Pros and Cons of immediate versus delayed post-mastectomy breast reconstruction

A new breast cancer diagnosis is emotionally challenging, and it becomes even more difficult when women must also make decisions about treatment during a stressful time. In the case of a woman who will have a mastectomy, the difficulty can be even more overwhelming due to the variety of options available and the choices she must make about if, when and how to have breast reconstruction.

According to Constance M. Chen a board-certified plastic surgeon and breast reconstruction specialist, “there are two types of breast reconstruction, breast implants and natural tissue breast reconstruction that uses the body’s own tissue, also known as autologous tissue breast reconstruction.” And with each scenario, there are multiple options. One time-sensitive consideration is whether to have the reconstruction performed immediately in the same surgery as the mastectomy, or delayed by months or even years after the mastectomy. Dr. Chen details the considerations of immediate versus delayed post-mastectomy reconstruction.

Immediate Reconstruction

One of the primary advantages of immediate reconstruction is blunting the emotional suffering from losing one or both breasts. “For many women, waking up from a mastectomy and seeing that she still has breasts is very positive”. Immediate reconstruction that conserves the nipple, areola, and skin is the highest standard in breast reconstruction. Nipple-sparing mastectomy preserves the entire skin envelope, which makes it possible to preserve the breast shape. Thus, regardless of the type of reconstruction, whether implants or natural tissue, the resulting breast shape will always be best after nipple-sparing mastectomy. When performed with natural tissue, the reconstructed breast has the added benefit of being soft, warm and alive, and it is also possible to reconnect nerves to restore feeling.

One drawback of immediate reconstruction is that the hospitalization and recovery time may be longer than with a mastectomy alone with breast reconstruction. Moreover, for women with advanced disease who need immediate chemotherapy, immediate reconstruction may delay treatment until after healing is complete.

Delayed Reconstruction

Delaying reconstruction sometimes shortens the recovery time after a mastectomy. If a patient has a high-grade tumor or advanced disease, she may elect to delay reconstruction so that she can start her chemotherapy or radiation therapy sooner. With both implants or with the woman’s own tissue – breast reconstruction can be performed after healing from the mastectomy is complete and after chemotherapy and radiation therapies, if those are required.

The biggest drawback to delaying reconstruction is the need for another surgery at a later date, and the potential for an inferior aesthetic result. This is particularly true if the patient has not undergone nipple-sparing mastectomy, and/or if the patient needed radiation therapy. Without nipple-sparing mastectomy, a significant amount of breast skin may have been removed, which permanently deforms the breast by changing the shape and flattening it. Radiation therapy also alters the remaining breast skin and tissue so that it does not stretch and heal normally. Without nipple-sparing mastectomy, the skin will need to be stretched with a tissue expander if using breast implants. With natural tissue breast reconstruction, skin from the patient’s donor site can make up for the lost skin, but it may appear as a patch. In these cases, there will likely be a need for additional follow-up procedures to improve the overall cosmetic result.

One of the biggest considerations driving the timing of reconstruction is whether the woman will need radiation therapy after her mastectomy. “Radiation therapy always automatically unfavorably affects the aesthetics of any breast reconstruction,” says Dr. Chen. “But if a woman wants autologous tissue reconstruction, she may be advised to postpone placing the natural tissue until her radiation is completed.” In these cases, the patient can undergo a delayed immediate reconstruction, in which a tissue expander is placed at the time of mastectomy to save the breast skin, and then the natural tissue reconstruction is performed after the radiation is completed.

The Takeaway

According to Dr. Chen, “women have the best aesthetic result and the most sustained level of satisfaction with nipple-sparing mastectomy and natural tissue breast reconstruction. Autologous tissue reconstruction produces a soft, natural breast that looks and feels like the breast lost to mastectomy. Most breast surgeons are reluctant to perform nipple-sparing mastectomy without immediate breast reconstruction, because of the deflated appearance of the breast skin. Whether immediate or delayed, however, preservation of the nipple-areola complex and all of the breast skin sets the foundation for the best possible breast reconstruction”.

“There are pros and cons to immediate and delayed reconstruction, and each woman must consider personal and medical reasons for choosing the best course of action for them. Breast reconstruction is an integral piece of managing breast cancer,” says Dr. Chen. “We’ve made amazing developments in our ability to reconstruct a breast that closely resembles the breast lost to mastectomy. Today more than ever we can offer women a wide range of options to fit their medical needs and personal preferences, including the choice of when to have reconstruction. Each breast cancer patient has unique needs and we can help her get the best care that is ideal for her”.

