Franklyn Elliott, M.D.

Tissue expanders are the most common method of reconstructing a breast if a breast implant is used. The tissue expander is a device that stretches the skin to the desired size and shape. Tissue expanders are particularly useful if the patient is smaller than she would like to be preoperatively. Expanders are necessary in patients who choose delayed breast implant reconstruction as the tissue contracts after the cancerous tissue is removed. The expander is used to initiate a process in which the patient visits the office every week for expansion of the device until the breast is as large as or slightly larger than the desired size and shape. At that point, a plan is made to remove the tissue expander and replace with a soft, natural looking (usually gel) breast implant. To view Dr. Elliot’s breast reconstruction with expander surgery results click here.

The scarless latissimus breast reconstruction was developed by Dr. Elliott and employs the use of the latissimus muscle, located on the back, for additional coverage of a tissue expander and/or breast implant. The latissimus muscle is harvested at the time of mastectomy and is rotated around to the front of the chest and coupled with the pectoralis muscle to give full muscle coverage of a tissue expander / implant. Expansion is done to achieve the desired size and shape of the breast. This is followed by exchange of the tissue expander for a gel implant, which feels more natural. The entire process involves implants placed under both the pectoralis and latissimus muscles. Because muscle function can be adapted by other muscle groups, even if they didn’t originate in the area, the scarless latissimus shouldn’t compromise the function of the arm or back.

Dr. Elliott, along with Atlanta Plastic Surgery founder Dr. Carl Hartrampf, Jr., was involved in developing breast reconstruction using TRAM. The TRAM operation transfers fat and skin from the lower abdominal wall to the chest to reconstruct the breast. This fat and skin must have its own blood supply, which comes through a small portion of muscle known as the rectus abdominus muscle.

Just as there are multiple reconstruction procedures available, there are different types of TRAM procedures: the pedicled TRAM and the free TRAM. The pedicled TRAM passes tissue behind the upper abdominal skin to reach the chest for shaping into a new breast. The free TRAM flap completely detaches the tissue from the abdominal wall (along with its blood vessels) before being transferred to the chest where it is then reconnected to an artery to re-establish blood supply. Then, it is shaped into a new breast. There are various pros and cons to each of these techniques, which Dr. Elliott takes time to discuss with each patient considering this operation.

Dr. Elliott is at the forefront of developing and performing breast reconstruction surgery for patients who had breast implants prior to breast cancer. Mammaplasty is an operation Dr. Elliott developed to allow for immediate reconstruction of the breast once a mastectomy is performed. The implant from the previous breast augmentation and its covering capsule is left in place while the surgeon removes the affected tissue. Once the mastectomy is complete, the existing capsule is then accessed to remove the old implant and expand the pocket to allow for a gel implant that will remain comparable to a woman’s breast pre-mastectomy. To view Dr. Elliot’s mammaplasty results click here.

Nipple / areolar reconstruction is typically performed 2-3 months after the completion of the breast reconstruction. It is a small, outpatient procedure performed under local anesthesia. Areola reconstruction can be done on one or both sides; restoring the nipples to the patient’s desired size. To complete the breast reconstruction process, the areola, or pigmented tissue surrounding the nipple, is then added once the nipple has healed (one or two months or two later) using a tattoo technique. To view Dr. Elliot’s nipple / areolar reconstruction results click here.