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 breast reconstruction for large ptotic breasts. Safer with better shape and outcomes.

Innovative Breast Reconstruction for Large-Breasted Women with Ptotic Breasts: A Two-Stage Approach by Dr. McClellan

In breast reconstruction, especially for women with larger, ptotic (sagging) breasts, traditional methods often struggle to deliver the desired outcomes, leading to complications and aesthetic compromises. Dr. McClellan's innovative two-stage approach offers a new solution, addressing common reconstruction challenges by prioritizing patient safety, reducing complications, and improving breast shape and contour.

Stage One: Skin-Sparing Mastectomy with a Wise Pattern Incision

The initial stage involves a skin-sparing mastectomy through a Wise pattern incision, which allows for better control over the skin envelope, removing excess skin and preparing a smaller, lifted breast shape. Dr. McClellan will join your general surgeon in the operating room and help them to perform the mastectomy to optimize outcome. This approach helps avoid complications often encountered with traditional techniques.

Reduced Necrosis and Infection Risk: The Wise pattern incision method allows for more effective skin envelope management. As noted in Plastic and Reconstructive Surgery, “Wise pattern mastectomy designs facilitate skin sparing while reducing the complications associated with skin necrosis and infection.” By avoiding a tissue expander and allografts, Dr. McClellan’s technique further lowers the risk of infection and skin breakdown.
Optimized Aesthetic Results: Shaping the skin envelope at the initial stage creates a better foundation for implant placement, which supports a more natural, symmetrical breast contour post-reconstruction. A report in Aesthetic Surgery Journal mentions that “a two-stage approach in ptotic breasts can lead to improved aesthetic outcomes by controlling skin tension and shape.” This method is instrumental in achieving the refined, lifted look that patients desire.

After the mastectomy, patients stay in the hospital for one night. They typically require only oral pain medication and antibiotics when they go home the following day. Drains, which stay in for about one week, are designed for minimal discomfort, making removal a simple and generally painless process.

Stage Two: Implant Placement with Minimal Discomfort

Two months after the mastectomy, once the skin envelope has healed and settled, patients return for the second stage of reconstruction. This outpatient procedure involves re-entering through a 4.5 cm incision at the inframammary fold. As described in Breast Cancer Research and Treatment, “Revisiting initial incisions often increases the risk of delayed wound healing and infection,” which makes the new incision approach highly effective. This stage is typically a day surgery, with minimal pain reported by most patients.

Dr. McClellan selects Mentor Boost Gel implants for this stage, ideal for their cohesive, natural feel. Studies in Journal of Plastic, Reconstructive & Aesthetic Surgery have shown that “Boost Gel implants provide superior contour and feel for post-mastectomy reconstruction, especially in patients with larger breasts.” Their stability and shape retention help create a lifted, aesthetically pleasing appearance, even in larger-breasted patients.

The Results: A Natural, Lifted Look with Minimal Discomfort

This unique approach to breast reconstruction for large-breasted women with ptotic breasts offers a range of benefits:

Fewer Complications: By eliminating the need for tissue expanders and allografts, Dr. McClellan’s technique effectively lowers the risks of necrosis, infection, and potential allograft failures, an outcome highlighted as significant in Plastic and Reconstructive Surgery.
Improved Shape and Contour: The two-stage approach and Wise pattern incision allow for a smaller, controlled skin envelope, which supports a more natural and lifted breast shape in the final result.
Enhanced Patient Comfort: With Exparel nerve blocks, a single night hospital stay, and minimal pain in both stages, patients can experience a smoother, more comfortable recovery.

Dr. McClellan’s innovative technique redefines breast reconstruction for large-breasted women, delivering beautiful, lasting results with an emphasis on safety, comfort, and aesthetic excellence.