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Breast Reconstruction

Dr. John Q. Cook is an experienced Chicago breast reconstruction surgeon that many women have trusted to restore their breasts.





John Q. Cook, M.D.

Chicago 312-751-2112
Winnetka 847-446-7562

There Are Important Decisions You Will Need to Make About Breast Reconstruction

If you are considering breast reconstruction surgery, there are a number of important decisions you will need to make about your surgical plan. These decisions include the timing of reconstruction, the type of reconstruction, and the treatment of the opposite breast

(If you are to undergo a single rather than a double mastectomy.)

The information that I am sharing with you here comes from the experience I have gained in my over 20 years of breast reconstruction surgery. The majority of the breast reconstruction surgeries that I perform are at Rush University Medical Center, an academic medical center in Chicago and a major center for the treatment of breast cancer.

The Timing of Breast Reconstruction Surgery

If your surgeon has recommended mastectomy as the treatment for your breast cancer and you are interested in breast reconstruction surgery, the first decision you will need to make is whether to have immediate reconstruction or delayed reconstruction.

Immediate Reconstruction after Mastectomy

The advantage of immediate reconstruction is that the main step of your reconstruction can be carried out as soon as your general surgeon finishes the mastectomy. If I am to be your plastic surgeon, I will coordinate my schedule with your surgical oncologist at Rush. If you have been referred to me and do not yet have a general surgeon to do the mastectomy, I will arrange for an expedited referral to one of our breast surgeons. Even though I have a very busy schedule, my team knows to make room in my schedule on a priority basis for breast reconstruction patients.

Different types of reconstruction can be done immediately after mastectomy. This includes reconstructions with implants and tissue expanders as well as reconstructions that involve flaps from the abdomen or back.

When given the choice, most of our patients opt for immediate reconstruction. Even though the reconstruction is usually not complete with a single operation, it is a work in progress, and this helps to give our patients a psychological boost during the recovery.

Why Would A Patient Not Opt For Immediate Reconstruction?

Some patients feel overwhelmed by the number of decisions they need to make, and they may choose to just focus on treating the breast cancer and then deal with the reconstruction at a later date. Some patients have aspects of their breast cancer that will require aggressive treatment with radiation and chemotherapy, such that it may be better to carry out the reconstruction when they have completed this process. There are also patients who are perfectly comfortable with how their bodies will look after mastectomy and prefer to use a simple breast prosthesis which fits inside the bra.

I generally recommend that patients who have decided to undergo delayed reconstruction still come to see me for a consultation before the mastectomy. This is because the information I give them provides a clear understanding of what the eventual reconstruction will involve, and this helps to provide peace of mind.

Delayed Reconstruction after Mastectomy

I see many patients for delayed reconstruction. A good number of them were either too overwhelmed at the time of mastectomy to consider reconstruction or had surgeries at hospitals where there was not a strong commitment to immediate reconstruction. Some had complex issues with their initial treatment that required such attention that it made sense to consider breast reconstruction at a later date.

Since I perform the vast majority of my reconstructions with tissue expanders and implants, for reasons that I will describe later, the good news for my delayed reconstruction patients is that I can usually carry out all of the steps for delayed reconstruction as outpatient procedures with relatively quick recoveries.

There Are Two Very Different Possible Paths to Breast Reconstruction

Breast reconstruction can be achieved with two very different approaches. The method that I use most commonly is to place a tissue expander under the pectoral muscle and skin of the chest after mastectomy has been carried out. The tissue expander is a breast implant with a valve into which I can add salt water and gradually stretch the new breast to its desired shape and size. At this point I replace the tissue expander with a permanent implant and do other things to shape the breast in an outpatient surgery.

The other method of reconstruction involves the transfer of your own tissue, typically from the back or from the middle of the abdomen to the area of the breast. This is referred to as flap reconstruction or autologous reconstruction, which means that the breast comes from your own tissue. It is necessary for the surgeon to maintain a blood supply to the tissue that forms the new breast. The two main ways of doing this are a) using a muscle that provides a lifeline to the flap via an artery and vein that run through the muscle and into the overlying fat and skin; and b) finding a set of vessels that nourish the tissue that forms the new breast and sewing these vessels to the arteries and veins near the breast.

I generally prefer implant reconstruction to flap reconstruction for reasons that will be explained when we consider the goals of breast reconstruction surgery.