Breast Reconstruction Specialist Dr. Constance M Chen Offers Tips on Restoring Breast Sensation After Mastectomy

Each year in the United States, more than 100,000 women have mastectomies. Advances in surgical techniques today offer women the hope of a soft, warm breast that may look similar and feel much like her original breast, especially if she undergoes natural tissue breast reconstruction. As a result, more and more women now choose breast reconstruction, either at the time of the mastectomy or later. However, in some cases, women who undergo breast reconstruction learn that the natural “look and feel” of her restored breast actually relates to how the breast will look and feel to someone else. Some women report that their reconstructed breasts do not feel at all natural to her and moreover that the reconstructed breast lacks all feeling and is completely numb to touch and sexual arousal.

“The prevalence of social media and zoom conferences has led some women to be more self-conscious about how they look”, says Dr. Constance M Chen, plastic surgeon and breast reconstruction specialist. “While our capability to reconstruct a woman’s breast after a mastectomy has come a long way, the emphasis has been on rebuilding her appearance, with less focus on how she feels. In fact, after mastectomy, many women discover that their breasts are numb – a reality for which they were unprepared. The positive news today is that new techniques in breast reconstruction allow specially trained surgeons to reconnect nerves with the possibility of restoring sensation”.    

Why the loss of sensation. In a mastectomy the nerves that provide feeling to the breast and nipple are cut, resulting in a loss of sensation in the remaining skin, regardless of whether or not the woman undergoes breast reconstruction. In the case of breast reconstruction using implants, the artificial breast implant may actually form a physical barrier that prevents nerves from growing through it to reach the skin. However, with natural tissue breast reconstruction, microsurgeons can suture together nerves from a woman’s own tissue to create a new sensate breast. In these cases, rejoining blood vessels and nerves allows them to grow through the transferred tissue to reach the skin and increase the potential return of sensation.

There are different types of sensation – deep pressure, light touch, pain, and temperature – and they each come back at different rates. Deep pressure sensation usually returns most quickly and temperature most slowly. Moreover, regenerated nerves can take months or even years to reach the skin, and the quality of sensation is variable. “Since nerve growth is slow and the return of sensation is not ensured, not all surgeons prioritize reconnecting the nerves to restore sensation”, says Dr. Chen. “However, taking the time in surgery to carefully repair the nerves can result in the return of feeling and improved sensation”. Innovative microsurgical techniques that use neural tubes and nerve grafts have provided some patients with excellent sensation and even erectile function of the nipple.

“Restoring sensation is on the frontline in breast reconstruction”, Dr. Chen concludes. “Sensory restoration can help a woman feel more normal after mastectomy. Each woman will have a unique experience and result, but it is important for surgeons to do their best to restore a woman’s body as fully as possible to help her regain 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.

Breast Reconstruction Specialist Dr. Constance M Chen Offers Tips on Restoring Breast Sensation After Mastectomy

Each year in the United States, more than 100,000 women have mastectomies. Advances in surgical techniques today offer women the hope of a soft, warm breast that may look similar and feel much like her original breast, especially if she undergoes natural tissue breast reconstruction. As a result, more and more women now choose breast reconstruction, either at the time of the mastectomy or later. However, in some cases, women who undergo breast reconstruction learn that the natural “look and feel” of her restored breast actually relates to how the breast will look and feel to someone else. Some women report that their reconstructed breasts do not feel at all natural to her and moreover that the reconstructed breast lacks all feeling and is completely numb to touch and sexual arousal.

The prevalence of social media and zoom conferences has led some women to be more self-conscious about how they look. While our capability to reconstruct a woman’s breast after a mastectomy has come a long way, the emphasis has been on rebuilding her appearance, with less focus on how she feels. In fact, after mastectomy, many women discover that their breasts are numb – a reality for which they were unprepared. The positive news today is that new techniques in breast reconstruction allow specially trained surgeons to reconnect nerves with the possibility of restoring sensation.

