Feel whole again, emotionally and physically

Breast Reconstruction Rochester NY

Breast reconstruction is a complicated, highly individualized procedure. Pioneering the latest advancements microsurgical techniques, Dr. Vega offers specialized options for your full recovery.

Dr. Stephen VegaDedicated to Restoring Your Well-Being

Dr. Stephen Vega Dr. Stephen Vega is a board-certified plastic surgeon who is nationally recognized as one of the top breast reconstruction specialists in the country. A true leader in the field, he has pioneered new techniques and procedures in breast reconstruction.

Dr. Vega completed five years of residency at University of Rochester Medical Center (URMC) and then fulfilled a one-year fellowship specializing in breast surgery under the mentorship of Dr. Joseph M. Serletti. He continued his work with URMC for nearly 5 years as a faculty surgeon.

During this time, Dr. Vega focused his efforts on revolutionizing breast reconstruction practices and procedures. His work on microsurgical techniques, such as the SIEA, DIEP and TUG-gracilis flaps, has been instrumental in the advancement of these cutting-edge surgeries.

Dr. Vega opened Vega Plastic Surgery in 2009, after 10 years at URMC. His driving goal has always been, and continues to be, to stay at the cutting-edge of innovation and improvement in order to provide the best possible care and service to his patients.

Breast Reconstruction Testimonial

Thank you so much for your care—pre, during and post my breast reconstruction. Your friendly, informative, professionalism eased my mind of much of the stress I might have felt. - Kathie Quote

Personalized Care & ConsultationHelping You Select the Best Procedure for Superior Results

There are several breast reconstruction methods, and the many options available can feel overwhelming during an already difficult time. Dr. Vega is committed to ensuring that each patient understands her options and feels comfortable and confident in the decision she and Dr. Vega make together.

The Right Reconstruction for You

Every woman has a different story and different options for reconstruction. For example, thinner women are typically not ideal candidates for flaps, while implants aren’t recommended for women who will be having radiation. Some surgeries are performed at the same time as the mastectomy, while others occur several months later.

The information included here will help you understand the methods available and the advantages and considerations of each. Select a procedure to learn more:

Implant Reconstruction Overview

Reconstruction of the breast using a saline or silicone permanent implant is one option. This is performed in two stages. The first stage involves placement of a tissue expander underneath the pectoralis muscle. This is typically done at the same time as the mastectomy. Over the following few weeks, once your incisions are well healed, we expand these “balloons” through a small port accessible right underneath the skin with injectable saline. Once you have reached a size that you like, we schedule you for the second stage, removal of the expander and placement of the permanent implant.

The initial surgery takes approximately 1-2 hours in addition to your mastectomy surgeon and depending on whether we are reconstructing one or both of your breasts. The initial hospital stay is usually 1-2 days.

For the second stage surgery where we remove the expander and place a permanent implant, you can return home that same day. This second surgery takes only an hour or two. The total recovery time for implant reconstruction is 3-4 weeks for the first stage and approximately 1 week for the second.

There are many good reasons why implant reconstruction might be the best option for you, although it is best to keep all of your options open as you discuss your treatment with our surgeon.

Autologous Tissue Reconstruction Overview

Autologous tissue reconstruction is offered to patients through two different techniques: a pedicled (or attached) flap or by a free flap microsurgical technique. Because Dr. Vega specializes in microsurgery, we are able to provide you with a free flap for reconstruction of the breast. The “free” flap is named as such because in order to perform this operation, the tissue is “freely” removed from your body for reattachment.

The most common donor site for breast reconstruction is the abdomen. Here there are three major flaps that we can use for your reconstruction: the SIEA (superficial inferior epigastric artery flap), the DIEP (deep inferior epigastric perforator flap) and the free TRAM (or transverse rectus abdominis myocutaneous flap). Another newer less common site for breast reconstruction is the upper inner thigh using the myocutaneous gracilis flap or TUG flap. This flap has the added benefit of giving you a natural breast without leaving you with any functional deficit as the gracilis is a redundant muscle of the adductor muscles in the thigh. Dr. Vega performs all of these operations on a routine basis, both for one sided and two sided defects. Ask him during your consultation which flap will be best for you.

