James D. Namnoum, M.D., F.A.C.S.
Board Certified in Plastic & Reconstructive Surgery
Co-Director of the internationally acclaimed Atlanta Breast Symposium
Chief of Plastic Surgery, St. Joseph's Hospital
Reconstructive Surgery
Reconstruction is a surgical specialty to restore function and correct defects and abnormalities of the face and body. Dr. Namnoum is board certified cosmetic and reconstructive surgeon.
Click on a reconstructive surgery procedure listed below to read more
Breast Reconstruction |
TRAM Flap Technique in Breast Reconstruction |
Breast Reconstruction using an Implant |
Nipple / areola reconstruction |
Breast Reconstruction using a tissue flap |
Breast Reconstruction
Breast reconstruction is a surgery for women who wish to rebuild their breast(s) after a mastectomy (the removal of one or both breasts in the treatment of cancer). Using the latest surgical techniques, a natural looking breast can be rebuilt at the same time as the breast cancer surgery or even years later – depending on the wishes of the patient. Each breast reconstruction patient is different; depending on the severity of the cancer, the patient’s breasts before surgery, and the amount of skin tissue available after a mastectomy, various techniques are used to rebuild a natural looking breast.
Dr. Jim Namnoum completed his fellowship training in breast surgery and is committed to mastering the latest techniques in breast reconstruction. He is co-director of the internationally acclaimed Atlanta Breast Symposium, held at Atlanta Plastic Surgery, where plastic surgeons from around the world come to learn about the latest innovations in breast reconstruction and cosmetic surgery.
In order to ensure comfort and keep patients as informed as possible, Dr. Namnoum gives patients the option to view detailed procedural videos – so that they may have a better understanding of the reconstructive surgery.
Breast Reconstruction using an Implant
Women commonly opt for breast reconstruction through the insertion of an implant during breast reconstruction. Like a breast enhancement/augmentation surgery, a silicone shell (filled with either saline or silicone depending on the preference of the patient) is inserted into the breast area to create a new breast mound. A patient who has good skin laxity and who has enough persevered skin from the mastectomy surgery can opt for a “direct to implant” procedure – where the permanent implant is inserted into the breast directly after the mastectomy operation.
For patients who do not have enough excess skin after a mastectomy to support a full size implant, an expander may be used. An implant expander is a temporary implant designed to create a big enough pocket for a full size, permanent implant. After the mastectomy operation, the tissue expander is placed under the muscles of the chest wall and filled with a small amount of saline. After the initial reconstruction procedure has sufficiently healed, a patient will come into the office every couple of weeks to have more liquid placed into the temporary implant. Most expanders have a small opening that is built into the front of the device. Your surgeon will use a small needle to access this opening and insert more volume into the expander. After the “pocket” is large enough for the desired breast size, the expander is replaced by the permanent implant.
The size of the implant in either type of procedure depends on the amount of skin available and the desired look of the patient. Even if a patient has only one breast removed during breast cancer treatment, a breast implant is usually put into both breasts – to create visual symmetry and a similar feel.
Breast Reconstruction using a tissue flap
Another type of reconstruction is the rebuilding of the breast mound with a natural tissue flap. The two most common types of tissue flap reconstruction are the TRAM flap (transverse rectus abdominis muscle flap), which uses tissue from the stomach area, and the latissimus dorsi (LD) flap, which uses tissue from the back. Using one’s own tissue for breast reconstruction can be preferred over an implant because there is no risk of allergic reaction and, in some cases, can provided a more symmetrical look for patients who are only having reconstruction on one breast.
TRAM Flap Technique in Breast Reconstruction
The leading approach to tissue flap breast reconstruction is called the TRAM flap technique; named so because the tissue used to reconstruct the breast comes from the transverse rectus abdominus myocutaneous also known as TRAM flap. Instead of grafting solely skin tissue, a large section of skin and fat from the tummy is used to reconstruct the breast. Because of the amount of tissue removed from the abdomen, there will be some scarring in the area; however patients will also have a flatter looking stomach as a result of the procedure. With this type of reconstruction, the use of a patient’s own tissue makes for a more natural looking and feeling breast. It is especially recommended for patients who only wish for reconstruction of one breast – resulting in a more natural looking symmetry than the implant alternative.
Nipple / Areola Reconstruction
The final step in breast reconstruction involves the reconstruction of the nipple and areola (or dark area around the nipple). Modern technology allows surgeons to recreate a natural looking nipple, similar to nipple on the opposite breast. After the breast mound has been reconstructed, surgeons can create a nipple mound using a flap of skin taken from other parts of the body or the reconstructed breast itself. Typically the areola is tattooed onto the nipple mound, to match the coloring of the opposite nipple. Nipple tattooing is also an option for patients who do not wish to surgically reconstruct their breast, although the new “nipple” will be flat and less natural in appearance.
Please click here for Dr. Namnoum's Plastic & Reconstructive Surgery Glossary
