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.

Plastic Surgeon and Breast Reconstruction Specialist Dr. Constance Chen Offers Practical Tips about Inverted Nipples

Inverted nipples are a common and normal variation in nipple shape. Also called retracted nipples, inverted nipples turn inward toward the breast instead of protruding. They occur in either one or both breasts, in both men and women, and may be congenital – present from birth – or may develop later in life.

As many as 10% of women may have one or both nipples inverted. Inverted nipples are not generally a cause for concern and require treatment only if they interfere with breastfeeding, if there is an underlying medical condition that must be addressed, or to satisfy aesthetic preferences.

Dr. Constance M. Chen, Breast specialist and plastic surgeon

Nipple inversion may be permanent or temporary, with the nipples fluctuating between inverted and erect. Some women experience inversion during pregnancy even if their nipples weren’t inverted before. While nipple sensitivity varies from person to person, inverted nipples are not ordinarily less sensitive to stimulation than erect nipples.

There are different grades of nipple inversion that may help determine whether it will interfere with breastfeeding or if treatment is needed. At the lowest level of inversion, the nipple can be easily pulled out and may remain protruding for some time. At a moderate level, the nipple can be pulled out, but will retract when released. With the most severely inverted nipples, it may be difficult or impossible to pull the nipple out. The higher the level of inversion, the more likely breastfeeding is to be difficult or impossible.

Breastfeeding is often problem-free with inverted nipples by having the baby latch onto the entire areola. Also, inverted nipples sometimes protrude naturally during pregnancy and breastfeeding or can be made to protrude by stimulation. Devices such as a ‘nipple shield’ that helps the baby latch on or a ‘breast shield’ that helps the nipple protrude may be helpful.

There are several treatment options for inverted nipples, most of them temporary and all of which should be discussed with a doctor to determine the best solution for each individual. There are home exercises for drawing the nipple out as well as suction devices that achieve a similar result in some cases. Inverted nipples can also be surgically corrected.

“Surgical options try to preserve the milk ducts to enable breastfeeding, but sometimes the milk ducts will be divided. When the milk ducts are disrupted to correct an inverted nipple, future breastfeeding may be difficult or even impossible”, says Dr. Chen. In either case, the procedure, generally performed under local anesthesia, involves a very small incision under the nipple through which a fine instrument is used to detach the fibers and duct(s) that are holding the nipple in an inverted position. A suture placed beneath the nipple then keeps it in position.

While inverted nipples aren’t generally medically troublesome, particularly when present since birth or when occurring gradually, over several years, there are indications that require medical attention. Nipples that had been protruding but flatten or turn inward suddenly or in a short period of time should be brought to the attention of a doctor. Other symptoms that require medical examination include discharge, a lump or swelling of the nipple, dimpling or thickening of the skin, and redness or pain.

“Inverted nipples are one of the many normal variations in the breast”, says Dr. Chen. “Depending on the degree of inversion, they may be easily manipulated to enable breastfeeding and they may be made to protrude for some period of time. When they cause distress for any reason, surgical correction is usually minimally invasive. As with many such procedures, correction can have a positive effect on a woman’s physical and emotional well-being”.

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.

One Size Doesn’t Fit All: Finding the Right Bra for Every Breast Shape

No two breasts are alike. For many women, even her own two natural breasts may not quite match. It is normal to have breasts that are different sizes and even different shapes. Breasts come in many different shapes, all of them completely normal, but important to be aware of when shopping for a bra.

A properly fitted bra is important for all women, not just large-breasted women who suffer discomfort in their necks and backs when their bras don’t support them adequately. Every woman will be more comfortable and less restrained in her physical activity if she is wearing a properly fitted bra.

