After battling cancer and undergoing a mastectomy, women want to regain a sense of normalcy and well-being, which can be gained through breast reconstruction. Breasts can be restored and enhanced through various techniques performed by Seattle area plastic surgeon, Dr. Marosan. One of the most successful is the BRAVA + AFT procedure, which is minimally invasive with no incisions or new scars. A BRAVA, or external expander, is worn like a bra over the breasts (if a lumpectomy was done) or over the chest wall from where the breast was removed to gently expand the breasts and or the skin to promote the growth of breast tissue to ready the breast for a fat transfer.
Fat transfer to the breast after a mastectomy and radiation treatment is especially beneficial for returning the tissues to natural softness from the scarred woody feel that radiation causes. Sometimes 4-6 sessions might be needed to return the breast to a normal shape and softness.
Afterwards, Dr. Marosan will use liposuction to remove fat from an area of the body with ample fat to be placed into the breasts. As part of the process, nipple reconstruction can be completed to reposition nipples and leave them with a natural look. When the entire procedure is complete, the breasts should appear and feel natural, giving women a restored sense of self-esteem. Depending on breast size to be reconstructed, this process might need to be repeated. The "new" breast not only feels natural, but skin sensation can return to the area.
The advantage of the fat transfer technique is that it avoids any visible scarring. A mastectomy scar is traumatic enough and any muscle flap reconstruction will create new scars in other areas of the body. As the saying goes: you have to rob Peter to pay Paul.
Things to Consider
The surgical planning for a breast reconstruction typically begins at the same time as the planning for the mastectomy. There are points to consider such as how soon the patient will have the reconstruction and what type of reconstruction technique is best per the surgical case. It will need to be decided whether implants or tissue grafts are used, what type (if any) nipple and areola reconstruction will be used, and other techniques that are specific to the patient’s circumstance. The general goal is to help the patient regain a normal appearance of the breasts as part of the final phase of breast cancer treatment.
"37 Yr Old Fit Mom of 3. Bellevue, WA - Dr. Marosan is the best of the best. My results are over-the-top amazing."- F. / RealSelf / Feb 13, 2016
"Highly Recommend Dr. Marosan, MD - Dr. Marosan, MD came highly recommended and I am completely satisfied with the results of my surgery. I was apprehensive when I was diagnosed with gynecomastia; but Dr. Marosan was the right choice for me. From my initial consultation, surgery, and follow-up appointments have been flawless. Dr. Marosan and his entire staff are polite and professional."- J. / RealSelf / Aug 24, 2020
"Cant Recommend Enough - Im now 6 weeks op and I have a completely different shape! - I had some weight fluctuation in my lifetime and was unhappy with the tire around my stomach and stubborn fat in areas that were hard to exercise away. I thought it’s amazing that you can transfer fat from one area to another so I decided to get a Brazilian butt lift.I was drawn to Dr. Marosan because he has years of experience, is highly educated, knowledgeable and specializes in the procedure. Also in the reviews and in my experience he was very respectful to me as a woman, and I never felt uncomfortable around him. And we all know you can feel vulnerable when your naked in front of a doctor. He meets you for a free consult, which is amazing! We went over what I wanted to change and improve he was able to educate me on how to approach it to get the best results. He really knows the body well, truly an artist and master sculptor!! He took pictures of my body which he was able to bring up on a screen and draw right on it to show me what he was going to do. I felt very confident in him. I went into surgery during the pandemic and due to the complexity of that to keep everyone safe my husband was not able to come with to support me. However, George and his staff made me feel very comfortable and well taken care of. Everyone there is so warm and kindhearted!I went home with a garment, Lipo pads and drainage tubes. Some doctors don’t give you drainage tubes and your just supposed to drain freely onto your bed, and that would’ve ruined my $3,000 mattress. So I’m really thankful my doctor cares enough about post op to give me drainage tubes that were easy to manage. The doctor and his nurse were always very prompt at responding to questions and being available if I had any concerns.Im now 6 weeks op and I have a completely different shape! I have an hourglass figure, hips, fuller butt and flatter stomach! I can’t believe the transformation! This is already doing wonders to my self-confidence...something I’ve lacked for so long. I find myself actually saying something good about myself and seeing myself in a different light now. I’m so happy with the results and I’m so glad I went to the right doctor!"- S. / RealSelf / Aug 17, 2020
