Dr. Becker is recognized both nationally and internationally as a leading authority in breast reconstruction in Florida. He has lectured and published extensively on this important subject.
In recognition of National Breast Reconstruction Awareness Day, Dr Hilton Becker had the honors to speak on the evolution of breast reconstruction as part of a panel of experts covering the evolution of breast reconstruction surgery, options available, potential complications and life, body image and sexual health after breast cancer.
Evolution of Breast Reconstruction
October 17, 2019
Hilton Becker, MD
Dr. Becker Developed a New Technique of Breast Reconstruction Following Mastectomy.
Dr. Hilton Becker presented at Ground Rounds at the Division of Plastic & Reconstructive Surgery University of Miami, on October 30th, 2018. The title of the lecture:
Immediate Breast Reconstruction Using a Pre-Pectoral Spacer.
The Surgeon performs a skin / nipple sparing Mastectomy when possible. The scar is placed beneath the breast where it is then hidden in the fold. If the breast is sagging a vertical incision is used which elevates the breast.
The breast is reconstructed by placing an adjustable spacer/implant in the pocket where the breast tissue was removed from. The tissues are injected with long acting local anesthetic thus reducing the pain after surgery. Patients may be discharged on the same day or spend the night in the hospital.
Once the circulation to the breast skin improves further saline is added to the spacer. Once the correct volume is achieved the injection port attached to the spacer/implant is removed leaving the implant in position. Alternatively, the saline implant can be converted to a gel implant. If the patient wishes, Fat grafting can be performed, and the spacer/implant removed.
See video below.
Following bilateral mastectomy with vertical scar and prepectoral breast reconstruction with adjustable saline implantView Gallery
Innovator and Developer in Modern Breast Implants
Dr. Becker is best known as the inventor of the adjustable breast implant, known as the Becker Expander Mammary prosthesis. The Becker Expander implant functions as a tissue expander, and then converts to a breast implant after the tissues have been expanded sufficiently.
Now that skin sparing mastectomies are being performed, expansion of the skin is less necessary. It is advantageous, however, to place the implant underfilled to prevent excessive pressure on the overlying incision and skin flap in order to prevent wound breakdown and tissue loss. The adjustable implant is therefore initially placed underfilled and only filled once healing is assured.
Breast Reconstruction at the Time of the Mastectomy in Single Surgery
Traditionally, a tissue expander is placed at the first surgery and used to expand the overlying skin. It is then removed at a second surgery and replaced with a breast implant. Thanks to the invention of the Becker Expander implant, a second operation may no longer be necessary to replace the expander with an implant; it can all be accomplished in a single surgery, by simply removing the injection port once the correct size has been obtained during the Boca Raton breast reconstruction surgery.
The Becker Expander implant has become one of the most widely used implants for breast reconstruction. It is used by surgeons in many countries throughout the world.
Breast Reconstruction With Fat Grafting
Thanks to recent advances in tissue transfer, it is now possible to reconstruct the breast following mastectomy using the patient’s own fat. This is done without implants or complex surgical procedures. Dr. Becker is a pioneer in fat harvesting techniques having developed several instruments currently used in this procedure. He has now combined techniques developed in the United States and Europe to offer the patient breast reconstruction using their own fat. Fat is harvested during a liposuction procedure.
The procedure is often enhanced with external expansion known as the BRAVA®. This is an external expansion device that stretches the skin before the fat is injected. Recovery is more rapid and there is less down time. The breasts feel natural and sensation often returns. An added benefit is the body contouring as a result of the liposuction.
Fat grafting can be done:
- At the time of the mastectomy and continued after surgery
- As a delayed procedure after the mastectomy
- To correct complications following previous surgery
- Following lumpectomy and radiation defects
Fat tissue contains fat derived stem cells. These cells stimulate healing, increase the circulation and have a rejuvenating effect on the tissues. Fat grafting therefore is also used for facial rejuvenation and correction of scarring such as burns wounds and radiation.
Results of Breast Reconstruction – The Technique Matters.
The results of our Florida breast reconstruction surgery following mastectomy are directly related to the mastectomy technique that is performed. The techniques used for mastectomy are dependent on the nature of the condition being treated and the philosophy of the treating surgeon.
