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.
"Perfect! No more gynecomastia, love handles or belly fat - Dr. Marosan made my dream come true. No more gynecomastia, no more love handles, no more belly fat. I'm the person I've always wanted to be. Everyday I look at myself in the mirror and thank my lucky stars that I met Dr. Marosan."- B. / RealSelf / Jan 07, 2023
"Couldn't be more pleased - my breasts are so soft and natural - I couldn’t be more pleased with my experience and the results. My breasts are so soft and natural. I highly recommend Dr. Marosan and his staff and will definitely be seeing him for any future procedures."- P. / RealSelf / Jan 03, 2023
"Gynecomastia surgery - 3 months later and I could not be happier with the result! - I previously had gynecomastia surgery and then an additional correction, both procedures were with a different doctor and both procedures did nothing but leave me with scarring. I thought it would be a good idea to try one more time and thank goodness I did! Dr. Marosan explained everything perfectly and made me feel really comfortable moving forward. 3 months later and I could not be happier with the result! I would recommend Dr. Marosan to anybody considering getting work done. 10/10"- R. / RealSelf / Dec 16, 2022
"The surgery went well, but felt rushed after - I would give Dr Marosan a 9/10. I am conflicted between the 4 and the 5 stars, btu given my results I will lean up.The surgery went well, but after the fact things felt a little rushed. 15 minute time slots for appointments where you are taking 6 photos isnt a lot of time to discuss what needs to be done for successful recovery. After my first of these I to looked around online for more information and found what I was hoping for. For the price I was expecting a more personalized experience. All went well though, my results are exactly what I was hoping for and I am glad I did the procedure. It has been 7 or so months and I hardly think about it anymore."- N. / RealSelf / Nov 28, 2022
"Ab Etching Dramatically Increased my Motivation! - In Sep 2021 I had VASER Hi-def lipo, gynecomastia, and abdominal etching work performed by Dr. Marosan. Being former military, I previously tried to just force body discipline by 5am sessions with a personal trainer, random gym apps, CrossFit (twice), but still couldn't get (and maintain) my body the way I wanted. I knew I didn't need the motivation of group support, and if I could just find the right catalyst then I could do this on my own. So I bought a Tonal machine for at home workouts, and went in for the procedure with the objective that the surgery was just the start of my fitness journey (for immediate visual motivation), versus the end (ie no more work needed). I was fortunate to live right down the street from a respected true master of his craft who could do this work on me! Dr. Marosan fully explained what would happen, why he would do certain things, and equally important why he would not do other things that I'd found online (like sculpting a sixpack into the abdominal fat so I'd look like Batman 24/7). Not much to share on the procedure itself, I remember going in and laying on the table, and next thing I know I was getting up and wheeled out to my ride. I did have a few drainage tubes for a week which were a pain to manage for bathroom trips, and the garment/foam isn't the most comfortable, but once the tubes came out and the swelling went down things greatly improved.A year after surgery and I know that seeing the difference in my body has helped me make better dietary choices, and has kept me motivated with my workouts. This was definitely one of the best decisions I've made for myself, as I see the results every single day and know that it's 100% up to me to continue the work to highlight the impact of the sculpting even more. As I put in more work (nutrition & exercise), I now see the impact faster, and the benefit is more pronounced. If you're on the fence, just treat yourself & go in for a consultation, you won't regret it!(my pics are on his website gallery)"- F. / RealSelf / Oct 07, 2022
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
- Surgeon Fees
- From $8,000
- 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.