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.

Breastfeeding Won’t Cause Your Breasts to Sag and Nine other Surprising Facts about Breasts

More than any other organ in the human body, the breast occupies a place in our social and cultural landscape well beyond its physiological function to nourish our offspring. “The soft tissue that we think of as a breast is actually a mammary gland, a complex system of fat cells and ducts that produce milk and deliver it to a baby via the nipple”, says plastic surgeon and breast specialist Dr. Constance M. Chen. 

As much attention as we pay to the size, shape and appearance of a woman’s breasts, there are many fascinating facts – both important and trivial – that most people don’t know about breasts. Here are just a few of them.

1.   Breast size is hereditary. Genetics do play a role in determining breast size but not necessarily as you’d expect and they don’t tell the whole story. We inherit half our genes from each parent, so your breasts may not resemble your mother’s, her mother’s, or her sister’s. Your father’s genes have a say. “Environmental factors also play a role”, says Dr. Chen, “especially weight. Breasts are partly made up of fatty tissue so as you gain and lose weight, your breast size will change”.
2.   Humans are the only primates with permanent breasts. All mammals have breasts and produce milk for their young but we are the only ones who develop breasts at puberty and keep them throughout our lives. Others are temporary, growing when needed to nurse then receding until needed again.
3.   The ancient Egyptians knew about breast cancer as far back as 1600 B.C. Writings on papyrus describe tumors consistent with modern descriptions of the disease. Over the following centuries, many causes were suggested – from imbalances of bodily fluids to compression from tight clothing – and treatments ranged from cauterization to opium to arsenic.
4.   You cannot exercise your way to bigger breasts. “Breasts are made of tissue, not muscle”. says Dr. Chen. “They may change in size with hormonal and weight changes. But even exercising the underlying chest muscles won’t increase the size of your breasts any more than creams or lotions will”.
5.   Some animals get breast cancer. It is more common in dogs – and in some breeds – than in cats but tends to be more aggressive in cats. Spaying female dogs before their first heat dramatically reduces their risk of developing a malignant mammary tumor.
6.   Breastfeeding won’t cause your breasts to sag. Droopy breasts are a natural consequence of aging as skin loses elasticity and as dense breast tissue is replaced by fat, which is more prone to sagging. Smoking and multiple pregnancies are contributing factors but breastfeeding has no effect on elasticity and will not cause breasts to sag. Only corrective surgery can lift sagging breasts.
7.   The left breast is usually slightly larger than the right one. Very few women have perfectly symmetrical breasts. Differences in size up to 20% are normal. No one knows why the left breast is usually the larger one.
8.   Larger breasts don’t produce more milk. Milk production does not depend on the size of the breasts. Large breasts are often large because they contain more fat cells, not more milk-producing cells.
9.   Breasts are growing. The average bra size was 34B twenty years ago. Today, it is 34DD. Some of the change is due to companies inflating the sizes on their labels but increasing obesity, the number of women taking birth control pills, and exposure to environmental pollution are contributing factors.
10.   Breast implants won’t last a lifetime. Breast augmentation is the most commonly performed cosmetic surgery in the U.S. But women who get implants in their 20s should not expect to still have them thirty years later. “Most implants have a ten-year warranty”, says Dr. Chen, “but many develop problems well before then and have to be removed or replaced”.

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.

Advances in Post Mastectomy Breast Reconstruction: Nipple Preservation

Dr.-Constance-M-Chen

Mastectomy has changed a great deal over the years. Long gone are the radical mastectomies of your grandmother’s day which removed not only breast tissue but also extensive breast skin, lymph nodes, and underlying chest muscles. By the 1980s, the most common approach was the modified radical mastectomy, which left the chest muscles intact.

Since then, the standard mastectomy is the simple mastectomy in which all of the chest muscles, most if not all of the lymph nodes, and most recently, the nipple and areola complex are all preserved. When combined with an immediate breast reconstruction at the time of the mastectomy, these techniques produce a superior cosmetic result while eliminating diseased tissue.

