Breast Reconstruction

Dr. McClellan and his team take Breast Reconstruction very personally and want to make sure your journey is safe and successful. We do this by leveraging the latest technology and techniques possible, some of which has been developed by Dr. McClellan himself. For example we use special incisions, equipment, devices, and take every facet of your health history into consideration in order to improve outcome.

Below you will find some information to help you understand breast reconstruction. This information will be updated and expanded periodically, so make sure to check back. We are here with you throughout your journey and look forward to taking care of you.

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What is a Breast Reconstruction?

Breast reconstruction is a surgical procedure performed following a mastectomy. It helps restore the natural look and feel of a woman’s breast. Breast reconstruction can allow clothing to fit better, help maintain the natural proportion of a woman’s body, and most importantly boost the self-confidence for women that have lost one or both breasts to mastectomy. Breast reconstruction is most generally a multi-staged procedure, meaning there are general at least 2 surgeries to achieve the final result.

What is a Allograft or ADM Breast Reconstruction?

Dr. McClellan uses an Allograft also called an Acelluar Dermal Matrix in order to help rebuild the area around your breast following a skin sparing mastectomy. This structural matrix help to stabilize the implant, reduce capsular contracture, and thickens the skin flap as you body grows into the matrix following surgery.

What type of incision is used for mastectomy?

The standard incision used for mastectomy is a simple ellipse around the nipple areola complex. When this incision is closed its becomes a straight line across the chest. This type of incision has been used for more than 40 years to complete the mastectomy. Dr. McClellan doesn’t like the surgical look that this straight line creates. This led him to design a new incision for the skin sparing mastectomy. He designed the “Lazy Lateral” skin incision specifically for the skin sparing mastectomy. This incision provides a more natural breast shape and projection for the woman while giving outstanding visualization for the cancer surgeon to remove tissue and lymph nodes. Please see the paper below that Dr. McClellan wrote on the design of a better, more aesthetic, mastectomy incision to improve patient outcome and satisfaction.

Click to read Dr. McClellan's paper on the Lazy Lateral Incision

How do you make sure the skin flaps are ok from the mastectomy before reconstruction?

Using state of the art technology of Laser Assisted Indocyanine Green Angiography
This technology is named SPY-PHI and has had a remarkable improvement on Dr. McClellan's practice to improve safety and outcomes.
Making sure the skin flaps have good perfusion is a combination of both the breast surgeon as well as the plastic surgeon who is inspecting the flaps. Blood supply to the skin flaps is critical because robust blood supply is needed for incision healing as well as to get the Acellular Dermal Matrix integration in implant based reconstruction.
Utilizing the SPY-PHI system from Stryker involves injecting a harmless die called indocyanine green into the bloodstream through your IV and looking at the skin with a special camera to evaluate blood flow to the edges of the wound. This technology is so important because skin edges that appear viable to the naked eye may in fact not be viable when examining blood flow digitally. Knowing this information helps to determine if the breast reconstruction can be completed, guides the filling of the Tissue expanders, and shows the Plastic Surgeyr where to resect non viable tissue to improve skin healing.

Click the picture watch a Video in which Dr. McClellan uses the SPI-PHI system from Stryker to evaluate skin flaps following a skin sparing mastectomy.

Will my reconstruction be 1-step or 2-steps?

The number and length of surgeries depends on what type of breast reconstruction you elect to have. The most common way to reconstruct the breast is called a Tissue Expander Implant reconstruction. Typically you would receive the tissue expander, or balloon, at the time of mastectomy followed by a second stage operation that would occur approximately 3 months later.

How long do I have to stay in the hospital after breast reconstruction?

Hospital stay following skin sparing mastectomy it typically just one night in the hospital. Surgeries are performed at Mon Health Center in conjunction with the general surgeon of your choosing. Following surgery you're are admitted for observation to a private floor bed. The next day both the general surgery team and the plastic surgery team will see you and determine to send you home.

What is the pain like after mastectomy and breast reconstruction?

