PeaceHealth Medical Group works with PeaceHealth Southwest’s Kearney Breast Cancer Center to educate patients in Southwest Washington and the Portland area on their options before their breast cancer surgery (mastectomy) and develop their best reconstruction plan. Dr. Gabriel and Dr. Champaneria will collaborate with every member of a patient’s mastectomy treatment plan to deliver the optimal results throughout the process. This seamless collaboration and increased reconstruction options are instrumental in helping patients better deal with their diagnosis and treatment. Breast reconstruction surgery is an extremely personal choice and whether the patient decides to proceed with reconstruction immediately following their mastectomy or wait until they are more comfortable moving forward, the PeaceHealth Medical Group Plastic Surgery team will be there to help along the way. Dr. Gabriel and Dr. Champaneria have vast experience in many traditional breast reconstruction techniques, as well as newer, innovative treatments.
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.
Breast Reconstruction Reviews
"Dr.Gabriel performed my breast reconstruction in 2011 after my mastectomy. He had to make a nipple for me because mine had to be removed due to the cancer. He did this using an innovative method. He worked with my insurance company to insure my insurance company paid for the entire reconstruction. He made sure I got the best care I could possibly receive. My reconstruction is beautiful. He has made me whole again. I have been seeing him for two years. I feel so lucky to have him on my team. He has been supportive and has kept me informed of my rights and choices throughout my journey. He has made the difference between my surviving and thriving this ordeal. I highly recommend him to anyone needing a 5 star surgeon."- Anonymous / UCompareHealthcare / Aug 11, 2013
"Working with cancer patients (he does a lot of the breast reconstruction surgeries for our breast cancer patients) for the past 6 yrs I always and only heard wonderful things about Dr. Allen Gabriel through out the yrs. He has always been the nicest doctor anytime he would call our clinic to speak to one of our docs where a lot of doctors can be rude over the phone, but never Dr. Gabriel. I always knew that if I was to ever get any work done it would be hands down with Dr. Gabriel. I finally had the opportunity to make that dream happen and he surpassed all my expectations. He is hands down the most caring, compassionate, down to earth, funny, generous, honest and nicest doctor I've ever met. Not only is he one of the best in his field he has so much passion for what he does and it shows. He makes you feel like you are his only patient and the most important person. He and his staff go above and beyond for their patients and always makes you feel so welcomed anytime you come into his clinic or call. I am over the moon happy with all my results from my surgery. I trusted his judgment of what to do and what not to do and I am so glad I did. He did such an amazing job that if any of my friends or family was to have work done or myself again we would with out a doubt choose Dr. Gabriel as the doctor. I can't say enough wonderful things about him. He is one in a million and can't thank him enough for everything he has done for me. I truly wish there were more doctors out there with your passion, intelligence, compassion, generiousity, down to earth attitude and wonderful bedside manner with your patients. Thank you again for being such a wonderful doctor and person Dr. Gabriel!!!!!!!"- Anonymous / UCompareHealthcare / Jul 18, 2014
"Bilateral Breast Reconstruction Following Mastectomy - Vancouver, WA - Dr. Gabriel is an amazing combination of brilliance, incredible medical expertise and skill, artistic perfectionism, strong integrity, tremendous compassion, and an unparelleled depth of understanding of the overall impacts of a breast cancer diagnosis for a woman and her husband. Dr. Gabriel's "whole body" approach to easing the anguish of a woman who has just received a cancer diagnosis is a very rare trait that sets him so far apart from other surgeons in the industry who may have great skill but lack the depth of compassion and understanding of how life has changed for a woman in this circumstance. I have so appreciated how incredibly caring, understanding, and compassionate Dr. Gabriel has been to both me and my husband as we have struggled with life's changes following my cancer diagnosis. His drive to ensure that "all of me" is doing well -- not just the reconstructed part -- is a trait that I cherish because I know just how real his passion is that I be made whole, in every sense of the word. He is dedicated completely to doing whatever he can to help my life return to normal. Dr. Gabriel remembered the date of the consultation I had with my oncologist when I was to receive my oncotype score that would determine whether or not I would have to have chemotherapy; he called me before I was even out of that consultation because he cared about this result and the impact it would have on me and my reconstruction, and quite simply just because he wanted to let me know that he was thinking about me . . . . and then we both celebrated when the results showed that I would not need any chemotherapy. Dr. Gabriel calls me immediately to let me know the results of any new suspicious growths he removes, because he doesn't want me to worry a minute longer than I have to about the results. He asks how my husband is doing if we're not both present at a follow-up appointment, and he always talks to my husband during each appointment so that my husband feels completely included in my care and the decisions we're making together. Dr. Gabriel seeks to ensure that I'm absolutely satisfied with the results and always talks about the options we have for making any needed changes. He looks me in the eye with such focus and concentration that I know I'm the only patient he has right at that moment and my entire health and welfare are his only concern. His reassurances throughout this difficult journey have kept me from panic more times than I can count, and the results I've received are nothing short of amazing when I look in the