Breast Reconstruction Specialist Dr. Constance M. Chen Offers Tips for Patients

Among women who opt for reconstruction after losing a breast to mastectomy, 80% undergo reconstruction with implants. “Many women see implants as the quickest, simplest reconstructive option”, says plastic surgeon and breast specialist Dr. Constance M. Chen. “Their other choice – natural-tissue reconstruction – requires a more complex surgery and longer recovery time”. However, studies have shown that the risk of cosmetic and health problems with implants in the first few years is significant and the risks increase over time. Implants aren’t expected to last forever. Most have a ten-year warranty although many will have to be removed before that.

Studies have shown that the risk of cosmetic and health problems with implants in the first few years is significant and the risks increase over time. Implants aren’t expected to last forever.

Dr. Constance M. Chen

Implants fail for many reasons. Different types have different characteristics that women must weigh against their individual requirements and preferences but all implants are foreign bodies and pose the risk of comfort and cosmetic problems. Dr. Chen describes some of the common complications and unsatisfactory results of implant reconstruction and provides tips on corrective measures and on options if implants have to be removed.

Infection can develop in the tissue around an implant, often in the days or weeks following surgery. That said, infection has been seen 20 years after implant surgery. Women with breast implants should take antibiotics if they undergo teeth cleaning or colonoscopy. Signs of infection are redness and swelling. Treatment with an antibiotic may be sufficient; if it isn’t, the implant may have to be removed.

Capsular contracture is a tightening – or contracting – of the scar tissue that forms around the implant as a natural reaction to the presence of the implant. The capsule is usually soft and barely noticeable but it may become hard and painful, like a calcified shell that develops around the implant. Symptoms of contracture usually develop gradually and may be noticed first as a feeling of mild tightening.

As contracture increases, the breast may appear misshapen and become very firm and painful, especially when lying on it. Treatment is to remove the implant and capsule surgically, but the capsule will reform and usually become harder more quickly. In some cases, the implant may be replaced with a new one wrapped in acellular dermal matrix to try to reduce capsular contracture; in others, natural-tissue reconstruction may be the best option.

Rupture becomes more likely as an implant ages. Saline implants may appear deflated or misshapen. Silicone implant ruptures are either silent, or they present as unusual pain due to the irritation to the surrounding tissues. Since silicone implant ruptures are silent, the FDA recommends breast MRIs for surveillance every 2-3 years for women with silicone implants. Ruptured implants are generally removed as long as the patient is healthy enough to tolerate surgery.

Displacement of the implant can occur for several reasons, one of which results from the placement of the implant under the chest muscle (sub-pectoral placement). Placement of a breast implant under the chest muscle can cause the breast to feel tight and painful, and flexing the chest muscle can also cause the implant to shift visibly under the skin and distort the breast.

The problem can be corrected by removing the sub-pectoral implant and placing a new implant above the muscle (pre-pectoral). A prepectoral breast implant is closer to the natural anatomy of the breast, because the natural breast is also above the chest muscle. The new implant may be wrapped in acellular dermal matrix to provide some additional soft tissue protection under the skin.

Many women who have had unfortunate experiences with implants prefer not to try again, even with a different type of implant or modified surgical procedure. They turn to natural tissue breast reconstruction, also known as autologous reconstruction, which is the ‘gold standard’ of breast reconstruction. Natural tissue breast reconstruction uses a woman’s own tissue to create a breast that is soft and warm and that lasts a lifetime.

Feeling cold occurs because there is no blood supply to the implant and because the skin that remains after the removal of breast tissue can be quite thin. Fat-grafting can help by adding additional ‘padding’ over the implant, but it is often of limited utility. A better solution is natural-tissue reconstruction, which recreates a soft, warm living breast.

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

Correcting Breast Asymmetry after Cancer Surgery and Reconstruction

Dr.-Constance-M-Chen

The goal of breast reconstruction after mastectomy is to restore symmetry – to create a breast with the shape and softness of the original that is in proportion with her opposite breast as well as the rest of a woman’s body. Matching a reconstructed breast to the existing natural breast may not be possible in a single surgical procedure, however. Follow-up modifications may be necessary to achieve the desired symmetric result.

“Breast reconstruction is often a process rather than a single surgical procedure”, says Dr. Constance M. Chen, board-certified plastic surgeon and breast reconstruction specialist. “Lack of symmetry in mastectomy patients after reconstruction can be corrected with adjustments to the reconstructed breast or to its unaffected ‘sister.’ Asymmetry may also be a problem for women who have had a lumpectomy that conserved the breast but left them with breasts that no longer match. For all these women, advanced surgical techniques that address their individual needs can produce an improved symmetrical outcome to help put cancer behind them”.

