Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Alexandra McSpadden

Alexandra McSpadden, PA-C

Plastic Surgery

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Santa Rosa Medical Center
Appt/Advice: 707-566-5288

See all office information »

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Overview

Breast reconstruction is a surgical procedure for women who have had a breast removed (mastectomy). The procedure, which is done by a plastic surgeon, attempts to rebuild your breast to near its normal shape. Tissue to match your nipple may also be reconstructed, and the colored area around the nipple (areola) may be added.

Many different decision points are involved when you are considering breast reconstruction. We will work closely with you to ensure that you understand your options regarding when to have surgery and what type of surgery to have and are aware of how long your recovery will be. We want to make sure that you have realistic expectations about how your reconstructed breast will look and feel.

There are several types of reconstruction techniques available. Your newly shaped breast can be formed with a breast implant, your own tissue (called a flap), or a combination of the 2. Some women needing only a very small breast may be able to achieve a satisfactory result using fat injections alone.

You may be able to choose to have the reconstruction at the same time as your mastectomy, or it can be done later. You may also choose not to have surgery.

There are several reasons why a woman may want to have breast reconstruction. You may want to have a balanced appearance without using a prosthesis. Or you may want to permanently regain your breast shape. Many women experiencing the effects of cancer find that their body image and self-esteem improve with breast reconstruction.

Most women can have breast reconstruction. However, it may not be the best choice if you are obese (BMI greater than 30), smoke, have diabetes or high blood pressure, are in poor health, or have advanced cancer.

Additional References:

Types

Breast implants are available in saline- and silicone gel-filled models. Flap surgery involves taking tissue from another part of your body and creating the form of a breast.

Implants

The most common breast implants have a round or teardrop shape made from a silicone shell filled with saline (salt water). Today, implants can also be filled with silicone gel. Silicone gel-filled implants were not used for a decade or so due to concerns that silicone leakage may contribute to immune system disease. Since no proven link between silicone gel breast implants and immune system disease was found in multiple large studies, these implants have been deemed safe to use by the Food and Drug Administration, and we are using them again in certain cases.

Breast implants may be placed at the time of your mastectomy (immediate) or later (delayed). Immediate placement may not be recommended if radiation therapy is part of your treatment plan. Radiation therapy may leave the skin and underlying tissue discolored or damaged and intolerant of an implant.

Breast reconstruction with implants usually requires more than one operation: the first to place the tissue expander under the chest muscle (pectoral) and the second to remove the expander and insert the final implant. In addition, there will be multiple visits to our office over several months for the gradual filling of the tissue expander with sterile saline solution. This process is similar to slowly inflating a balloon and is done by inserting a needle through your skin into a small valve in the expander.

Before choosing breast implants, you may want to consider the following:

  • Breast implants generally do not last a lifetime. You may require additional surgery to replace the implant in the future.
  • The implants can break (rupture).
  • Scar tissue may form around the implant, which can cause distortion of its shape and discomfort for you.
  • You may not like the appearance of your new breast.

When choosing between saline- and silicone-filled implants, you may want to consider the following:

  • In the case of rupture, saline is absorbed by your body, while the silicone gel may be contained in the scar tissue or capsule around the implant or may leak out.
  • The size of some saline implants can be changed, while silicone implants can be changed only with additional surgery.
  • Silicone is thought to have a more natural look and feel than saline.

Tissue Flap Procedures

These procedures take tissue from one part of your body and use it to create a new breast. The 2 most common tissue flap procedures are a TRAM flap (transverse rectus abdominis myocutaneous) or latissimus dorsi flap, which uses tissue from your back.

The TRAM flap procedure uses tissue and muscle from the lower abdomen. The skin, fat, blood vessels, and an abdominal muscle are moved from the abdomen to the chest. It may decrease the strength of your abdominal muscles and results in a tightening of the lower abdomen, or a tummy tuck. There are 2 types of TRAM flaps:

  • Pedicle flap. The flap remains attached to its original blood supply, moving it under the skin to the chest.
  • Free flap. The flap of skin, fat, blood vessels, and some muscle is detached from its original location and attached to blood vessels in the chest. This requires microsurgery and takes longer than a pedicle flap.

The latissimus dorsi flap uses muscle and skin from your midback. The flap is made of skin, fat, muscle, and blood vessels. It is tunneled under the arm to the chest.

Another type of flap procedure, the DIEP flap (deep inferior epigastric artery perforator), uses fat and skin from the same area as the TRAM flap, but it uses much less muscle. This technique lessens, but does not eliminate, the damage to normal muscle by dissecting the blood vessels needed to supply the overlying fat and skin from the muscle below. This procedure requires cutting a flap of tissue from the abdomen and moving it to the chest. It requires microsurgery to connect the tiny vessels.