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

Why the loss of sensation. In a mastectomy the nerves that provide feeling to the breast and nipple are cut, resulting in a loss of sensation in the remaining skin, regardless of whether or not the woman undergoes breast reconstruction. In the case of breast reconstruction using implants, the artificial breast implant may actually form a physical barrier that prevents nerves from growing through it to reach the skin. However, with natural tissue breast reconstruction, microsurgeons can suture together nerves from a woman’s own tissue to create a new sensate breast. In these cases, rejoining blood vessels and nerves allows them to grow through the transferred tissue to reach the skin and increase the potential return of sensation.

There are different types of sensation – deep pressure, light touch, pain, and temperature – and they each come back at different rates. Deep pressure sensation usually returns most quickly and temperature most slowly. Moreover, regenerated nerves can take months or even years to reach the skin, and the quality of sensation is variable. “Since nerve growth is slow and the return of sensation is not ensured, not all surgeons prioritize reconnecting the nerves to restore sensation”, says Dr. Chen. “However, taking the time in surgery to carefully repair the nerves can result in the return of feeling and improved sensation.” Innovative microsurgical techniques that use neural tubes and nerve grafts have provided some patients with excellent sensation and even erectile function of the nipple.

“Restoring sensation is on the frontline in breast reconstruction”, Dr. Chen concludes. “Sensory restoration can help a woman feel more normal after mastectomy. Each woman will have a unique experience and result, but it is important for surgeons to do their best to restore a woman’s body as fully as possible to help her regain 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.

Board-Certified Plastic Surgeon Dr. Constance M Chen on Why Breast Implants are Removed

Over 400,000 women in the United States receive breast implants each year. Three quarters receive breast implants for cosmetic breast augmentation, while the other one quarter receive breast implants to reconstruct a breast lost to cancer. According to the implant manufacturers, about 50% of women with breast implants undergo another surgery to revise, replace, or remove their breast implants within 7 years. Since breast implant problems are common, on October 27, 2021, FDA strengthened breast implant risk communication to help those considering breast implants make informed decisions.

According to the implant manufacturers, about 50% of women with breast implants undergo another surgery to revise, replace, or remove their breast implants within 7 years.

For starters, the FDA now requires a black box warning on all breast implants to let people know that they are not considered lifetime devices and carry risks. In addition, patients are required by law to initial and sign an extensive patient decision checklist that outlines many potential risks and complications, including Breast Implant Illness and Breast Implant Associated Anaplastic Large Cell Lymphoma. There are also updated silicone gel-filled breast implant screening recommendations, device descriptions with a list of specific materials used to make breast implants, and a patient device card. Finally, the FDA released updated information on the status of breast implant manufacturer post-approval studies.

Board-certified plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen comments that there are many medical and cosmetic reasons that women have implants removed. “In some cases the implants basically fail and must be removed for the health of the woman. In other cases, women realize that they don’t have to live with implants that are not comfortable for them. For example, women with cosmetic breast implants sometimes reach a new stage in their lives in which they no longer feel that breast implants fit their lifestyle anymore.”

Breast implants don’t last forever

Implants aren’t expected to last forever. Most implants have a ten-year warranty although many are removed before the warranty period is over. The risks only increase with time.

Implants are foreign material, and as such, they elicit a natural response in which the body creates a barrier of scar tissue around the implant to wall it off and protect any foreign substance from penetrating other parts of the body. In some cases this barrier, or capsule, is soft, flimsy and not noticeable. In other cases the scar tissue around the implant can become hard and painful. This uncomfortable condition, known as capsular contracture, is among the most common reasons for implant removal. Other common problems include rupture, where the saline solution or silicone gel that fills the implant leaks into the surrounding tissues; infection, caused by bacteria becoming rooted in the implant; and rippling, in which the skin over the implant appears irregular.

What’s in ‘vogue’ changes

The allure of the full-breasted figure of the 1950s has given way today to a more natural, athletic and healthy look. Some women find that large, augmented breasts are heavy and unwieldy to manage. “In some cases, women who are unhappy with their implants have them replaced with smaller implants,” says Dr. Chen, “and others revert to their own natural breasts. The aesthetic outcome depends on several factors, including how long the implants were in place. Sometimes a breast lift (or mastoplexy) or fat-grafting procedure may be needed to create attractive breasts”.