Nipple-sparing mastectomy has become more widespread as more breast surgeons realize the importance of the nipple-areola complex to patients after surgery. Looking and feeling normal and whole improves self-esteem both for women who are losing a breast to cancer and for those who are considering prophylactic (or preventive) mastectomy because they are at high risk for breast cancer due to family history or because they carry a genetic mutation.

Dr. Constance M. Chen

Women who are considering skin and nipple-sparing surgery must be evaluated for factors such as the size, location, and nature of the cancer to ensure that they are good candidates for the procedure. Imaging and examination are performed to look for tumor in the nipple and to rule out symptoms such as nipple discharge that might indicate the presence of disease in the nipple.

During surgery, all breast tissue is removed and the breast specimen is submitted to pathology to ensure that there are no cancer cells in or near the skin and nipple complex. Nipple preservation is possible with both small and large breasts and can be used when reconstruction is to be either with implants or with a woman’s own tissue (‘autologous reconstruction’).

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

The primary benefits of skin and nipple preservation are the superior aesthetic outcome and the resulting psychological boost. The combination of skin and nipple preservation with autologous reconstruction produces a soft, warm, natural breast that may be difficult to distinguish from the woman’s original breast.

The risk of breast cancer is considerably greater for women who inherit a genetic mutation, such as the BRCA1 or BRCA2 gene, that makes a woman more likely to develop breast cancer. As more women become aware of their risk, those who test positive for the harmful mutations face the difficult decision of whether to reduce their risk by undergoing bilateral prophylactic mastectomy – preventive removal of both breasts.

These women may wonder if surgery that conserves the nipple will leave in place breast tissue that might be subject to cancer. The experience of thousands of women and their healthcare providers has been that nipple-sparing mastectomy is safe for women with genetic mutations and a major study in 2017 confirmed that prophylactic surgery essentially eliminates the risk of cancer with or without breast reconstruction.

(‘Oncologic Safety of Prophylactic Nipple-Sparing Mastectomy in a Population With BRCA Mutations’ by Jakub et al, was published in the Journal of the American Medical Association in September 2017.) The report concludes that nipple-sparing mastectomies are ‘highly preventive’ against breast cancer in a BRCA population.

For women with no indication of disease in or near the nipple, including those with BRCA mutations, a nipple-sparing mastectomy essentially eliminates the risk of breast cancer and offers the opportunity for state-of-the-art breast reconstruction that maintains both the woman’s health and her sense of self.

 

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.

 

 

 

 

 

Managing Expectations for Breast Reconstruction; It’s a Process

Dr.-Constance-M-Chen

Breast reconstruction has come a long way. Advances in surgical technique have made it possible to use a woman’s own tissue to construct a breast that is soft and warm and often very similar to the breast she has lost to mastectomy. This ‘autologous reconstruction’ has become the gold standard in breast reconstruction and can even offer women the possibility of reconnecting nerves to restore sensation to the breast.

Autologous reconstruction can be performed with excellent results at any time, but the best aesthetic outcome is achieved when we do reconstruction in a single surgery at the time of the mastectomy. When the woman awakes after surgery, she already has a new breast, which reduces the emotional impact of having lost a breast. However, it is important for women to know from her first surgical consultation that the breast she wakes up with after surgery – whether performed at the time of her mastectomy or later – may not represent the end of breast reconstruction but a giant first step. For most women, breast reconstruction is not a single procedure but requires a process of adjustments until the best possible result is achieved.

Dr. Constance M. Chen

The goal of reconstruction is to restore symmetry to a woman’s body – symmetry to her other breast and proper proportion to the rest of her body. Symmetry is easier to achieve when both breasts have been removed and are being reconstructed at the same time (bilateral reconstruction). When reconstructing one breast (unilateral reconstruction), it can be more difficult to match the size, shape, and position of the ‘sister’ breast and adjustments may be needed to one or both breasts to achieve the desired symmetry.

We have a wide range of techniques we can use to make the necessary adjustments. Each woman will have an individualized plan that may include one or more of these procedures.

Dr. Constance M. Chen

A mastoplexy or breast lift may be performed on the unaffected breast if its natural droop cannot be replicated in the reconstructed 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 the unaffected breast will typically involve placing a silicone gel or saline implant under the pectoral muscle.