On average, operating time for these flaps is 4-8 operating hours, depending on if we are reconstructing you with one or two breasts. You will always spend at least two to three days in the hospital for the nursing staff to monitor your new tissue reconstructions. Total recovery time for the abdominal based tissue flaps is 6-8 weeks. For the gracilis or TUG flap the recovery is even faster, closer to 3-4 weeks. Most patients are completely happy with their first surgical results and a few require revisions, but you can expect to return to full activities within 2-3 months.

DIEP Flap

DIEP Flap

A now commonly used flap by microsurgeons to reconstruct a breast mound, this refers to the Deep Inferior Epigastric Perforators. This flap is composed of tissue taken from your lower abdomen (the same tissue taken in a “tummy tuck”), to make a breast mound. This is the same tissue from the lower abdomen, as in a TRAM flap, but it consists of skin and fat only; no muscle is used. Because of this the abdominal wall will normally remain strong and have good muscular tone. This is a more complicated flap to perform than the pedicled or free TRAM because it involves increased dissection of the flap vessels to save muscle and abdominal wall function. Not all patients are candidates for this procedure, but if you are a candidate, this will usually make your long term recovery from surgery easier.

The advantage to using the lower abdominal tissue for surgery is that women get a flatter midsection, like a “tummy tuck”. In cases where women have excess lower abdominal tissue, this is a very good operation, because the reconstructed breast mound is natural feeling and projecting, and ages with you despite your body type. Sensation will never be normal as your breast has been removed, but the flap will gain protective (temperature and pain) sensation over time. Because it is made of your own tissue, it is a very natural type of reconstruction.

Because of its complexity, DIEP flap surgery is not available everywhere. However, Dr. Vega is very experienced in this flap and performs this routinely, which is the most important factor in searching for an experienced surgeon.

Silicon Implants

TUG Flap

This is the most modern of the free flaps or autologous tissue flaps (natural or own tissue flaps) for breast reconstruction. The TUG flap or Gracilis flap takes the tissue from the inner thigh of the patient and makes a breast mound just like the other tissue flaps. The tissue is taken from the upper, inner thigh of the patient and the scar from the donor site is easily concealed, and infrequently seen. Dr Vega has extensive experience with the TUG flap or Gracilis Flap and has been performing this for breast reconstruction since 2004.

The big advantage of this flap is that there is no abdominal wall incision making the recovery faster for the patient. The TUG also has the advantage of giving the patient natural breast mounds through a concealed hidden incision. Because of the redundancy of adductor muscles in the inner thigh, the gracilis muscle can be taken for the TUG flap reconstruction without any functional impairment.

SIEA

SIEA Flap

This is the best but least frequently used of the the flaps for breast reconstruction from lower abdomen. SIEA stands for Superficial Inferior Epigastric Artery flap. The vessels used for this flap run in the subcutaneous fat of the lower abdomen. They are very small and not present in at least half of the patients who present for breast reconstruction. But when they are present they can be used and provide for a completely natural breast mound without any incision into the muscle of the abdominal wall. This is a commonly used flap in cases where natural tissue flaps are used for both breast mound reconstructions. It is used in this case to make the recovery better in the short term and long term.

The advantage to using the lower abdominal tissue for surgery is that women get a flatter midsection, like a “tummy tuck”. In cases where women have excess lower abdominal tissue, this is a very good operation, because the reconstructed breast mound is natural feeling and projecting, and ages with you despite your body type. Sensation will never be normal as your breast has been removed, but the flap will gain protective (temperature and pain) sensation over time. Because it is made of your own tissue, it is a very natural type of reconstruction.

Dr. Vega performs this operation frequently and successfully, which is very important. Because the caliber of these vessels is very small (half the size or smaller than the DIEP), it is a higher risk operation, but in the right hands success rate for this flap should be close to, if not exactly that of the other lower abdominal flaps.

TRAM Flap

TRAM Flap

The TRAM flap consists of the skin and fat from the lower abdomen and a portion of the Transverse Rectus Abdominis Muscle. This muscle is also known as the “six pack” muscle of the abdomen. Because this muscle carries the blood supply to the skin and fat of the lower abdomen this is commonly used to reconstruct a breast mound. Traditionally this procedure was performed by flipping the muscle up to the removed breast site without disconnecting the blood supply.