In addition to facing medical complications, some women find that their implants look distorted and unnatural, feel hard and uncomfortable, or that they’ve lost all sensation in the breast. “In some cases, the solution is to remove the implant and the entire surrounding capsule and to repair the muscle and skin around it,” says Dr. Chen. “Thankfully, there are ways for women to address problems with breast implants whether it is discomfort or a disappointing aesthetic look. Women today have many options for improving the appearance of their breasts. Sometimes simply removing the implants is the first step”.

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.

To Commemorate the 60th Anniversary of the First Breast Augmentation, Plastic Surgeon Dr. John Anastasatos Shares his Top Ten Myths Regarding the Procedure

Sixty years have passed since the first breast augmentation was performed with silicone gel implants, and yet the public and media still maintain incorrect information and misconceptions about this iconic cosmetic operation. Dr. John Anastasatos, board-certified Beverly Hills and Athens plastic surgeon, reveals the top ten myths regarding breast augmentation that he encounters.

1) Breast implants must be changed every ten years.
There is no medical necessity for breast implants to be replaced every ten years. Breast implants should be replaced when there is a problem or the patient desires a change. The most common problem is implant rupture. At my practice, Los Angeles Plastic Surgery in California, most patients change their implants to go bigger or switch from saline to silicone implants or vice versa. My patients from Athens and Europe prefer to make changes when they have problems.

2) Saline breast implants are safer than silicone ones.
Both saline breast implants and silicone ones are considered safe. Silicone breast implants are often preferred by plastic surgeons and patients because they are softer and more natural. Saline implants allow for more accurate breast volume asymmetry corrections.

3) Under the muscle is better than over the muscle.
Not always. The practice of placing breast implants under the pectoralis major muscle depends on breast anatomy and type of breast implants selected. Some patients get better results with the breast implants under the pectoralis major muscle while others over the muscle.

4) Textured breast implants can prevent capsular contracture (scar tissue) formation.
Not true. This has been a popular notion in Europe. The term “textured implants” means that the breast implant surface is rough (not smooth). The rough surface causes mild inflammation and helps the implant to adhere to the tissues. This was thought to decrease the incidence of capsular contracture but was never proven to be true. People who have textured breast implants still get capsular contractures.

5) Breast implants cause cancer.
The information we have up to date does not support such a claim. There has been recent evidence that a rare type of lymphoma was found on the capsule surrounding breast implants in some women with prior breast augmentation. This does not necessarily mean that in those people the lymphoma was caused by the presence of the breast implants. More investigation is currently being undertaken. Apart from this recent report, there has never been any association between silicone gel or saline-filled breast implants with any cancer in the body. There is no cause-and-effect relationship between breast implants and cancer.

6) You cannot breastfeed after you have had a breast augmentation.
False. When a breast augmentation is done via an incision through the inframammary fold, armpit or belly button there is usually no problem with breastfeeding.

7) I will lose breast or nipple sensation if I get a breast augmentation.
Rarely. If the breast augmentation is done via an incision in the breast fold, then, on the contrary, a women’s nipple sensitivity may be heightened. The reason why some women lose nipple sensation is if the plastic surgeon over dissects the outer breast pocket or tries to fit too large of an implant.    

8) You need breast implants for a breast lift.
False. Breast implants are not a treatment for breast sagginess. Only a breast lift (mastopexy) corrects sagginess. Most patients incorrectly believe breast implants are required to achieve an effective breast lift.

9) Darker-skinned people are prone to darker, thicker and more visible scars.
False. Black, Latin, Indian and Southern European patients often believe this to be true. It is not. The color of the skin does not affect the wound healing process and eventual look of an incision.