Fat grafting, which transfers fat from another part of the body to the breast, is very useful for filling small areas to improve size, shape, and symmetry. Fat is removed from the donor site, frequently the abdomen, using liposuction, which suctions fat out through tiny incisions, and injected into the breast. Fat grafting and liposuction may be used on the unaffected breast or to make small corrections to the reconstructed breast.

Abdominal wall repair may be performed if tissue taken from the abdomen to fashion the new breast leaves the abdomen in need of improvements to its contour.

“Adjustments to autologous breast reconstruction are generally made after the initial surgery has healed and other treatments are complete”. says Dr. Chen. “They represent the final steps in a woman’s journey to restore her health and sense of self”.

 

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.

 

 

 

 

‘In Depth’ Series With Laurence Fishburne Discusses Breast Cancer Awareness

Photograph by Anna Shvets

Critically acclaimed actor Laurence Fishburne is given high praise for his compelling performances throughout the decades. Now the ‘King of New York (1990)’ actor is using his talents as host for public television’s ‘In Depth’ with Laurence Fishburne. The informational program highlights a large variety of globally essential topics to inform its viewing audience. An upcoming episode is to feature an issue that impacts the lives of many women worldwide: breast cancer.

In the United States, breast cancer is one of the most common types of cancer found in women. Statistically, 1 in 8 women in the U.S. will develop breast cancer in their lifetime. This type of cancer occurs when DNA changes make normal healthy breast cells cancerous.

Risk factors include a family history of breast cancer, being overweight, and women of a Caucasian or African American ethnicity have a higher chance of developing the disease. Regular self-examinations are recommended for catching breast cancer early on, as well as regular breast cancer screenings for women age 40 and up.

Breast cancer is a scary experience for any woman, which is why increased awareness of the disease is crucial in prevention and saving lives. ‘In Depth’ will reveal more details about breast cancer awareness in the new episode. The segment is expected to be distributed during October, or Breast Cancer Awareness month.

‘In Depth’ with Laurence Fishburne is carefully inspected before broadcast. The informational TV segment has accepted numerous awards for its endeavors.

Immediate vs Delayed Breast Reconstruction: What is Right for You?

Dr.-Constance-M-Chen

Among the many medical, personal, and financial decisions a woman must make following a diagnosis of breast cancer and the need for a mastectomy are decisions about breast reconstruction. Does she want reconstruction? What kind? When? With so many questions coming at her, some women are relieved to learn that the decision about reconstruction is one that doesn’t have to be made right away.

With proper planning before mastectomy, breast reconstruction can be done with excellent results months or even years later. That said, there are advantages to immediate reconstruction – in a single surgery at the time of mastectomy – and every woman should be made aware of all the factors involved and given the opportunity to decide what is best for her.

Dr. Constance M. Chen

Both immediate and delayed reconstruction are viable options whether the woman opts for implant-based breast reconstruction or natural tissue breast reconstruction (also known as ‘autologous reconstruction’, because it uses a woman’s own tissue to create her new breast). While many women see implants as the quickest, simplest reconstructive option, controversy about the long-term safety of implants has led more and more women to consider natural tissue breast reconstruction, which many consider to be the ‘gold standard’ in breast reconstruction. Dr. Chen explains the advantages:

Along with nipple preservation and techniques that reduce scarring, autologous reconstruction can deliver a soft, warm, natural breast that is similar to a woman’s original breast. In natural tissue breast reconstruction, the reconstructed breast is living so it grows and shrinks as the patient gains and loses weight. Furthermore, new advances also make it possible to reconnect nerves and restore feeling to the reconstructed breast.

Dr. Constance M. Chen

Whichever type of reconstruction is chosen, there are many factors that affect the timing of reconstructive surgery, including a woman’s age, the stage of her disease, her general physical condition, and her treatment plan. For example, women who will need post-mastectomy radiation therapy and want natural tissue breast reconstruction are best served by delaying autologous reconstruction. She can undergo either tissue expander breast reconstruction or no reconstruction at the time of mastectomy, and then undergo autologous reconstruction after radiation therapy is completed to avoid radiating and damaging the healthy new tissue in her reconstructed breast.

This decision should be discussed with her medical team as early as possible,” says Dr. Chen. “If, after weighing all the factors, it is determined that a woman is a good candidate for immediate reconstruction, she can then examine the pros and cons of each approach.