Reconstructive Options for a Patient Diagnosed with Breast Cancer
The reconstructive options are directly related to the surgery recommended by the surgeon to deal with the breast cancer. The surgical options include:
- Lumpectomy and Radiation
- Radical mastectomy
- Modified radical mastectomy
- Skin-sparing mastectomy
- Nipple-sparing mastectomy
The reconstructive options will also depend on the individual patient’s’ health, breast size, shape, and weight.
Lumpectomy and Radiation
- No further treatment may be necessary
- Fat injections can be used to fill in the deformity
- Rotation of surrounding tissue can be used to fill in the defect (Oncoplastic repair)
- Breast reduction following lumpectomy
The reconstructive options will also depend on the individual patient’s’ health, breast size, shape, and weight.
Radical mastectomy is performed less frequently than in the past. Reconstruction after a radical mastectomy requires flap repair. Modified radical mastectomy and nipple sparing mastectomy are more common, and can involve:
- Direct to implant reconstruction at the time of mastectomy
- Tissue expander placement at the time of mastectomy with second stage placement of silicone gel implant
- Adjustable breast implant placement at the time of mastectomy
- Flap reconstruction
Any of the above techniques may be performed, including fat injection with external expansion. Examples of the above techniques are available on this website.
Frequently Asked Questions
What is breast reconstruction?
Breast reconstruction is the procedure performed following mastectomy for breast cancer to restore the breasts.
There is a large variety of procedures that can be done including using the local tissue to reconstruct a small breast, adding fat grafting after the surgery, placing a cohesive silicone implant or an adjustable saline implant at the time of the mastectomy, and a variety of flaps and microsurgical procedures.
Why choose Dr. Becker?
Dr. Becker invented the Spectrum adjustable implant, which he uses most commonly in breast reconstruction. He has developed a technique where the adjustable implant is placed above the muscle without any additional mesh or acellular dermal matrix. Following the initial procedure, the breast is further improved by fat grafting to the skin flap. The adjustable implant can be replaced with a silicone gel implant and if acellular dermal matrix is necessary, it is placed at the second stage.
Does the “Virtually Scarless” breast lift damage the functionality of the nipple?
Loss of sensation of the nipple can occur with any breast lift; but is extremely rare. In the “Virtually Scarless” breast lift, the nipple is raised and there is no cutting of the deep tissue where the nerves may enter the nipple.
Dr Becker’s Surgical Technique in Breast Reconstruction
Due to the fact that surgeons are now more frequently performing skin sparing and even nipple sparing mastectomies, it is more feasible to place the expander above the muscle. Placement above the muscle has several advantages:
- Reduction of animation deformities (abnormal implant movement as a result of muscle contraction)
- Shorter surgery time, less post-operative pain and discomfort
- Less invasive surgery
In cases where additional protection is needed for the incision, such as cases with excess tension on the incision or poor blood supply for patients with thinner skin flaps, the implant is placed below the muscle. The implant can be placed above the muscle at the second procedure.
Dr. Becker discusses breast reconstruction in Boca Raton with Adjustable Implants
Breast Cancer and Diet
Prophylactic Mastectomy with Immediate Reconstruction
For women diagnosed with breast cancer, or advised by their surgeon to undergo a prophylactic mastectomy, revolutionary new procedures have become available that enable a patient to undergo a mastectomy with the possibility of preserving all the breast skin, the areola and even the nipple.
Prophylactic preventative mastectomy is the surgical procedure performed to remove one or both breasts in an effort to prevent or reduce the risk of developing breast cancer.
There are several options available to patients undergoing prophylactic mastectomy and reconstruction.
One of the techniques that many patients do not know about is that of nipple-sparing mastectomy: one stage reconstruction using an adjustable implant placed above the muscle.
The advantage of this technique is that it avoids the problems related to implant placement under the muscle such as abnormal breast movement when the muscle contracts and high riding implants due to the muscle tending to elevate the implant.
The adjustable implant enables the reconstruction to be done at the time of mastectomy.
Dr. Becker is a pioneer in this procedure, having been the developer of the Becker adjustable gel implant and the Spectrum adjustable saline implant.