10) Natural breast augmentation with fat is better and safer.
Rarely. Taking a person’s own fat with liposuction and adding it to the breasts may create future problems because some of the fat transferred will perish within a year. Lumps, bumps and contour irregularities may form. Breast lumps from fat can cause unnecessary scares and stress, as an anxiety-provoking breast mass will need to be examined. Furthermore, fat does not have the consistency to offer durable breast projection which is one of the most attractive attributes of breast augmentation with implants.

“Breast augmentation is the second most popular cosmetic surgical procedure in the world, following liposuction, and providing real facts to a wide audience regarding some of the most commonly believed falsehoods is vital,” says Dr. Anastasatos.

For more information, come into the beautiful world of Los Angeles Plastic Surgery.

Post Mastectomy Breast Reconstruction Basics: Understanding Your Options

Plastic surgeon and breast reconstruction specialist Dr. Constance Chen offers practical tips on breast reconstruction.

Breast reconstruction has come a long way. Although breast cancer was known to the ancient Egyptians as far back as 1600 B.C., it was not until the 18th century that it was understood to be a localized disease whose spread could be contained by isolating and removing the affected cells, and it was not until a hundred years later that pioneering work was done on what we know today as mastectomy.

Early practitioners of surgical breast removal did not believe in reconstruction. They feared that any intrusion at the surgical site could adversely affect the progression of the disease or hide a recurrence. So while the first attempts at reconstruction were made in the 1890s, it was not until the mid-20th century when radical surgery gave way to equally effective but less aggressive treatments that interest in breast reconstruction soared. Today, women have many options for breast reconstruction and every woman can make an educated decision about what is best for her.

Dr. Constance Chen, plastic surgeon

There are two types of breast reconstruction and multiple options for each: implant-based breast reconstruction and natural tissue breast reconstruction, also known as “autologous reconstruction.” Either type can be performed immediately, or months or even years after the mastectomy. For the best results, most breast reconstructions will require more than one procedure. Many factors will influence a woman’s decision on the best option for her. Chief among them are her general medical and genetic history, the size, location, and characteristics of her tumor, her treatment plan, and her aesthetic expectations. “An initial consultation with her surgeon will help a woman sort through her options,” says Dr. Chen, “but it is important for her to start with a general understanding of the basics of breast reconstruction.”

Reconstruction with implants

The introduction of silicone implants in the 1960s signaled the beginning of the modern era of breast reconstruction. Implant insertion used to be delayed until after the mastectomy had healed but now is often done in a single surgery at the time of the mastectomy. Usually, a temporary device called a tissue expander is placed on the chest wall and gradually filled with saline solution until the tissue has expanded enough to hold the permanent implant. Today, breast implants are either filled with saline or silicone, and the outer shell is either smooth or textured. The silicone gel has also become more cohesive over time so that there are now different types of silicone gel implants with different degrees of firmness.

“Implants have continued to improve and many women are happy with them,” says Dr. Chen, “but patients should be aware that implants are not expected to last a lifetime. In the United States, all breast implants have a ten-year warranty but complications such as pain, infection, hardening, and rupture lead many implants to be removed well before that. Some women find that their breasts feel hard and look unnatural, or that they’ve lost all feeling in the breast, or that their breasts are distorted and asymmetrical.” According to the implant manufacturers, at least half of breast implants need another operation within 7 years. Many women who suffer complications or are unhappy with implants ultimately have them removed and opt for reconstruction with their own tissue.

Reconstruction with your own tissue

The gold standard in breast reconstruction today is surgery that creates a breast from a woman’s own tissue, a procedure, known as “autologous reconstruction.” Natural tissue breast reconstruction creates a breast that is soft, warm, and when combined with nipple-sparing mastectomies can be barely distinguishable from a woman’s own breast. Unlike implant-based reconstruction, a restored breast made of her own tissue reacts just like any other part of her body, expanding or contracting with weight gain or loss, for example. When nerve reconstruction is added, the reconstructed breast may be sensitive to touch. Autologous reconstruction produces the best aesthetic result and the highest level of patient satisfaction but it should be noted that it requires more complex surgery and a longer recovery than reconstruction with implants.

