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

Dr.-Constance-M-Chen

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

Dr.-Constance-M-Chen

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.

 

 

 

 

Plastic Surgeon and Breast Reconstruction Specialist Dr. Constance Chen Provides Tips for Patients Traveling to Another City for Breast Reconstruction

Dr.-Constance-M-Chen

Women undergoing mastectomy must make decisions about breast reconstruction: whether, when, and how to have breast reconstruction and, crucially, who should perform the surgery. Often, women are referred to a plastic surgeon by their breast surgeon and assume that all of their options will be presented.

In reality both mastectomy and breast reconstruction have come a long way, and not all plastic surgeons are able to offer all reconstructive options. Cutting-edge innovations can be life-changing, but patients often have to do some extra research to educate themselves to find the right solution for their problems.

Breast reconstruction has made significant advances in recent years. When working with a mastectomy surgeon who is able to preserve the breast skin and nipples, a reconstructed breast can look and feel just like a normal breast and sometimes other doctors don’t realize that it is not the woman’s original breast. Surgical options to create a soft, warm, natural breast from the woman’s own tissue have improved to the point that new microsurgical techniques allow plastic surgeons to reconnect nerves and restore feeling to the breast. Sometimes, however, it takes some work to find highly specialized surgeons who have the skill set and commitment to achieve the best results. In some cases, women may need to travel away from home for a team who can provide them with adequate breast reconstruction options.

Dr. Constance Chen

Surgeons vary widely in their experience and in the operations they feel comfortable undertaking. Patients should understand a surgeon’s certifications and ask how often they have performed various procedures. Importantly, each woman should make sure that the recommended surgery is the best one for her and not simply the one preferred by the plastic surgeon that she happens to meet.

For example, newer procedures for autologous reconstruction (with the woman’s own tissue), such as the DIEP or PAP flap, require specialized microsurgical skills to reattach tiny blood vessels under an operating microscope. Plastic surgeons with advanced microsurgical training are not available everywhere. Furthermore, just because a surgeon can perform the technical operation does not mean that the final overall outcome is the same as someone with more finesse. Surgeons often have drastically different philosophies about the importance of the final medical and aesthetic outcome.

Beyond professional qualifications, patients must find a surgical team with which they feel most comfortable. Are questions welcomed and answered fully? Do you feel you can speak freely and have open and honest communications about your concerns? What kind of support will you get on administrative and financial matters? If the best team for you is far from home, what kind of assistance and support can you count on for travel arrangements and for managing follow-up care?

Dr. Constance Chen

Dr. Chen stresses that open communication with the surgical team is the most important factor in arranging for surgery far from home. She adds these tips for patients:
● Whether your plan is to have the mastectomy and immediate reconstruction in a single surgery or you are having reconstruction some time after the mastectomy, many of the issues regarding travel are similar.
● You will need accommodations in a hotel or short-term apartment rental that caters to and has special rates for surgical patients. Your surgeon’s office or hospital should be able to provide recommendations and help you estimate how long you will need to stay for follow-up care after your discharge form the hospital.
● Some cities have special facilities for patients such as the American Cancer Society’s Hope Lodge, which offers guest suites for patients and caregivers as well as communal kitchens and activity rooms. Hope Lodge has 30 locations in the United States, including New York City.
● Several charitable organizations including Corporate Air Network and Angel Flight provide free air travel for cancer patients. More information on charitable medically-related travel is available at patienttravel.org, a national referral service.
● You may need to coordinate local care in advance with a primary care physician or local surgeon for a pre-surgical exam and lab work as well as for post-operative follow-up care once you return home.

For a woman recovering from breast surgery, breast reconstruction is often a crucial aspect of the healing process, both physically and psychologically. For some women, traveling to achieve the best breast reconstruction option provides an enormous boost to her sense of self. Knowing that she has found the surgeon who is committed to her well-being puts her on the right road to recovery so that she can live a long and healthy life beyond cancer.

Dr. Constance 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.

 

 

 

 

Breast Reconstruction: Understanding the Women’s Health and Cancer Rights Act

Dr.-Constance-M-Chen

A diagnosis of breast cancer profoundly impacts a woman’s life. In addition to coping with overwhelming emotions, she must make important choices about treatment and all of its implications. One of those is the financial ramifications of her illness, particularly if she will need surgical treatment of her breast. She will need to learn all she can about her insurance coverage. Will the breast surgeon, the anesthesiologist, the hospital, the lab be covered?

What about procedures on the healthy breast to ensure symmetry? And what if she elects to have breast reconstruction at a later date? Fortunately, all insurance companies in the United States are required to cover breast reconstruction if mastectomy – which includes partial mastectomy (i.e., lumpectomy) – is also covered, so any woman undergoing surgical treatment of her breasts should be aware of her rights.

In 1998, Congress passed the Women’s Health and Cancer Rights Act (WHCRA), a federal law that requires group health plans and individual health policies that cover mastectomy to also cover breast reconstruction in connection with mastectomy.

Before the passage of the WHCRA, insurers could refuse coverage for reconstruction on the grounds that these were cosmetic procedures and not medically necessary. Women had to pay for reconstruction themselves or forgo it. Patients, survivors, healthcare workers, and their supporters worked hard to ensure that a woman would be legally guaranteed the option of reconstructive surgery following mastectomy.

Dr. Constance M. Chen

The WHCRA has specific provisions for breast reconstruction in connection with mastectomy. Insurance benefits are required to include the following:
●    All stages of reconstruction of the breast on which the mastectomy or lumpectomy was performed;
●    Surgery and reconstruction of the other breast to achieve symmetry and balance;
●    Prostheses, if needed, and treatment of any complications of surgery, including lymphedema;
●    One home healthcare visit within 48 hours of hospital discharge;
●    Outpatient or inpatient care in a healthcare facility based on generally accepted criteria.