Today this procedure is most often performed as a muscle sparing free TRAM flap. This means that instead of taking the whole muscle and flipping it up, the skin and fat is removed from the lower abdomen (like a tummy tuck procedure), with a small amount of muscle, hence “muscle sparing”. This makes the reconstructed breast mound easier to mold into a breast and gives it more reliable blood supply which can be used in most patients who desire this reconstruction. The blood vessels (which happen to be the same ones used in the DIEP flap) are then micro surgically reattached to vessels in your chest to give you a new breast mound.

The advantage to using the lower abdominal tissue for surgery is that women get a flatter midsection, like a “tummy tuck”. In cases where women have excess lower abdominal tissue, this is a very good operation, because the reconstructed breast mound is natural feeling and projecting, and ages with you despite your body type. Sensation will never be normal as your breast has been removed, but the flap will gain protective (temperature and pain) sensation over time. Because the muscle sparing free TRAM is made of your own tissue, it is a very natural type of reconstruction. In the long run the outcomes from this operation for breast reconstruction are more natural than those obtained by implants alone.

It is important to note that tissue can be taken from your abdomen only once. If you ever need a second breast reconstruction, the tissue used will come from a different site.

Nipple Sparing Overview

A nipple-sparing mastectomy, is a way to remove breast tissue, and save the breast skin and nipple. This allows the woman to maintain her nipples, in which the traditional mastectomy does not. The nipple-sparing procedure removes cancerous breast tissue, and removes the ducts and tissue behind the nipple. The surgeon leaves most of the breast skin, creating a natural skin envelope, or pocket, that is filled with a breast implant or with the patient’s own tissue from another part of her body. The nipple-sparing techniques significantly improve the cosmetic outcome and gives a nice option for patients but not appropriate for all patients.

It is important to remember that not all patients are candidate for this procedure. It is important to consult with your breast surgeon and your plastic surgeon to find out if you are a good candidate for this type of breast reconstruction.

Nipple Reconstruction Overview

After breast reconstruction you can decide if you'd like to have your nipple reconstructed. Nipple reconstruction is done after the reconstructed breast has had time to heal.

The nipple would be reconstructed from the surrounding skin at the desired placement. Dr. Vega makes small incisions and then elevates the tissue into position, forming and shaping it into a living tissue projection that mimics the natural nipple.

The new nipple can then be tattooed to add color and create the areola around the nipple. Melanie Morreale is our recommended tattoo specialist.

Nipple Reconstruction Gallery

3D Nipple Tattooing Overview

3-D nipple tattoos are a non-surgical option and offer very realistic results. This is accomplished by real tattoos that use oscillating needles coated with pigment. This approach essentially creates a “picture” of a nipple and has no physical dimension, but it can look quite real.

Learn more about our recommended tattoo specialist Melanie Morreale and view sample tattoos using the tabs to the left.

About Mellanie Morreale

Melanie MorrealeHello, my name is Melanie Morreale. I attended art school in 1992, majoring in graphic art. Some of the things I loved were color theory, photography and illustration. I started my tattooing apprenticeship while in school and began working full time as an artistic tattoo artist right after college.

In 2000, I opened Rite of Passage in Victor, NY and have been doing my artistic tattooing ever since. I love what I do and that I to get to know so many colorful clients. Beginning in 2002, I started doing medically supervised work such as permanent make up, camouflage, and corrective tattooing. I have found that this has been some of my most rewarding work. It has been a great pleasure to work with patients. I enjoy my areola work the most due to the dramatic difference in appearance and the importance of the procedure. I am so grateful to have the opportunity to feel like I may possibly make a difference for these women. I look forward to working with Vega Plastic Surgery as their tattoo artist and am happy to join their team.

What to Expect During the Procedure

When you come to the office, we will start by discussing any questions or concerns you may have regarding your procedure. You will sign consent forms which we will review together. Before and after pictures will be taken; while necessary for your medical record, you can decide where/how these pictures may be used.

If you are having your areolar and nipple area done, we will go over size and preferred placement and find a color that is complimentary to your skin type. This is the longest part of the procedure, as I mix pigments and adjust tones until we are both certain it’s “just right.” The actual tattooing takes about 15 minutes per side. Most patients find the tattooing either painless or only mildly uncomfortable.