Autologous tissue breast reconstruction uses tissue from a donor site in the patient’s own body to create the new breast. This type of reconstruction has been done for decades but new advances have made it unnecessary to sacrifice muscle from the donor site which reduces recovery time and enables a woman to maintain muscle strength. In this new type of reconstruction, known as “perforator flaps,” microsurgical techniques are used to carefully separate muscle from the fat and skin that will form the new breast. “Perforator flap reconstruction can use tissue from several donor sites,” says Dr. Chen. “Most often, tissue is taken from the abdomen, but for thin women or women who have had a previous tummy tuck, it may be more appropriate to use tissue from the upper inner thigh.”

Nipple and areola reconstruction

Changes in mastectomy itself have also facilitated improved restoration results. Surgery that spares skin and the nipple-areola complex enhances the surgeon’s ability to create a breast much like the woman’s own. If there are cancer cells in or near the nipple and it cannot be saved, the nipple-areola complex can be reconstructed later using skin from the breast or from another part of the body. Three-dimensional tattooing is also an effective option that creates a realistic illusion of a nipple.

Nerve restoration

During a mastectomy, the nerves that provide feeling to the breast and nipple are severed, causing loss of sensation in the remaining skin whether the woman undergoes reconstruction or not. With certain types of autologous reconstruction, however, it is now possible to reconnect blood vessels and nerves and have them grow through the transferred tissue to reach the skin and significantly improve the return of sensation. “This is the next frontier in breast restoration,” says Dr. Chen. “By microsurgically reconnecting nerves that are cut and restoring sensation to the breast, we can not only create a soft, warm breast that looks and feels natural to others but one that feels like her own breast to the woman herself.”

“The evolution of restorative techniques over the last several decades has been remarkable,” Dr. Chen concludes. “What makes a woman feel ‘whole’ again after mastectomy is an individual matter but we will continue to pursue solutions that enable her to regain not just her health but her confidence 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.

Plastic Surgeon and Breast Reconstruction Specialist Dr. Constance M Chen Offers Tips on Improving Post Mastectomy Breast Reconstruction Results

When secondary breast reconstruction is necessary. Breast reconstruction should be thought of as a process rather than a single procedure. Most mastectomies will not be identical, and it is unusual for the initial breast reconstruction to have perfect symmetry. Usually, breast reconstruction requires multiple stages to obtain the ideal results.

The objective of breast reconstruction after mastectomy is to create a natural breast with the shape, symmetry and softness of the original. In most patients, modifications are needed after the initial surgery to accomplish that goal. Women should know that with a customized plan and advanced surgical techniques, we can often improve shape, size, and symmetry after the initial breast reconstruction to help a woman’s breasts look better and feel more normal.

Dr. Constance M. Chen, plastic surgeon

In most cases, the best aesthetic outcomes are achieved with natural tissue. There is a principle in plastic surgery to ‘replace like with like’. On the operating room table, the actual breast tissue looks and feels like regular fat – breast tissue and fatty tissue look and feel the same. As a result, when it is feasible to use a woman’s own fat to recreate the breast, the reconstructed breast will feel very much like the original – sometimes it is almost identical.

Women should know that even if they had reconstruction with breast implants that the implants can be removed and replaced with natural tissue. While many women with implant-based breast reconstruction are happy with the results, some women who have undergone breast reconstruction with implants feel uncomfortable because breast implants are usually placed underneath the muscle. In these cases the subpectoral breast implants can cause rigidity and trouble with breathing, and a hyper-animation deformity can also result in which the patient’s breasts move up and down when she flexes her pectoralis muscle.

In our experience, many women are surprised when their breast implants are removed and replaced with natural tissue. They commonly report feeling much more comfortable and they are pleased that their new breasts feel and look normal.