There are other free flap procedures. Their names depend on the area and specific blood vessels used:

  • Lower abdomen = DIEP or SIEP/SIEA
  • Buttock = SGAP or IGAP
  • Back = TDAP
  • Inner thigh = TUG

Flap procedures create a breast shape more like your natural breast. This new form of a breast can enlarge or shrink as you gain or lose weight. In addition, unlike implants, there is no worry about replacement or rupture. However, all flap procedures are major operations that have increased risk of complications, including death of the transferred tissue.

We will assist you in determining if a flap procedure is right for you and recommend which procedure would be best.

Nipple and Areola Reconstruction

Nipple and areola reconstruction is optional and usually the final step in breast reconstruction. A separate procedure is done to make the reconstructed breast look more realistic. It can be done as an outpatient procedure under local anesthesia. Generally, this is done several months after the reconstruction surgery, allowing your reconstructed breast time to heal.

Nipple and areola reconstruction attempts to match the appearance of the original breast. Tissue used to rebuild the nipple and areola may be taken from elsewhere on your body. A tattoo may be used to match the color of the nipple and areola.

Additional References:

Risks

Most women who have a breast removed due to cancer can have reconstructive surgery. However, please be aware that there are risks associated with any surgery, and reconstructive surgery has unique risks. Common risks include:

  • Bleeding
  • Infection
  • Poor wound healing
  • Problems with anesthesia
  • Possible need to reshape the remaining breast to improve symmetry

Additional risks may occur if you undergo an implant procedure:

  • Breast firmness caused by scar tissue
  • Implant rupture
  • Increased risk of future breast surgery to replace or remove the breast implant

Additional risks may also occur with flap surgery:

  • Partial or complete loss of the flap
  • Problems at the site where tissue was removed (donor site) on the body
  • A collection of fluid, perhaps requiring drainage
  • Abdominal wall hernia or weakness with TRAM flaps

Alternatives

Breast reconstruction is not for everyone. You may choose to use an external prosthesis (bra insert), or you may be comfortable with your chest being flat where the breast was removed. Choosing an alternative to breast reconstruction does not have to be a final decision. The decision to have reconstruction can be made at any time, even years after your mastectomy.

Advantages of an external prosthesis include:

  • No additional risks of surgery after mastectomy.
  • No additional recovery time after mastectomy.
  • No need for revision surgery over a lifetime or for opposite breast surgery for symmetry.
  • No additional scars after mastectomy.
  • Excellent symmetry and size match when in clothing.
  • The prosthesis can be refitted as opposite breast changes with age.
  • Equivalent satisfaction rates compared to those who choose surgical reconstruction.

Disadvantages of an external prosthesis include:

  • Feeling of "heaviness"
  • Sweating between prosthesis and skin
  • Rashes or skin reaction (rare)
  • Inconvenient
  • Only improves symmetry when clothed

Before Your Surgery

Once you have a diagnosis of breast cancer and know that a mastectomy will be part of your treatment plan, you will want to begin considering breast reconstruction options. We will determine the best plan for you based on the following:

  • Medical history and overall health
  • Age
  • Body type
  • Lifestyle and personal goals

You will need to talk with us about your expectations for the breast reconstruction. We will let you know about the risks and benefits of each option and answer any questions you might have.

Breast reconstruction may help you feel better about yourself. However, it is important to remember that your new breast will not be exactly like your old one, and if you use tissue from other locations on your body, this will create additional changes.

Preparing for your surgery

Regardless of what type of breast reconstruction you choose to undergo, you will need a responsible adult to stay with you at home for some period of time after surgery. You will need care at home and will not be able to do childcare, cooking, laundry, driving, lifting, reaching, etc.

Do not take aspirin, aspirin-coated products, ibuprofen (Motrin, Advil), or vitamin E for 2 weeks before or after your surgery, unless instructed otherwise.

Expect to be off work for a period of time, usually 2 weeks to 2 months. The time needed will depend on what you do for a living and which breast reconstruction surgery you undergo. We will be able to help you plan and anticipate your recovery and time off work for your individual circumstances.

Smokers may not be offered reconstructive breast surgery since the healing process may be impaired. Risk and complication rates are generally greater for smokers.

Additional References:

During Your Surgery

Breast reconstruction often involves more then one operation. The first stage creates the breast mound and is done while you are under general anesthesia. Breast reconstruction begins with a flap technique or placement of a breast implant and/or tissue expander. We will work with one of these techniques:

  • Flap techniques. These use your own skin, fat, and muscle from one part of your body to create a new breast mound. Sometimes a breast implant is used in addition to achieve the desired breast size.
  • Implants. These are surgically placed to provide the form of a breast mound. They can be used with flap techniques but when used alone usually require tissue expansion.
  • Tissue expansion. The tissue expander is placed under the chest muscle so that healthy skin can be stretched to provide coverage for the breast implant. There is less recovery time but a more lengthy reconstruction time needed for this type of procedure, and a second surgery is required if the expander is not designed to serve as a permanent implant.