Dr. Constance M. Chen

Immediate reconstruction

Immediate reconstruction is performed in a single surgery at the time of the mastectomy. After the cancerous breast tissue is removed, the reconstructive surgeon fashions the new breast, either with an implant or with tissue from another part of the woman’s body, most frequently the abdomen. When she awakes after surgery, she has a new breast, which for many women can be an important factor in her psychological and emotional recovery. Additional advantages include the fact that she must undergo just one major surgery and hospitalization, which has financial implications and accelerates the sense that she is putting breast cancer behind her.

Another important consideration is that it is sometimes easier to achieve a satisfactory aesthetic result with immediate reconstruction. The combination of skin- and nipple-sparing techniques with immediate reconstruction produce the best possible cosmetic result.

Dr. Constance M. Chen

One disadvantage of immediate reconstruction is that while it entails only a single surgery, it is a more complex surgical procedure with a longer hospital stay and recovery period. Also, because mastectomy is often time sensitive, there is less time for a woman to think through what kind of reconstruction she wants or whether she wants reconstruction at all.

 

Delayed reconstruction

Since delayed reconstruction can be performed months or even years after her mastectomy, a woman can complete all other treatments and give plenty of time to her decisions about whether or how to have reconstruction. She might also consider that her initial mastectomy will be a simpler procedure and she’ll recover more quickly.

We want every woman to understand the options available to her and make the decision that is best for her. Surgical techniques have come a long way and we can assure every woman that whatever choice she makes, we can help her achieve the best possible result and reconfirm her sense of self as she puts breast cancer behind her.

Dr. Constance M. Chen

The primary disadvantage of delayed reconstruction is that she will require a second surgery and hospitalization. The scarring from the mastectomy may also limit options for reconstruction. Also, since the breast skin will shrink after mastectomy, the shape and size of the original breast will be lost and sometimes it is difficult to remove skin creases that have developed.

 

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.

 

 

 

Knowing What to Ask and Planning in Advance Before Breast Reconstruction Surgery

Dr.-Constance-M-Chen

Plastic Surgeon and Breast Specialist Dr. Constance M. Chen offers practical tips for women considering post mastectomy Breast Reconstruction.

A diagnosis of breast cancer upends a woman’s life, and forces her to make many personal, medical, and financial decisions. If a woman must undergo mastectomy, the predicament is further complicated by the decisions she must make about whether, when and how to have breast reconstruction. Many women undergoing breast reconstruction see implants as the quickest and simplest reconstructive option.

Controversy about the long-term safety of implants, however, has driven more and more women to choose ‘autologous reconstruction’, which uses a woman’s own tissue to create a soft, warm breast that looks and feels like her original breast.

“Whichever surgical option a woman chooses, she should have a thorough understanding of what to expect after surgery, when she goes home, and how her new breast will look and feel”, says plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen. “Knowing what to ask and planning in advance with her surgeon before surgery should reduce the risk of surprises later”.

“I’m going home! Yay! But with drains?”

Going home after surgery is an important step emotionally as well as medically. Each woman has a different sense of what is important to her sense of self. She should know in advance that she will probably leave the hospital with surgical drains still in place, and she will need to know how to manage the drains and accommodate them in her clothing as she resumes daily activities. She may be surprised that it is the mundane things, like being able to get in and out of clothes easily, going to the bathroom, and looking normal, that loom large.

“One or more surgical drains are usually required following mastectomy and reconstructive surgery”, says Dr. Chen. “Drains perform the important function of preventing the build-up of fluid in a surgical space”. The drain is a flexible tube that connects from the surgical incision to a small plastic bulb that collects fluid and must be periodically measured and emptied. Drains might be removed in the hospital but are more likely to be removed in the doctor’s office after surgery. Your nurse or doctor will instruct you on how to manage the drains and keep them secure and discreet. “Some patients find a post-surgical camisole with pockets for the drains to be convenient”, says Dr. Chen. “Others prefer an oversized sweater or blouse and loose-fitting pants with roomy pockets to hold the bulb”.

“What if my new breast isn’t what I expected?”

Autologous reconstruction, nipple preservation, and techniques that reduce scarring try to recreate a soft, warm, natural breast that is similar to a woman’s original breast. However, she may find that the natural ‘look and feel’ of her restored breast refers to how the breast will look and feel to someone else. The breast may not feel at all natural to the woman herself, because her reconstructed breast usually lacks feeling and may be completely numb to touch and sexual arousal.