While a flap can be used to replace the volume of the breast, the implant developed by Dr. Becker (the Mentor Becker 50/50) is considered by many surgeons to be the ideal implant to reconstruct the breast following prophylactic mastectomy.
The adjustable implant is placed above the muscle. The injection port which attaches to the implant is placed beneath the skin.
Once healing is assured (usually 1-2 days) filling of the implant is done by injecting saline into the port. Filling is usually completed in several days. The injection port is removed under local anesthesia once the patient is satisfied with the results.
As the implants are placed above the muscle, there is less pain and no abnormal distortion of the implant by the muscle. Saline is added once the skin has sufficiently healed, and then over-expanded to improve the shape of the breast. The volume is then reduced, and the injection dome is removed through a tiny incision. In select cases where circulation to the skin is not comprised, a gel implant can be used to eliminate the need for delayed filling or expansion.
Dr. Becker, an internationally known plastic surgeon, is the inventor of the adjustable breast implant and has published over 30 articles and contributed chapters to plastic surgery textbooks. He serves as an instructor at national plastic surgery meetings, lectures internationally, and holds regular workshops around the world demonstrating his sought-after surgical techniques
Dr. Becker, an internationally known plastic surgeon has pioneered this procedure. He is the inventor of the adjustable breast implant and has published over 30 articles and contributed chapters to plastic surgery text books. He serves as an instructor at national plastic surgery meetings, lectures internationally, and holds regular workshops around the world demonstrating his sought-after surgical techniques
Becker Adjustable Implant
For more information on the Becker adjustable implants, Click here. http://www.beckerbreastimplants.com
- Volume can be changed after surgery
- Patient has input into final size
- Better able to correct asymmetry
- Better able to treat complications following previous breast surgery i.e., irregularities in shape, capsular contracture, symmastia (disruption of midline)
Now you can change the size of your breasts without additional surgery.
The adjustable breast implant, which was developed in 1985 by Dr. Becker, is used in this procedure. The implant consists of a membrane that is filled with saline via detachable dome. Saline (salt water solution) is added or removed from the implant post-operatively by inserting a thin needle through the skin into the injection dome. Once the patient is satisfied with the size and shape of her breasts, the dome is removed usually three to six months post-operatively. The implant seals at the self-sealing valve. alternatively the injection dome may be exteriorizied and removed one week later.
If the patient wishes to enlarge (or decrease) the size of her breasts after surgery, a needle is placed through the skin into the injection dome. Saline solution is then injected (or removed) to adjust to the size (and shape) of the breast. When the patient is satisfied with the result, the injection dome can be removed under local anesthetic.
It is the ability of the adjustable breast implant to correct or improve difficult breast problems such as ptosis, tubular and unilateral breast development that makes this implant so unique. The adjustable-fill breast implant is useful in expanding underlying tissue and generating more breast tissue to create a more natural and symmetrical breast shape. Because these implants can be filled gradually over a period of several months, discomfort is minimized while the skin slowly stretches. In order to avoid the unnatural, hard-looking appearance of some augmentations, especially the upper fullness. Adjustable breast implants can be overfilled, then the volume reduced, allowing the breast to relax, producing a more natural appearance.
For more information on the Becker adjustable implants, visit http://www.beckerbreastimplants.com
Dr. Becker’s response to questions on realself.com
Dr. Becker believes that single-stage breast reconstruction affords his patients several important benefits. “The advent of single-stage reconstruction enhances the physical and emotional well-being of my patients because it allows them to awake after their mastectomy with some breast fullness that will be expanded to their satisfaction.”
Technical Information Breast Reconstruction: Complication Rate and Tissue Expander
Many patients look as good, if not better, after their bilateral mastectomy and reconstruction then they did before the surgery. For more information about options in breast reconstruction, please call (800) MENTOR-8.
It is important to note that every woman’s body and medical condition is different; so not all women are eligible for single-stage reconstruction. Your doctor is the best person to discuss with you whether or not single-stage breast reconstruction is a suitable option.
Dr. Becker has published numerous articles on this procedure. He lectures nationally and internationally and has been featured on 20/20, Healthcare network, MSNBC Special Edition and Extra. He was listed in Good Housekeeping as one of America‘s Top 184 Breast Cancer Reconstructive Surgeons.