Many surgeons place a biological membrane to protect and support the implants. This may be human or animal in origin and is processed to rigorous standards.

The final step in breast reconstruction surgery, creating a nipple and areola, is optional. If desired, it can be done as an outpatient procedure under local anesthesia. Generally, this is done several months after the reconstruction surgery, allowing your new breast time to heal.

After Your Surgery

Once your surgery is complete, you will probably need to recover in the hospital anywhere from 1 to 6 days, and you will need to follow the specific instructions that we give you.

You may have one or more drainage tubes in your breast and in the area where tissue was removed (donor area) if tissue flap procedures are used. We will teach you (and your family, if appropriate) how to empty the drains, how to record the amount of drainage, and care for the site. It is important to keep the drain exit sites clean. The drains will be removed in the clinic later.

To protect your incisions and your breast, back, or belly if applicable, please avoid activities that can make you bleed or can injure your breast muscle and skin. Here are some activities to avoid:

  • Do not drive.
  • Do not lean over, reach above your head or behind you, or lift anything heavier than your dinner plate.
  • Do not do housework or laundry and avoid vacuuming or sweeping motions.
  • Do not do yard work of any kind.

Check with us before resuming any type of strenuous physical activity.

You should expect to feel tired and sore for a few weeks and possibly longer, especially if you had a flap procedure. Medicine will be prescribed to control pain and other discomfort. In 6 to 8 weeks, you will be feeling better.

During the recovery process, we recommend that you keep the following in mind:

  • Normal feeling is not restored to your breast, but some feeling may return.
  • You will have bruising and swelling that may take several months to subside.
  • It may take 1 or 2 years for the tissue to heal fully.
  • Scars fade over time but never go away completely.
  • Follow our advice on when to begin normal activities.
  • Allow for a period of emotional readjustment if a period of time has elapsed between your mastectomy and reconstruction.

Breast reconstruction and self-care

Breast reconstruction does not increase your chances of cancer coming back. If your cancer does come back, having a reconstructed breast will not prevent treatment, but it may cause some problems. Reconstruction with a flap or implants has not been shown to hinder our ability to watch for local cancer recurrence.

It will continue to be important to have regular mammograms on your other breast, if both were not removed. Your oncologist or personal physician may advise you to have regular mammograms on your reconstructed breast as well.

It is important that you do breast self-examinations, checking both breasts at the same time. The important part is recognizing what is normal and feeling for changes in subsequent exams.

Removing the normal opposite breast for symmetry is seldom indicated in women without an increased genetic risk or developing cancer.

What to Think About

Choices about breast reconstruction depend on many personal factors:

  • Your overall health
  • The stage of your breast cancer
  • Your natural breast size
  • The amount of tissue available for flap reconstruction
  • If you want reconstructive surgery on both breasts
  • The type of procedure you are considering
  • The size of the implant or reconstructed breast
  • Your desire to match the look of your natural breast

Other issues may include:

  • The desire to delay reconstruction until you complete your cancer treatments
  • The possibility that you may not want additional surgery
  • The chance for partial or complete loss of the flap, causing additional surgery
  • The possibility that you will not like the way your new breast looks
  • Whether you will need to delay surgery due to smoking history or if you are ineligible due to obesity, being underweight, or having blood circulation problems or other severe medical problems
  • The possibility that you will need reshaping of the remaining breast to match the reconstructed breast

Your Care with Me

If you are having a breast removed (mastectomy), your general surgeon, oncologist, breast care coordinator, or personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together.

During your office visit, we will ask you a number of questions. Please be prepared to discuss the following:

  • Why you want to have breast reconstruction and your expectations for the results
  • Your medical conditions, drug allergies, and medical treatments
  • Current use of medications, vitamins, alcohol, tobacco, and drugs
  • Any prior operations
  • Type of breast reconstruction you are considering, and the expected outcome and risks associated with it
  • Treatment recommendations
  • Surgical and pregnancy history

In addition, we will discuss your medical and family history, and I will examine your breasts, taking measurements. We may take confidential photographs for your medical record. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, including likely outcomes and risks or complications, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with non-urgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.

If you have urgent concerns or issues while my office is closed, you can call the Appointment and Advice line, 1-866-454-8855. You will be connected with a nurse who can give you immediate advice. The telephone staff can send me a message or book an appointment with me or one of my colleagues, or your personal physician, if I am not available.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 

  • At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Interactive Programs
Podcasts
Prepare for Your Procedure
Videos

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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