mirror. To be enhanced rather than deformed, to look normal rather than butchered or even compromised is a GIFT that Dr. Gabriel gave to me with the incredible skill of his hands, the sharp intelligence of his mind, and the genuine compassion in his heart that no woman should go through the rest of her life with devasting daily reminders in the mirror that cancer invaded her life.I have also been the grateful recipient of Dr. Gabriel's innovative and highly-successful surgical techniques and advances in silicone implants. Dr. Gabriel remains on the cutting edge (no pun intended) of new reconstruction techniques and implant innovations that will reduce the intense pain and enhance the natural appearance for women undergoing breast reconstruction, and I'm a walking testament to his commitment to continue to improve the reconstruction process for women. My results are amazing, and I walk with my posture erect and my head held high because I am proud that I survived well and blessed that I had an amazing doctor on my side to help make this happen for me."- S. / RealSelf / Jul 05, 2014
"Breast Cancer/Double Mastectomy/Breast Reconstruction/Latissimus Flap - Vancouver, WA - Dr. Gabriel is an AMAZING man!!! Not only is he a top notch surgeon, but has the best bedside manners I've ever encountered with a doctor. He makes you feel like part of his family and is just down to earth. With all five surgeries I've had Dr. Gabriel has personally called me to see how I'm doing. Then to top it off, he does absolutely beautiful work!! I am truly grateful that he was referred to me."- A. / RealSelf / Sep 03, 2014
"Breast Reconstruction Revision/implant Replacement. Vancouver, WA - I would give Dr. Gabriel a 5 star rating in every category. His bedside manner is impeccable as is his aftercare and follow up. He encourages patients to call him if they have ANY concerns and he gets back to you immediately. His staff are very knowledgeable, professional, warm and welcoming. He answers all questions thoroughly. He is truly a wonderful surgeon and Vancouver is very lucky to have him in our community."- H. / RealSelf / Dec 11, 2014
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.
Musculocutaneous flaps take muscle from other areas of the body, like the abdominal muscles, to reconstruct the breast that has been removed. Since muscle does not grow back, muscle flaps can create weakness in the donor site that may limit actions. While muscle flap breast reconstruction may be best for some patients, others may consider microsurgical breast reconstruction techniques that use perforator flaps. These options can be reviewed on the page for microsurgical breast reconstruction.
TRAM flap (Transverse Rectus Abdominis Myocutaneous) reconstruction procedure uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and then tunneled up through the chest wall, or be completely detached, and then formed into a breast mound. This breast reconstruction technique is beneficial because the tissue and skin transferred from the abdomen is very similar in softness and look to the breast. Additionally, due to the removal of abdominal skin and tissue, the patient will also receive a tummy tuck, resulting in a tighter stomach.
MS (Muscle Sparring) TRAM uses less muscle than a standard TRAM to create the new breast. The needed muscle, skin, and fat will still be removed from the lower abdomen, but much less muscle is taken. The surgical procedure is similar to a standard TRAM flap surgery.
Latissimus Dorsi Flap
A latissimus dorsi flap procedure uses the skin, fat, muscle, and blood vessels from an area on the back, just below the shoulder. The latissimus dorsi flap breast reconstruction often looks very natural and it is best for women with small to medium sized breasts. If needed or wanted, an implant can be added to the latissimus dorsi flap for additional size and an improved shape.
Reconstruction With Implants
A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction. Dr. Gabriel or Dr. Champaneria will help each patient decide their best treatment plan. Reconstruction with an implant alone usually requires tissue expansion. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a lengthier reconstruction process. It requires many office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin. A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.
AlloDerm® Regenerative Tissue
AlloDerm Regenerative Tissue Matrix is made from carefully screened donor tissue to help provide extra support that may be needed during breast reconstruction. AlloDerm can be used in a one-stage implant reconstruction or in a two-stage implant reconstruction with tissue expansion. The use of AlloDerm during breast reconstruction helps the new breasts look more natural and feel comfortable. The added framework allows the plastic surgeon more control when forming the breast shape and size.
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, and the patient may feel disoriented with the newly formed chest. 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.
Botox for Pain Reduction
Dr. Gabriel and Dr. Champaneria developed a method that uses BOTOX to decrease the pain created by a breast expansion implant. After noticing the pain in their patients' chest from the contracts and spasms of the expansion implants, Dr. Gabriel and Dr. Champaneria began using BOTOX injections to temporarily paralyze the affected chest muscles and minimize the pain. Dr. Gabriel and Dr. Champaneria published a paper in the Aesthetic Surgery Journal that details their work and findings. The full paper can be found at asj.oxfordjournals.org/content/35/4/402.long.
Plan Your Procedure
- Recovery Time
- 2-3 Weeks
- Average Procedure Time
- 2-3 Hours
- Post-op Follow-up
- 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.
BOTOX for Pain Reduction?
Dr. Gabriel and Dr. Champaneria recently did a pilot study in which they evaluated the role of BOTOX in tissue-based breast reconstruction which can often be painful and discomforting after the procedure. Conclusions based on the study showed that BOTOX can be beneficial in expander-based reconstruction in reducing pain and aiding in expansion.
Read the pilot study: http://asj.oxfordjournals.org/content/35/4/402.long