Dr. Constance M. Chen, plastic surgeon

Breast reconstruction problems can also arise due to asymmetry. Breasts should look like sisters if not twins, and it’s best when at least they look like they belong to the same family. It is easiest to obtain symmetry with bilateral reconstruction, in which the incisions from the mastectomy and reconstruction method are the same. However, in cases where only one breast has undergone a mastectomy with breast reconstruction it may be necessary to perform additional procedures on the other breast to achieve symmetry. Fortunately, the 1998 Women’s Health and Cancer Rights Act requires all health insurance companies to cover all stages of breast reconstruction and any complications from all stages of mastectomy or breast reconstruction, and symmetry procedures on the opposite breast are also covered. A woman’s right to breast reconstruction at any stage is protected by federal law and many state laws.

Refining and improving breast reconstruction

One common type of secondary breast reconstruction procedure is fat grafting, in which fat is collected from another part of the body through tiny incisions via liposuction. The extracted fat is processed to remove impurities, and then the fat graft is transferred by injections into the breast. This process is used to make the breast larger or to correct contour deformities by sculpting and filling in small areas to improve breast size, shape, and symmetry.

Another common secondary breast reconstruction is called mastopexy or breast lift. Here the goal is to improve the look and/or evenness of the reconstructed breasts. Reconstructed breasts are usually perkier, particularly after implant-based breast reconstruction. If only one breast has undergone mastectomy and breast reconstruction, a mastopexy may be needed on the unaffected breast to match the reconstructed breast. A breast lift will remove excess skin and raise the nipple-areola complex so that the breast sits higher on the chest wall. A breast lift will not significantly alter the size of the breast.

Finally, in some cases the breast size may need to be modified with a breast reduction or a breast augmentation. A breast reduction is similar to a breast lift, except breast tissue is removed along with the breast skin to make the breast smaller. A breast augmentation may be performed with fat grafting or a breast implant.

Any of these procedures can also be implemented on the reconstructed breast(s).

Additional procedures to achieve symmetry are almost always needed for women who have undergone a unilateral (single-sided) mastectomy and breast reconstruction with a breast implant. On the other hand, the best aesthetic outcomes are from bilateral (double-sided) nipple-sparing mastectomies with immediate natural tissue breast reconstruction. When all the breast skin has been preserved and the breast reconstruction is performed with natural tissue at the same time as the mastectomy, it can be nearly impossible to tell that a woman has had a mastectomy.

“Too many women have experienced the devastating upset of a cancer diagnosis and subsequent treatment only to have added disappointment of an unsatisfactory reconstruction outcome,” says Dr. Chen. “Correcting a poor or uncomfortable reconstruction can be the last step in restoring a woman’s physical and emotional health and improving her quality of life.” Even women who have not had the gold standard in mastectomy and breast reconstruction from the beginning can undergo secondary breast reconstruction to improve their initial results.

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.

Understanding the Benefits of Short-scar Breast Reduction

Breast Reconstruction Specialist Dr. Constance M. Chen Provides Tips for Women Considering Breast Reduction Surgery.

Many women with large and heavy breasts experience significant discomfort including back, neck, and shoulder pain, challenges finding clothes that fit, and a feeling of self-consciousness about their bodies. Some report rashes under their breasts, stares and unwanted attention, and find that large breasts can also make vigorous physical activity difficult. Breast reduction surgery, or reduction mammoplasty, helps deal with these problems and helps many women feel more comfortable in their own bodies.

In a reduction mammoplasty, breast tissue and breast skin is removed and the nipple-areola complex is repositioned higher on the chest wall, creating a smaller and more youthful breast.

Dr. Constance M. Chen, plastic surgeon

A traditional reduction mammoplasty is performed with an incision that results in an “anchor scar,” which involves three discrete scars. One incision is made around the border of the areola, the second extends down vertically from the areola to the inframammary fold, and the third is a long horizontal incision along the bottom of the breast at the inframammary fold. Dr. Chen explains that “the horizontal scar sometimes can extend beyond a bathing suit or bra and be visible. This same scar is also susceptible to complications while healing and can become wider or hypertrophic (raised).” This is where a short-scar or limited-scar reduction can be advantageous. That’s because it eliminates the horizontal scar,” adds Dr. Chen.

