Immediate Reconstruction - when breast reconstruction surgery is done at the same time your general surgeon performs your mastectomy and before you have chemotherapy and/or radiation treatment.

Delayed Reconstruction - when breast reconstruction surgery is performed sometime after a mastectomy and/or radiation and chemotherapy treatments.

Dr. Kiesnowski performs both types of reconstruction surgery, but when possible prefers immediate reconstruction because it allows for more options with a reconstruction as well as provides a more cosmetically pleasing result.

Implant reconstruction is accomplished with two surgeries - one to place the breast shaped tissue expander to stretch the skin and one to place a permanent prosthesis at the completion of reconstruction. With implant reconstruction a breast shaped tissue expander is inserted at the site of the mastectomy and is filled at regular intervals with saline injections. When the desired size of a reconstructed breast is achieved, the filled tissue expander is allowed to "rest" for 2-3 months before it is removed and replaced with a permanent prosthesis.

Tissue expanders are usually replaced with silicone gel mammary implants. These are currently approved by the FDA for use in patients requiring a breast reconstruction and have recently been approved for costmetic augmentation as well.

Soft tissue reconstruction is another option. This includes the TRAM flap which takes soft tissue from the abdomen or a latissimus dorsi flap which takes tissue from the back. The tissue is placed at the site of your mastectomy so your breast is reconstructed out of your own tissue. This operation requires 5-6 hours in the operating room for one breast and 8 or more for two. This surgery is not appropriate for all patients, such as those who have had certain previous abdominal surgeries or with other underlying health conditions, however it may be an option for some. Doctor Kiesnowski will discuss the suitability of this type of surgery and its risks and benefits with you at your initial consultation.

Nipple reconstruction is performed in the office under a local anesthetic and is usually of minimal discomfort to the patient. The nipple is reconstructed from your own tissue and usually takes about 1-2 hours. You are awake and alert throughout the procedure.

Following the initial nipple reconstruction sometimes the pigment in the new nipple will fade. If so, the new nipple can be tattooed to match the areola on the opposite side to give a more symmetrical appearance to the reconstructed breast. This is done by Doctor in the office under a local anesthetic. Tattoos will fade over time and require periodic retouching.

Throughout your reconstructive procedure you will be followed closely post-operatively for a period of at least 1 year. As with other surgeries, Dr. Kiesnowski will perform your surgery at your insurance provider's participating hospital or outpatient surgery center.