“While results vary, advanced microsurgical techniques now make it possible to reconnect nerves and restore some measure of sensation to the breast”, says Dr. Chen. The importance of breast sensation is different for every woman and should be discussed in the initial surgical consultation so she knows what to expect – especially since not all surgeons are trained in techniques to restore breast sensation.

The goal of breast reconstruction, whether with implants or a woman’s own tissue, is to restore symmetry – to create a breast with the shape of the original that is in proportion with her other breast and with the rest of her body. Matching a reconstructed breast to an 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. “For many women, breast reconstruction is a process rather than a single procedure”, says Dr. Chen. “Lack of symmetry in mastectomy patients after reconstruction can be corrected with adjustments to the reconstructed breast or to its unaffected ‘sister.’ This possibility should be discussed in the initial surgical consultation”.

“Our goal is to help every woman make informed decisions so that she can better understand her treatment and recovery”, Dr. Chen concludes. “Comprehensive, accurate information about what to expect is helpful to optimize physical and emotional outcomes”.

 

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.

 

 

 

 

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.

Breast Reconstruction Specialist & Plastic Surgeon Dr. Constance M. Chen Provides Tips for a Comfortable Recovery

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While planning for breast reconstruction surgery, many women wonder about what they should wear during the recovery period. In the first weeks home, you may want to avoid tight-fitting, restrictive clothing and anything that requires you to lift your arms over your head. Clothes should be loose and comfortable and they should slip on easily and close in the front with zippers or buttons.

After surgery, both physical and emotional factors determine how well and quickly a woman will heal. Small things, like being able to get in and out of clothes easily, can ease recovery. Also, women should know in advance that they may leave the hospital with surgical drains in place and they will need to know how to manage the drains and accommodate them in their clothing as they resume daily activities. Knowledge and some planning can pave the way to a smooth recovery.

Dr. Constance M. Chen

“One or more surgical drains are usually required following mastectomy and reconstructive surgery”, says Dr. Chen. “The body doesn’t like empty spaces and will fill any area that has a potential space with fluid, which prevents the tissues from healing if not drained”. The drain is a flexible tube that connects from the surgical wound to a plastic bulb that collects the fluid, which is then periodically measured and emptied. Most people will keep the bulbs hanging on attachments on their surgical bra. Usually, patients go home with drains in place, and they are removed later in the doctor’s office. Your nurse or doctor will instruct you on how to manage the drains at home but it will take a little practice to learn the best way to keep the tubes and bulbs secure and discreet. If you want to Heal With Style, specialty companies such as Eileen + Eva make elegant postsurgical garments such as cardigans, wraps, and shawls with pockets for drains.

One item that many women find useful is a post-surgical camisole, which is a specially designed sleeveless tank top that provides needed support and may come in stylish colors and with lace trim. These garments are made of soft, stretchy, lightweight fabric and sometimes come with pockets that securely hold surgical drains in place and that can be detached after drains are removed. Some camisoles can be pulled up over the hips to avoid movement of the arms and shoulders. The needs of women who have had different types of breast cancer surgery differ. Lumpectomy, unilateral or bilateral mastectomy, breast reconstruction with implants or their own tissue, all leave women with unique requirements for recovery, particularly in choosing a bra. Nevertheless, they face the common challenge of finding comfortable and appropriate clothing.

Depending on what kind of surgery you had, your surgeon will talk to you about whether and when to wear a bra and what to look for, but there are overall guidelines for post-surgical bras.

Dr. Constance M. Chen

Some patients may be advised to wear a specialized bra that has attachments for drains for several weeks after surgery. When ready for a regular bra post-surgery, you can ensure your comfort by following these suggestions: Look for a bra made of soft, breathable fabric that is seamless or has flat seams to avoid irritation. Avoid underwire bras – especially while healing. Wide bands under the breasts ensure that the bra will stay in place and not dig into sensitive skin. A front-closing bra is a good idea, as you may have trouble reaching hooks in the back or pulling a bra over your head. The bra should not be so tight that it leaves marks when taken off.

Many cities and towns have boutiques that specialize in clothing and other items likes wigs and prostheses for breast cancer patients. Staff in these stores are often survivors themselves or are specially trained in fitting and working with women undergoing breast cancer treatment. What to wear may seem like an unimportant concern for a woman before surgery, but it can be helpful to plan for comfort after surgery and to think about what is important in terms of appearance and sense of self.