The gold standard in post-mastectomy reconstruction is natural tissue breast reconstruction, which uses a woman’s own tissue to recreate a soft and warm breast. The best possible result is achieved when reconstruction is performed at the same time as the mastectomy, because the surgeon can preserve the entire breast envelope including the nipple-areola complex. Even if it is not possible to preserve the entire breast envelope, the incisions can be carefully planned to preserve as much of the breast shape as possible. In addition, symmetry is often best in bilateral mastectomy with immediate reconstruction, when both breasts are removed and reconstructed at the same time, because it is easier to match size, shape and position.

Reconstructed breasts can be very difficult to distinguish from the original, but there are many reasons why ‘best case’ scenarios may not be feasible. For example, most breast surgeons do not perform nipple-sparing mastectomies, and the traditional transverse-scar mastectomy distorts the breast shape significantly. In addition, most women undergo breast reconstruction with implants rather than natural tissue, and the resulting breasts may have the artificial shape of an implant. Furthermore, there are medical and personal reasons that reconstruction may be performed months or even years after mastectomy, when the skin envelope has been distorted even more. And finally, if only one breast needs to be reconstructed, symmetry can be more difficult to achieve. In each scenario, however, it is possible to make adjustments not only to the reconstructed breast but also to the unaffected breast to improve symmetry.

Dr. Constance M. Chen

Techniques for Improving Symmetry. One of the most common procedures for correcting small defects is fat grafting, which transfers fat from another part of the body to the breast. Using liposuction, fat is removed through tiny incisions from the donor site, processed to remove impurities, and injected into the breast. Fat grafting and liposuction may be used on the unaffected breast, to make corrections to the reconstructed breast, or to fill in deficiencies resulting from lumpectomy.

A mastopexy or breast lift may be performed on the unaffected breast if its natural droop cannot be replicated in the reconstructed breast. This is often the case with implant-based reconstruction, which tends to create a breast that is “perkier” than the natural breast. A breast lift will remove excess skin and may elevate only the nipple and areola so they are placed higher on the breast or elevate the breast tissue itself so it sits higher on the chest wall.

A breast lift will not significantly alter the size of the breast. A breast reduction on the unaffected breast may be needed to match the size of the reconstructed breast. The procedure will remove excess skin and tissue and position the breast tissue and nipple-areola complex higher on the chest wall. Breast augmentation to increase the size of either the reconstructed or the unaffected breast may be achieved with fat grafting or with a breast implant.

Surveys have found that women whose breast reconstruction is symmetrical and aesthetically pleasing have improved postoperative quality of life compared to those who perceive their breasts as mismatched. “It’s important for women to know that they don’t have to live with asymmetrical breasts and that achieving balance will not impose a financial burden”, says Dr. Chen. “The 1998 Women’s Health and Cancer Rights Act requires health insurers that cover mastectomy to also cover all stages of reconstruction and secondary procedures as well as surgery on the opposite breast to achieve symmetry. At the end of the day, after undergoing breast reconstruction, women are entitled to have symmetrical breasts”.

 

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

 

 

 

 

Nipple Reconstruction: Creating a Natural Breast After Mastectomy

Dr.-Constance-M-Chen

Breast reconstruction recreates a breast mound either with implants or with the woman’s own tissue. In either case, nipple reconstruction can be performed in a separate surgery from the original breast reconstruction. “Modern techniques in mastectomy and breast reconstruction offer women many options,” says plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen.

Many women are candidates for nipple-sparing mastectomy, in which the nipple is preserved during the mastectomy. For women whose nipple has been resected a more traditional type of mastectomy, however, it is possible to surgically reconstruct the nipple to recreate a complete breast.

Dr. Constance M. Chen

There are several ways to create a new nipple and areola. The most common technique for nipple reconstruction uses the remaining breast skin after a mastectomy. The skin is folded and sutured to form a new nipple, and then the new nipple and surrounding skin is tattooed to create the nipple-areola complex. If there isn’t enough healthy skin to create a new nipple from the remaining breast skin, a skin graft may be used from another site, usually the groin.

The skin graft is then folded and sutured to create a new nipple. For patients who undergo a unilateral mastectomy and have a large nipple on the remaining breast, a nipple-sharing technique may be used in which part of the native nipple is resected and transferred onto the reconstructed breast. In each type of nipple reconstruction, the nipple is often dressed with antibiotic ointment and a special medicated gauze dressing that is then placed into a protective shield or ‘nipple house’ that remains in place for a week.

After the reconstructed nipple has healed, tattooing may be used to add color and create the areola. Some women forego nipple reconstruction altogether, and instead choose 3D tattooing to create the illusion of a nipple on the breast mound. “Many women feel that breast reconstruction improves their quality of life.” says Dr. Chen. “Surgical advances make it possible to create a soft, warm, natural breast that can be difficult to distinguish from a woman’s own breast. Many women would like to look normal without clothing. They feel that a breast that looks more like their original breast will help them put cancer behind them. Nipple reconstruction helps many women move on from their mastectomy and feel that they have restored their breast for a more confident future”.

 

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.