Short-scar reduction uses what we call a ‘lollipop incision’ – around the areola and down to the inframammary fold. “In this case, the horizontal scar is eliminated,” says Dr. Chen. The best technique for each woman is determined by the breast surgeon depending on the size and shape of the patients’ breasts and by the amount of reduction desired.

In most cases, patients who undergo a breast reduction will leave the hospital the same day, with overnight stays rare. The recommended recovery at home is typically 10-14 days before returning to work and several additional weeks before returning to a fully active lifestyle.

Dr. Chen says that “a breast reduction can be performed on healthy women after the breasts are fully developed. She reiterates that “short-scar breast reduction minimizes scarring on the breast after surgery. With advances in breast reduction surgeries, women today don’t have to tolerate the discomfort and emotional distress of large breasts that are out of proportion to their bodies so that they can be more comfortable in their own skin.”

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.

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.

Congenital Breast Deformities: Surgical Advances Offer Solutions

Breast development in adolescence and the teen years is an important marker in the transition to adulthood for young women. At an age typified by self-consciousness about body image, coming to terms with anomalies in breast development is particularly difficult. “Most congenital breast anomalies are not medically dangerous but can cause emotional distress”, says plastic surgeon and breast specialist Dr. Constance M. Chen. Fortunately, these conditions can usually be corrected surgically preempting long-lasting effects on self-esteem.

Breast development begins before a baby is born and while some congenital anomalies may be evident at birth, others may not become apparent until later in childhood or at puberty. While genetic factors sometimes play a role, the cause of most of these disorders is unknown.

Dr. Chen points out that many differences that may be initially worrisome – like breast buds of different sizes or breasts that develop at different rates – are part of normal development and may resolve on their own. “In these cases”, she says, “surgical intervention is best delayed until development is complete. In all cases, treatment will depend on the severity of the deformity and its psycho-social effects”.

Hypoplastic breast is a condition in which one or both breasts don’t develop normally during puberty. The result may be severely asymmetrical breasts or, if both breasts are involved, very small breasts that are out of proportion with the woman’s body. While most women with hypoplastic breasts have normal hormone levels, hormone production or regulation sometimes play a role and can affect lactation.

Treatment for hypoplastic breast is generally breast augmentation of the underdeveloped breast(s) with implants or by using a woman’s own tissue (‘autologous reconstruction’), usually taken from the abdomen, to fashion a new breast. These techniques are similar to those used for cosmetic augmentation or for breast reconstruction when a woman has lost a breast to mastectomy. When only one breast is hypoplastic, another option is to achieve symmetry by reducing the fully developed breast (‘reduction mammoplasty’).

Poland syndrome, first described by a19th-century doctor, is a congenital syndrome that develops in the first six weeks after conception and typically involves missing or underdeveloped chest muscles on one side of the body. The characteristics of Poland syndrome can vary widely and may include, in addition to an underdeveloped breast, abnormalities of the chest wall, the ribs, the arm, and the hand. Treatment is generally via reconstructive surgery and depends on the severity of the condition.

Tuberous breast deformity (also known as constricted breast) results in one or both breasts failing to develop normally during puberty. In mild cases, the affected breast may just be smaller. In more severe cases, the base of the breast may appear constricted, with less skin and volume along the crease, the crease may be positioned too high on the chest wall, or there may be bulging (herniation) of breast tissue through the areola. Treatment may include expanding the constricted breast base, lowering the crease, adding volume and skin, and reconstructing the nipple-areola complex.

Supernumerary breast tissue may develop in the embryo and cause breast tissue to be found outside its normal location on the chest, anywhere from the abdomen to the armpit. The tissue may be just a small nipple or a large amount of tissue. Treatment isn’t always necessary but depending on its location and the discomfort it causes, the tissue can be surgically removed. Polymastia (an extra breast) and polythelia (an extra nipple) can similarly be treated with surgical removal.

Correcting congenital breast deformities is often driven as much by psychological and social motivation as by medical necessity. Consultation with a plastic surgeon can help every woman evaluate her options, set appropriate expectations, and make the decision that is right for her.

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.

Advances in Post Mastectomy Breast Reconstruction: Nipple Preservation

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.