When it’s time to think about getting dressed, the clothes in your closet may not all work. Not only is your body different than it was before surgery but it will continue to change for some time. Whether you choose clothes designed for post-surgical wear or are able to find items in your own wardrobe or in regular shops that work for you, remember that the way you present yourself to the world is an important part of who your are and part of the process of putting cancer behind you.

 

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.

 

 

 

 

Managing the Emotional Aspects of Breast Reconstruction

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More than 268,000 new cases of breast cancer were diagnosed in 2018 in the US, according to estimates by the American Cancer Society. Many of these breast cancer patients need to decide whether or not to undergo mastectomy and breast reconstruction. A breast cancer diagnosis is difficult, and coping with decisions about surgical treatment and its aftermath adds an extra layer of complexity to the diagnosis. Fortunately, many tactics and resources can help manage the emotional aspects of mastectomy and breast reconstruction.

It’s physically and emotionally taxing to adapt to the changes in your body and your life after breast cancer. It’s abundantly clear why breast cancer patients would need effective tools to manage the emotional aspects of this tumultuous journey.

Dr. Constance M. Chen

Reconstruction can offer sense of control. Often, one of the ironies of dealing with a breast cancer diagnosis is the need to decide whether to undergo mastectomy, and if so, whether, when and how to have breast reconstruction. There are two main types of breast reconstruction – either using implants or a patient’s own tissue to create new breasts – but sometimes, part of the emotional burden of breast cancer is the choice itself.

According to 2014 research in the Journal of the American College of Surgeons, fewer than 40% of women who undergo mastectomy choose to undergo immediate breast reconstruction. For many women, they are not offered breast reconstruction because it is not available where they live. For others, the advanced state of their disease may force them to conserve their energy on physical survival alone. While breast reconstruction after mastectomy can lengthen a woman’s initial hospital stay and recovery period, however, doing so can provide important emotional advantages.

“For many women, it’s very helpful to wake up from a mastectomy and look down to see that she still has breasts,” says Dr. Chen, who is also 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. “And even if a woman chooses to or is advised to wait for reconstruction surgery at a later date, being able to look forward to regaining a more natural and familiar body shape offers a sense of control, which can help calm her during an emotional time,” Dr. Chen adds. “Women who opt to forego reconstruction can also achieve a sense of normalcy by using a mastectomy bra with slots for breast forms. Either way, looking and feeling more like their pre-mastectomy selves can help a great deal emotionally”.

 

Tips to find support

It’s OK – in fact, it’s expected – that you may need emotional and social support during the period surrounding breast cancer treatment, especially for women who’ve undergone mastectomy and breast reconstruction. It’s normal to mourn the loss of your breast(s) due to mastectomy and to be worried about the breast reconstruction process. Here are some ways to seek support and insight:

  • Communicate: Open communication with your partner and your surgeon helps manage expectations and concerns.
  • Find a therapist: One-on-one therapy is often incredibly helpful for dealing with the tough emotions following a mastectomy, Dr. Chen says. “Therapists – especially those who often deal with cancer patients – can help women cope with feelings of a changing body, femininity, and any accompanying anxiety or depression.”
  • Check out support groups: “Breast cancer support groups at your local hospital, or even online, can connect you with others in your shoes,” she says. “For example, Young Survival Coalition (http://www.youngsurvival.org/) is targeted toward women under the age of 40 years who are diagnosed with breast cancer, and Facing Our Risk of Cancer Empowered (http://www.facingourrisk.org) is targeted toward people affected by hereditary breast and ovarian cancer. We even have our own group of patients, the Bosom Buddies (http://constancechenmd.com/bosom-buddies) who are committed to helping other patients in their breast reconstruction journey.”
  • Tap the American Cancer Society: If you’re feeling at loose ends about who can help you manage your emotions, call the ACS at 1-800-227-2345 to be connected with a group or resource that can work for you. https://www.breastcancer.org/

Breast cancer can feel very lonely, but you don’t have to deal with overwhelming feelings about mastectomy and reconstruction on your own, It’s important to know that you have support and that your family, friends, and health care providers are there to help.

Dr. Constance M. Chen

 

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.