After you go to sleep to undergo the mastectomy, the anesthesia team will perform a pectoralis block on you in order to provide pain relief after the procedure. The shots typically last a few days if the drug named Exparel is used; which is a long acting bupivicane. This medication is placed below and between the pectoralis muscle groups providing very good non-narcotic pain relief. Although the block doesnt provide total pain relief it reduces pain significantly.

Click to watch a Video in which Dr. McClellan and Anesthesia team perform a pectoralis block in order to reduce pain from breast surgery.

Dr McClellan innovates new 5-Step Delayed Breast Reconstruction

A Safer, More Thoughtful Approach to Breast Reconstruction

Breast reconstruction is not just about restoring shape; it's about protecting your health, minimizing risk, and achieving the best possible long-term results. Over the past three years, I have developed and refined a reconstruction approach designed specifically to reduce complications while improving aesthetic outcomes. This method is called Tissue Optimized Delayed Direct-to-Implant Reconstruction. I created this technique out of necessity. The complications from traditional immediate reconstruction approaches were just too high, particularly when implants or tissue expanders were placed into tissue that was underperfused following mastectomy. I chose to take a different path, one that allows your body to heal first and then reconstruct under optimal conditions. I perform reconstruction this way because I believe it is better for you. It is not the fastest path, but it consistently produces safer outcomes, more predictable results, and better aesthetic results.

Why This Approach Is Different

Traditional immediate breast reconstruction often places an implant or tissue expander immediately at the time of mastectomy, frequently using a mesh or allograft for support. While this is common, it introduces a foreign body into tissue that has just been surgically traumatized and has a reduced blood supply. This creates an environment that increases the risk of infection, skin necrosis, fluid collections, and implant loss. In many studies, complication rates for immediate breast reconstruction approach 20 to 40%. My goal is to minimize these risks whenever possible, especially in patients who do not require radiation therapy. This approach is based on a straightforward concept. Let your body heal first, then reconstruct your breast under more ideal conditions.

The Five-Step Approach

Step 1: Precision Mastectomy and Surgical Planning

I am present and scrubbed in for your mastectomy alongside your breast surgeon. This allows me to design the incision, perform the initial incision, and ensure that your skin and tissue are arranged in a way that supports the best possible reconstruction later. For smaller breasts, I use a technique I developed called the Lazy Lateral Incision, which avoids the traditional straight-line scar and produces a more natural, aesthetically pleasing result. For patients with larger or more ptotic (lower) breasts, I use a Wise Pattern design, similar to what's used in a breast lift. The Wise Pattern allows me to control the breast envelope, remove excess skin, narrow the breast width, raise the height, improve symmetry, and place scars in more favorable and less visible locations. During your mastectomy, I prepare the future reconstruction pocket, place a drain, and personally close the incision.

In most cases, I do not preserve the native nipple areola complex (NAC) during the mastectomy. If the NAC is spared during mastectomy, it tends to scar and displace laterally, making it difficult to reposition in the future, which leads to a less aesthetic result. For NAC reconstruction after breast reconstruction, I prefer 3D nipple areola tattooing, which typically produces a more natural and symmetric appearance.

I also follow enhanced recovery (ERAS) protocols, including a Pectoralis I and II nerve block, which significantly reduces postoperative pain and greatly improves comfort after surgery. After the mastectomy, you will stay in the hospital overnight for observation and are typically discharged the following morning.

Step 2: Healing Without an Implant

After the mastectomy, your breast skin is closed without placing an implant, tissue expander, mesh, or allograft. A drain is left in place for about one week and then removed in the office. This is a critical part of the process. By avoiding foreign materials during this early healing phase, the risk of infection and other complications is significantly reduced. Your skin, blood supply, and lymphatic system are able to recover naturally, without added pressure/stress from a Tissue Expander or Implant pushing on the skin envelope.

If issues such as infection, hematoma, or skin healing problems do occur immediately post-op, they are much easier to manage because there is no foreign body present. Just as importantly, this approach helps improve the long-term outcome of your reconstruction. By allowing the tissue to heal fully before placing an implant, there is a lower risk of infection and better preservation of skin quality. This can lead to a longer-lasting implant and reduce the likelihood of needing additional procedures, such as early implant exchange or skin envelope loosening, in the first few years after surgery.

