Robert M. Wald, Jr., MD - The Aesthetic Institute
Contact Us : (714) 312-3549

Orange County | Fullerton, CA

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Category: Breast Reconstruction

Choosing a Breast Reconstruction Technique

Breast Reconstruction Before and AfterWhether you are considering breast reconstruction following your mastectomy or would like reconstruction performed at the same time as your mastectomy, your consultation is very important. Breast reconstruction techniques vary depending on the extent of your mastectomy and your natural physique. Personal preference, recovery, and postoperative effects can also sway you away from some techniques. While not every woman qualifies for every technique, Dr. Wald will provide you with detailed options that can help you achieve the breasts you desire.

Tissue Expanders With Implants

Using tissue expanders with implants is one of the least invasive breast reconstruction techniques. An empty tissue expander is placed in the breast pocket following your mastectomy. Over a period of months, the expander is gradually filled with more and more saline, effectively stretching the breast tissue to make room for an implant. During a final surgery, the expander is removed and replaced with a permanent implant.


  • Doesn’t require transplanting harvested tissue
  • Shorter recovery period
  • Less invasive surgery
  • Control over the size and shape of the breasts using implants


  • Not ideal for women with thin breast tissue
  • May cause tissue loss in women who have undergone radiation treatment
  • Risk of the breast capsule constricting

Latissimus Dorsi Flap

The latissimus dorsi flap uses tissue harvested from the patient to recreate the breast mound. Skin, fat, and muscle are removed from a selected portion of the back, often along the bra band area, to hide scarring. The tissues are then transferred to the breast mound. In some cases, a free flap may be used, where the tissue is attached to a new blood supply at the breasts. In other cases, the tissues may remain attached to the original blood supply. Smaller breasts may be formed from just the transplanted tissue, or implants can be used to increase the size and improve the shape of the breasts.


  • Reliable procedure
  • Provides adequate tissue coverage for the implant
  • Low risk of the breast capsule constricting


  • Visible scarring on the back
  • Loss of strength in the back where muscles were removed
  • Possible circulation problems with transferred tissue


The TRAM flap also uses patient-harvested tissue to create the breast mound. However, this technique uses tissue harvested from the abdominal region. One of your rectus muscles along with skin and fat are tunneled under the skin to the breast mound. A new breast is created, and, in most cases, the provided tissue is adequate so that an implant isn’t required. A synthetic mesh is used to strengthen the abdominal wall to prevent complications.


  • Natural-looking breast results
  • Patients receive a minor tummy tuck in the process
  • No risk of the breast capsule constricting
  • Scars can be hidden beneath clothing


  • Weakness of the abdominal wall
  • Possible hernia formation
  • Poor circulation can cause tissue loss

Nipple Reconstruction

Nipple reconstruction is usually the final step of breast reconstruction and helps provide a natural breast appearance. Tissue is taken from the upper thigh or behind the ear, areas which are typically darker pigmented to provide contrast. The tissue is shaped to appear like a nipple and then placed. To achieve more realistic coloring, many patients have the nipple and areola tattooed following their reconstruction.

If you are considering breast reconstruction, schedule your consultation with Dr. Wald today. Contact our office at (714) 312-3549, or fill out our online contact form here for additional information.

Breast Reconstruction Surgery in Orange County

Innovations in Breast Reconstruction Surgery Enhance Results

breast reconstruction surgery

Breast Reconstruction Surgery Images

Plastic surgeons for the last few years have human tissue (Acellular Dermis) available that enhances our breast reconstruction results.  This material (Alloderm), made by Life Cell, gives extra coverage and support in selected patients.  By placing this material under the breast skin and subcutaneous tissue we are able to help prevent rippling of an underlying breast implant.  This also is true for a very thin cosmetic patient.  Recent articles suggest that ACD may also help prevent capsular contracture.  Even though the results with ACD are still early, it appears that this material will continue to enhance our results.

Breast Revision procedures for post-breast reconstruction and post-breast augmentation are also enhanced by ACD.  Problems such as bottoming out, inframammary fold malposition and breast asymmetries can be corrected using this material.  There appears to be very few problems associated with ACD and it has been found to be extremely safe.  I have found ACD to be very helpful in problem cases.

Dr. Robert Wald

Advances in Breast Cancer Reconstruction

Patients who are faced with breast cancer and require a mastectomy, have many options for reconstruction. Our techniques continue to improve. One of the newest techniques is the use of alloderm or strattice dermal sheets of prepared tissue. By using these materials at the time of mastectomy with tissue expanders, a more natural breast shape and contour can be achieved. Immediate expansion of the overlying breast skin is accomplished. In patients that are candidates for skin sparring and nipple/areola preservation, a breast implant may be placed immediately and avoid the need for prolonged expansion.

These regenerative tissues help mask implant palpability and visibility and bottoming out of the implant. In my experience, I have found these new tissues to be beneficial and improve my results in breast reconstruction.

Dr. Robert Wald

Dr. Wald Looks forward to
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Robert Wald, MD
100 E. Valencia Mesa Drive, Suite 300
Fullerton, CA 92835

Phone: 714-312-3549
Fax: 714-738-1862

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