Once I am finished, we will take the time to ensure we’re both completely satisfied with your result. At this point I will remind you that what you see when the tattooing is complete, is not the final tone of your areolas healed. Immediately after a tattoo, your skin will appear irritated and red. After the healing process, your new nipples and areolas will appear much lighter and more natural.

After the procedure, I will go over after care instructions with you and send you home with detailed, written instructions for your reference.

Frequently Asked Questions

Planning your appointment

If you are planning a vacation of swimming and sun or plan on using a hot tub, please make sure you allow at least 2 weeks between your appointment and your trip. This will give you enough healing time and you will be most comfortable.

On your appointment day

It is important to have had something to eat, come relaxed and to be in good health for your appointment. If you would like to bring a friend, please do so; anything to make you feel more comfortable. It’s also nice having another opinion when making size and color choices.

How long does it take for tattoos to heal?

The healing process takes about 2 weeks, and you will want to carry ointment and lotion with you during this period. Tattoos heal best if the area is kept clean and moist.

What if I have concerns afterwards?

If there are any adjustments that you would like made to your areolas, I will gladly do so. Please make sure that it has been 6 to 8 weeks before scheduling another appointment. We want you to be completely healed before tattooing in the same area, as this avoids creating scar tissue.

Remember, having realistic expectations and being well informed will yield the best outcomes. As mentioned above, what you see is not what you get on the day your tattoo is done. Your areolas will initially appear much darker, with red undertones (due to expected skin irritation). I promise, the final look will be much more natural.

My philosophy

It is important to me that this part of your journey feel like you’ve “reached the finish line and won the race,” so if there is anything I can do to make this a more pleasant experience, please do not hesitate to ask. Thank you.

Breast Reconstruction Testimonial

Heartfelt thanks for all that you have done to help me through such an emotionally traumatic time. I feel that I have been blessed to have such a gifted surgeon. What you do for breast cancer patients is amazing and I thank you for your dedication. - Teresa Quote

What to ExpectBefore and After Surgery

Consultation

You will meet with Dr. Vega staff to discuss options. You will then return to meet with Dr. Vega for coordination of surgery. Together you’ll review the methods available and select the one he believes will give you the best possible result.

Financing Available Through: Care Credit

Pre-Operation

One week before surgery you 'll meet with Dr. Vega's staff to have pre-operative visit. On the day of surgery, you will be seen and have an opportunity to meet with Dr. Vega. He will review your procedure with you and perform an exam to confirm that you’re in good health for your surgery. You may have paperwork to complete or be given prescriptions to fill; we may also take “before” photos. As always, we will answer any questions and discuss any concerns so that you feel completely confident as your surgery approaches.

Breast Reconstruction Testimonial

The highlight of my day was Dr. Vega coming in with his wonderful cheerfulness and joyful encouragement. To describe a cancer experience as wonderful seems odd, but it has been just that. These people have reminded me of what true compassion and understanding are. - Elizabeth Quote

Final Preparation

One day before your surgery, confirm the arrangements for your procedure (including transportation) and to prepare your home for a relaxing and comfortable recovery. Shower with antibacterial soap, avoid eating or drinking after midnight, and be sure to follow any other specific instructions provided by Dr. Vega and our staff. Please remember to avoid Aspirin, Vitamins and other homeopathic medications unless specifically discussed with Dr. Vega and staff.

Surgery

Please plan to arrive early to check in and prepare for your procedure. You should wear loose-fitting, comfortable clothes, and leave jewelry and valuables at home. You can expect to remain in the recovery room for several hours following completion of the surgery. When you get home, start taking your pain medication and antibiotics, and limit your activity for at least the next 24 hours.

Recovery

We will schedule follow-up appointments as necessary throughout your recovery. Dr. Vega will assess your healing, remove or change dressings, and document your results. Based on your progress, he will also let you know when you can expect to resume normal activities.

Breast Reconstruction Testimonial

Having cancer is a life changing experience. I knew I had made the right choices for doctors.– I am extremely pleased with the way everything turned out. I feel like a new woman. - Karen Quote

Schedule a consultation to learn more about your breast reconstruction options.
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