Step 3: Skin Conditioning and Recovery

Once the drain is removed, I have you begin a guided skin massage protocol for approximately two to three months. This helps maintain soft, flexible tissue and prepares your skin to accept an implant in the future. This step is often overlooked in traditional reconstruction, but it plays an important role in improving both safety and final aesthetic outcomes by allowing the tissue to become more pliable and better suited for reconstruction.

I typically recommend using Aquaphor or a body lotion to gently but firmly massage the breast skin. This helps improve lymphatic drainage, keeps the tissue mobile, and reduces the risk of scar tissue forming beneath the skin.

During this phase, I also allow you to return to exercise and normal activities sooner than with traditional reconstruction. In many cases, I incorporate physical therapy to help accelerate recovery and restore strength and mobility more quickly.

Step 4: Final Reconstruction in an Outpatient Setting

After two to three months, once your tissue is fully healed and ready, you return for a short outpatient procedure. At this stage, I place a properly sized silicone implant without the need for a tissue expander. The implant is positioned in a new, untouched submuscular plane, creating a clean surgical environment and avoiding scar tissue from the initial mastectomy.

The procedure is performed through a small incision under the breast, which helps keep scars discreet. I do not use mesh, allograft, or additional support materials. This allows for a more controlled and predictable operation with a lower risk of complications.

Placing the implant in the submuscular plane also provides important long-term benefits. It improves implant support and upper pole fullness and is associated with a lower risk of capsular contracture over time. Together, these advantages contribute to a more durable, natural-looking result that is less likely to require additional surgery in the future.

At this stage, I also perform a matching procedure on the opposite breast when needed. This may include a lift, reduction, or implant to improve symmetry and achieve the best overall aesthetic result.

Step 5: Return to Activity, Nipple Areolar Tatoo, Long-Term Outcomes

This approach is designed to create a safer, more reliable reconstruction with better long-term results. By separating the mastectomy from the reconstruction and allowing your body time to heal between stages, complication rates are significantly reduced compared to traditional immediate reconstruction. In my experience, this leads to more predictable outcomes, improved implant longevity, and a more natural overall aesthetic.

Recovery is also more streamlined. Most patients are able to return to normal daily activities and exercise within about three weeks, since this technique avoids the added stress and restrictions associated with mesh or allograft-based reconstruction.

Approximately 2-3 months after reconstruction is complete, 3D nipple-areolar tattooing can be performed in an outpatient setting. This is a simple, painless procedure that is customized to match your skin tone and desired appearance, helping restore symmetry and a natural look. There is minimal downtime, and for many patients, this final step is an important part of feeling complete and confident in their reconstruction.

Summary

Tissue Optimized Delayed Direct-to-Implant Reconstruction is designed to reduce complications, improve aesthetic results, and provide a safer, more controlled path to reconstruction. By allowing your body to heal first and reconstructing under optimal conditions, we can achieve better outcomes with significantly lower risk. If you have questions, I will walk through each step with you so you feel informed, comfortable, and confident in your care.

Selected References

Chun YS, Verma K, Rosen H, Lipsitz S, Morris D, Kenney P, Eriksson E. Implant based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plastic and Reconstructive Surgery.
Ho G, Nguyen TJ, Shahabi A, Hwang BH, Chan LS, Wong AK. Complications following immediate compared to delayed breast reconstruction. Annals of Surgical Oncology.
Zenn MR, Garofalo JA. Delayed immediate breast reconstruction: surgical technique and outcomes. Plastic and Reconstructive Surgery.
Nahabedian MY. Overview of implant based breast reconstruction and outcomes. Clinics in Plastic Surgery.
Sbitany H, Piper M, Lentz R. Prepectoral versus submuscular implant based breast reconstruction: outcomes and considerations. Plastic and Reconstructive Surgery.