Following a mastectomy, cancer patients face how to rebuild their lives, beginning with their breast.
Dr. Luther "Tripp" Holton
Dr. Luther “Tripp” Holton, a plastic and reconstructive surgeon with Novant Health New Hanover Regional Medical Center, performs comprehensive breast reconstruction techniques and counsels patients on which is the best option for their unique needs. By having access to top-tier specialists with a full complement of advanced techniques and therapeutics, patients can take charge of their breast reconstruction choices, he said.
Holton’s goal is not just to allow patients to see their breasts without the reminders of their cancer, but ideally to help them love their new appearance.
“I feel incredibly lucky to work with breast cancer patients,” he said. “I am in the silver-linings business and that can be wonderful.”
Holton came to Novant Health in 2024 to offer this comprehensive menu of the newest and best breast reconstruction techniques to Eastern North Carolina.
Advancements in breast reconstruction surgery techniques
pDTI reconstruction
One of Holton’s areas of expertise is pre-pectoral direct-to-implant (pDTI) reconstruction, a permanent breast implant placed in front of the pectoral muscle during the mastectomy procedure. Informally, he calls this “breast in a day.” He performs this technique by working exclusively with breast surgeons who remove the involved breast or breasts while also managing to carefully preserve the remaining tissue.
"Ninety percent or more of these patients go to sleep with cancer in their breast then wake up after mastectomy with their permanent implant in front of the muscle,” Holton said.
For appropriate candidates, pDTI can offer significant benefits in terms of reducing surgical burden and recovery time. It’s ideal for people who want to stay the same breast size or just be slightly larger.
“More recently, I have been able to combine this technique with a breast reduction so an immediate implant result can often be delivered to women who hope to be smaller with younger-looking breasts that match,” Holton said.
Oncoplastic surgery
Holton is an advocate for oncoplastic surgery, a technique where breast surgeons and plastic surgeons work together to remove tumors through lumpectomy (partial mastectomy), then reconstruct the cosmetic appearance of the breast during the same operation with maneuvers like a breast lift or reduction.
“Quite honestly, this is what I would select if I needed breast cancer care,” Holton said. “It is the best of all worlds and typically allows a patient to maintain a healthy breast, including the nipples with sensation, and bypasses the need for future implant maintenance.”
Like pDTI, patients who receive oncoplastic surgery have their tumor removed at the same time their reconstruction is completed, and typically go home the same day.
Reconstruction from your own tissue
Holton also performs autologous tissue reconstructions, in which tissue from other parts of the body are removed then transplanted, using microsurgery, to create a new breast.
The most notable procedure of this type involves harvesting fatty tissue and skin from the abdomen to reconstruct a breast in what’s called the DIEP flap or a “tummy tuck” flap. It can result in a smaller belly (much like a tummy tuck) and new breasts without implants.
“We operate with a microscope and use suture needles that cannot quite be seen with the naked eye,” Holton explained. “We are currently assembling the team required to do these procedures so that patients in Wilmington will soon no longer need to travel for this type of advanced care.”
Changes in options during breast cancer reconstruction surgery
Saving the nipple
Oncologists and surgeons were historically reluctant to leave the nipple when removing breasts. Better imaging techniques and more targeted treatment mean that this has changed when there is no evidence of cancer in, or very close to, the nipple itself.
“Now we are increasingly able to maintain the nipple,” Holton said, which invariably yields a more natural and aesthetically pleasing outcome for patients when adequate blood supply remains for the nipple after the breast tissue is removed.
Holton is the first surgeon in the Wilmington region to use a process he calls “re-sensation.” This is a microsurgical nerve preservation and grafting technique that allows patients to potentially have more sensation in the skin of their breasts following mastectomy surgery.
Re-sensation helps restore “protective” sensation, allowing patients to feel when they touch or bump their reconstructed breast — an important safety and comfort benefit.
What patients can learn about their options
Holton hopes to help shift the mindset about breast reconstruction through better communication and collaboration between breast surgeons and plastic surgeons, who then can empower patients to find the best reconstruction options.
“It is important to remember that treating cancer is the most important goal,” he said. “When the treatment minimizes the visual reminders of the cancer diagnosis, patients can move on with thriving in their lives rather than simply surviving.”
Patients and their families can take an active role in ensuring they have access to the latest, most advanced breast reconstruction techniques. Holton recommends:
Ask your breast surgeon about a consultation with a plastic surgeon. This gives you the opportunity to learn about all your options.
Ask about the full range of reconstruction possibilities, from implant-based to autologous tissue procedures. Don't just accept the first recommendation — be informed about the pros and cons of each approach. A supportive care team will help you order your priorities and will inform you what would work and not work in your unique case.
Seek out plastic surgeons who specialize in breast reconstruction and continuously stay up to date on new techniques. This ensures you're working with a true expert who can discuss all the options that can safely work for you.
The main types of breast reconstruction
Four paths predominate: Flap procedures, implants, breast conservation, and no reconstruction.
Flap surgery: In flap surgery, tissue is excised from other parts of the body and is attached to the breast area to recreate the original shape of the breast. Depending on the amount needed, surgeons can use tissue from areas such as the abdomen, inner thigh, buttocks or back, and use microvascular surgery to reconnect nerves and restore some sensation to the breast.
Implants: Implants are a safe and viable option, and an important tool in reconstruction, Holton said. Implants can replicate the original breast size or be bigger or smaller. They can be placed beneath the skin and above the pectoral muscles of the chest, which often allows people to go home the same day following surgery.
Breast conservation during lumpectomy/partial mastectomy: A lumpectomy or partial mastectomy is commonly done to remove a small tumor from one breast. Increasingly, plastic surgeons are helping rebuild the affected breast in these operations. This allows the breast surgeon wider and easier access to the tumor, while also giving the patient the benefit of a rejuvenated breast that matches the unaffected breast.
No reconstruction: Patients have the option of “going flat,” or avoiding any reconstruction surgery. Women can use an external prosthesis or a specialty bra if preferred.