"Dr. Marosan Did a Great Job! [Tummy Tuck/Liposuction/Muscle Repair] - After researching dozens of plastic surgeons in the greater Seattle area for tummy tuck/liposuction, I went with Dr. Marosan because I could tell he was very experienced and does a lot of abdominoplasty and he was the one surgeon who places his incisions super low, right above the pubic area, and his incisions stay there (low) instead of eventually pulling up during recovery. For some reason (probably because it's easier), many other surgeons results showed incisions that were placed much higher than they needed to be. Just check out his before and after pictures and compare them with other surgeons: his after pictures show the whole incision area so you get a very good idea of where your incision will end up. [So many other surgeons after pictures are of women in underwear, so you have no idea where the incision was placed, or if you do get to see the whole area, you'll see how high the cut was]. I am now 10 weeks post surgery and am very happy with my results- he did a great job with the incision, the liposuction of my entire torso, and also the muscle plication (sewing them back together since I've had three pregnancies that separated my ab muscles). He also does a lot of follow up visits and takes pictures of your progress and gives you access to them, so you can really see your transformation.I'm so happy I went with Dr. Marosan- he (and his entire staff!) is wonderful and I highly recommend him/his practice!"- P. / RealSelf / Aug 05, 2020
"Great Doctor — the end results are fantastic. - I had a lower facelift and chin lift about 7 weeks ago after choosing Dr. Marosan for the procedure and I couldn't be happier. He took the time to thoroughly explain what was involved and didn't pressure me to book the surgery. After the surgery, he was very patient with the inevitable questions that I had and was careful to make sure that he saw me regularly while I was healing. (at the age of 67, it took a little longer for my swelling to go down) The end results are fantastic. I have a much smoother jawline without the "pulled" look that one sees in some face lifts and the saggy chin is history. His staff was great also. I would definitely recommend this doctor."- D. / RealSelf / Jul 10, 2020
Surgical techniques vary and today, patients are getting more options that can match their personal preferences. It is important to find a highly specialized plastic surgeon to perform breast reconstruction and one who will work with the cancer surgeon to achieve a natural result.
Reconstruction With Implants
Breast implants are a common method used with a reconstruction procedure. When implants are being considered, the reconstruction process is usually performed in a multi-stage treatment session. A tissue expander is placed under the chest muscle and the skin during the mastectomy. This expander will be gradually filled with a saline solution to expand the muscle/skin and eventually replace it with an implant.
Flap procedures harvest skin and muscle tissue from donor sites and transfer it to the breast. This procedures are not performed by Dr. Marosan anymore. They are listed here for your benefit only, if you choose that route.These surgeries are done in a hospital setting under general anesthesia and might require several days stay in the hospital.. The surgeon may choose between one of the following common techniques:
- TRAM flap involves grafting skin and muscle tissues from the lower part of the abdomen.
- DIEP and SIEA flap graft tissue from the lower part of the abdomen, but harvests only the skin and fat tissues instead of muscles.
- Latissimus Dorsi flap uses skin and muscle tissues from the upper back.
- GAP flap uses skin, fat and muscle tissues from the buttocks area.
- TUG flap harvests skin, fat and muscle tissues from the inner thighs near the buttocks area.
- Autologous fat transfer (AFT) to the breast. This is the only one done by Dr. Marosan as an in office surgery under intravenous sedation only.
When a breast is surgically removed, the nipple and areola are not spared. To recreate this area, skin and muscle tissues are grafted and formed to look like a nipple while the areolar color is achieved by tattooing. This is done when the breast reconstruction has fully healed.
Breast reconstruction uses general anesthesia and the patient is often required to stay in a hospital if done simultaneously with the mastectomy. Patients who have flap surgeries sometimes stay up to 5 days for monitoring. There will be discomfort and pain within the first week. Temporary drain tubes and bandages are placed to assist in healing. It can be unnerving to go through a major body change; however, patients find it gratifying and relieving that they are able to once again look and feel normal as they start their new journey towards becoming a cancer survivor.
Fat grafting to the breast is done as an outpatient procedure under intravenous sedation only. No scars, no drains, no hospital stay.
Plan Your Procedure
- Average Cost
- $8,000 - $12,000
- Recovery Time
- Average Procedure Time
- 3-4 Hours
- Post-op Follow-up
- Next Day
- Procedure Recovery Location
Breast Reconstruction FAQs
With breast reconstruction, a plastic surgeon will work alongside the cancer surgeon and be primarily involved and responsible as it pertains to restoring the appearance. It is a highly specialized surgery so it is critical to choose a plastic surgeon that has years of successful experiences in this type of surgery.
If a patient knows she will want to restore her breasts with a reconstruction procedure, it is recommended that this process begins at the time as the mastectomy. During the breast removal portion, the tissue expanders can be put into place, which eliminates a new surgery. This ultimately decreases the risk for complications.
Because the breast is completely removed and a new one is formed, there will be a loss of sensation. Over time, there is a possibility that this sensation can be slowly regained. This is different for every patient. While some patients regain their sensitivity, there is no guarantee that this will be the case for everyone.