes for a breast mound that looks and feels much like a "normal" breast. The results thus far have been superb and patients have raved about their overall results.

Happy New Year!

Happy New Year to all!

I hope that much of the information has been helpful to you.

Please continue to follow as I look forward to continually adding information on the subject this coming 2012 and into the future!

To a healthy & happy 2012!!!

Analysis of Sensibility in the DIEP breast reconstruction

The DIEP flap has been considered by many authors as "the definitive standard in breast reconstruction" due to its "achievable shape and consistency, permanence of static and dynamic symmetry, and aesthetic and functional gain in the donor site". One question regarding this most-innovative type of breast reconstruction such as the DIEP and other free tissue transfer breast reconstructions is the amount of sensation that is restored postoperatively.

Although I, as well as several of the few other surgeons who perform such microsurgical flaps, spare the nerves, there have been no publications to specifically look at the sensibility in breast reconstruction with the non-reinnervated DIEP flap. A recent study followed 30 consecutive women following DIEP flaps and studied the sensation. They found that "for immediate breast reconstruction undergoes satisfactory progressive spontaneous sensitive recovery at 6 and 12 months after surgery" This may significantly save intraoperative time for this already complex procedure and hopefully improve the overall postoperative wellness of the patient with a shorter anesthetic time. Overall, the DIEP flap has become a bright spot in breast reconstruction!