Under the WHCRA, women are legally entitled to the breast reconstruction method of their choice – even if the woman’s chosen plastic surgeon is outside the insurer’s network. And while it is important to remember that patients will be responsible for deductible and co-insurance payments as with any other care covered by their plans, it is also true that when insurance companies have denied claims or presented obstacles to coverage, challenging those decisions, up to the state’s attorney general if necessary, can be successful with skilled patient advocates who fight for you.

“The WHCRA is of enormous value to women,” says Dr. Chen. “It provides a crucial baseline benefit in helping women recover from breast cancer. The sponsors of the WHCRA in Congress understood that breast reconstruction was often pivotal for a woman’s physical and emotional well-being. In my practice, we work hard to ensure that women can focus their energies on getting well without the additional burden of financial pressure, so we do everything we can to relieve our patients of the anxiety and stress of managing the relationship with their insurers”.

 

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.

 

 

 

 

Breast Cancer Survivors: “You Don’t Have to Live with Unsatisfactory Implants”

Among breast cancer patients who opt for breast reconstruction, 80% undergo implant-based breast reconstruction. Studies by implant manufacturers, however, show that within three years, three out of four breast reconstruction patients with implants will experience at least one complication, such as pain, infection, hardening, or the need for additional surgery. Many women live with chronic implant problems, or else they undergo multiple operations to adjust or replace their implants with new implants in the hope of improving their implant-based breast reconstruction. According to plastic and reconstructive surgeon Dr. Constance M. Chen.

There is a risk of cosmetic and health problems in the first few years, 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. But women should know that there are alternatives to replacing failed implants that will give them a more natural result and a long-lasting solution.

Dr. Constance M. Chen, plastic surgeon and breast reconstruction specialist

Since implants are foreign bodies, they can cause various problems: Many women find that that their implants feel hard and look unnatural, or that they’ve lost all feeling in the breast, or that their breasts are distorted and asymmetrical. Further complications include infection; rupture; capsular contracture, in which scar tissue forms around the implant and becomes hard and painful; and extrusion, in which the implant erodes through the skin. All of these problems are exacerbated by radiation treatment, which is considered a relative contraindication to implants.

In general, implants problems can be resolved by removing the implant with the entire surrounding capsule and repairing any muscle or skin around it. When faced with the prospect of multiple repeated surgeries that are often required to remove and replace an implant throughout a lifetime, a woman should consider the alternative – surgery that creates a breast from her own tissue, a permanent breast that is also natural.

Dr. Constance M. Chen, plastic surgeon and breast reconstruction specialist

Multiple studies have shown that any breast reconstruction that uses the body’s own tissue, known as autologous tissue reconstruction, provides higher levels of patient satisfaction over the long term compared to implants. Since it is made of your own tissue, the restored breast is soft, warm, and behaves just like any other part of your body, growing or shrinking as you gain or lose weight, for example. If nerves are reconnected, the breasts can even regain sensation.

Autologous tissue breast reconstruction has been around for a while, but older procedures sacrificed muscle to rebuild the breast. New advances have made it unnecessary to sacrifice muscle from the donor site to create a new breast. Preserving muscle enables faster recovery and means a woman can maintain muscle strength over the long term.

Dr. Constance M. Chen, plastic surgeon and breast reconstruction specialist

This new type of breast reconstruction, called “perforator flap” breast reconstruction, has become the gold standard of breast restoration. Perforator flaps are achieved by using microsurgical techniques to carefully transfer fat and skin along with a blood supply to create a new breast, while preserving the underlying muscle. Perforator flaps adhere to the plastic surgery principle of replacing “like with like.” Perforator flaps are appropriate for most women.

Patients falsely believe that very thin women are not candidates for natural tissue breast reconstruction. This isn’t true. In our experience the body provides the right amount of donor site tissue to suit a woman’s proportions.

Dr. Constance M. Chen, plastic surgeon and breast reconstruction specialist

There are two basic types of perforator flaps that are appropriate for different women, depending on body shape, with each using tissue from a different donor site and preserving muscle at those sites:
● Abdomen: The most common option is the deep inferior epigastric perforator (DIEP) flap, which preserves abdominal muscles and improves outcomes for patients compared to the traditional TRAM flap which, sacrificed the muscles. The DIEP flap reduces the risk of infection and other postoperative complications and speeds recovery time. The DIEP flap removes excess abdominal fat, providing the equivalent of a cosmetic tummy tuck.
● Thigh: The profunda artery perforator (PAP) flap uses fat from the upper inner and posterior thigh to reconstruct the breast and is typically used when the abdomen is not serviceable as a donor site, either because a woman is too thin or because of previous abdominal surgery. The PAP flap removes excess inner thigh fat, providing the equivalent of a cosmetic thigh lift.

While less common, other perforator flaps can also be used to transfer excess fat and skin (while preserving muscle) from other areas like the back or the buttocks to restore the breasts. “Women today have a lot of options for breast reconstruction and can make educated decisions about what is best for them”, says Dr. Chen. “State-of-the-art procedures restore a soft, warm, and living breast that looks and feels natural while preserving muscle strength and minimizing postoperative recovery time. Nerves can be reconnected to the living tissue to bring back sensation. For women who have suffered from pain and discomfort after implant-based breast reconstruction, natural tissue breast reconstruction is a safe and reliable way to bring back health, confidence, and quality of life”.

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.