Dr. Constance M. Chen, Breast specialist and plastic surgeon

Breast shape is determined primarily by genetics, but influenced by several additional factors, weight chief among them. The breast tissue that isn’t made up of milk ducts is largely composed of fat cells that increase and decrease as weight is gained and lost, potentially changing the shape as well as the size of the breast. Other factors are the hormonal changes that accompany pregnancy and breastfeeding and the changes that are a natural consequence of aging as skin loses elasticity and as the composition of breast tissue changes to a higher concentration of fat, which is more prone to sagging. Most women find that the shape of their breasts changes more than once over the course of their lifetimes and with that change comes the realization that it may be time to retire the bra style worn for decades and get fitted for a new one.

Any catalog of breast shapes is only an approximation, Just as every woman is unique, her breast shape cannot be expected to conform to a picture or description. However, even having a general idea of the one or two shapes that match you best can make all the difference in making sure you get a bra that fits. These descriptions of breast shapes aren’t comprehensive but most women – with the aid of a mirror – should be able to get an idea of which ones come closest to her own.

Dr. Constance M. Chen, Breast specialist and plastic surgeon

Round breasts appear to be equally full at the top and bottom of the breast. Not many women have well-rounded breasts, but many bras are designed for this presumed shape and account for lots of poor fit. Tear drop breasts are also rounded but fuller at the bottom than at the top. Women who have lost weight may find that their breasts now reflect this shape as they have less roundness at the top.

  • Bell breasts are also fuller at the bottom, but narrower at the top and less rounded than tear drops.
  • East west breasts have nipples that point outward, away from each other.
  • Side set breasts have a wide space between them; close set breasts have very little space between them.
  • Slender breasts are narrow and long and have nipples that point downward.
  • Athletic breasts tend to be wide-set and more muscular with less breast tissue, correlating with an athletic body that is muscular with little fat.
  • Conical breasts are cone-shaped rather than round and are more common in small-breasted women.
  • Asymmetric breasts may have differences in size or shape.
  • Relaxed breasts have looser tissue and nipples that point downward, similar to slenders, but generally fuller; they are more common later in life.

“Many women wear a bra that does not fit properly, which can lead to discomfort,” says Dr. Chen. “The best way to be properly fitted for a bra is in a specialized shop with experienced bra fitters. But with or without expert help, understanding the shape of your breasts will help you get the right fit. When a bra fits properly, there will be no gapping and no overflow in the cups, the straps won’t slip or dig into your shoulders, and you should be able to slip two fingers under the band in the back. Remember that the shape of your breasts will affect which bra is right for 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.

Why Do My Breasts Hurt? Understanding Causes of Breast Pain

Most women suffer some form of breast pain at some point in their lives. It may be mild or severe, constant or intermittent. It may be in the form of soreness, sharp burning pangs, or tightness. “Breast pain, or mastalgia, is usually straightforward to diagnose and treat”, says plastic surgeon and breast specialist Dr. Constance M. Chen. “While it is seldom a sign of something serious, pain that doesn’t go away after one or two menstrual cycles or that persists in women after menopause should be evaluated by a doctor”.

Most breast pain is cyclical – linked to hormonal fluctuation associated with the reproductive cycle. Women describe cyclical breast pain as the breasts feeling heavy, tender, swollen, and achy. It is caused by increases in estrogen and progesterone that occur before the menstrual period and cause the breasts to swell. Cyclical breast pain generally affects both breasts, intensifies in the week or two leading up to the menstrual period, then recedes. It most often affects women during their childbearing years and as they are approaching menopause. Breast tenderness can be eased with over-the-counter pain relievers and by reducing salt, fats, and caffeine in the diet. Birth control pills – or switching to a different formulation – can also help.

The breasts may remain tender during the first trimester of pregnancy in response to increased hormone levels and that continuing breast soreness often accompanies a missed menstrual period as an early sign of pregnancy.

Dr. Constance M. Chen

Fibrocystic breast disease, also triggered by hormones, is characterized by dense, lumpy breast tissue that may become painful in response to the monthly cycle. The lumps are fluid-filled cysts and can be clearly differentiated from more dangerous lumps composed of a solid mass of cells that may signify a benign or malignant tumor. Cysts may resolve on their own but any lump in the breast must be evaluated by a doctor via mammogram, ultrasound, or aspiration – drawing fluid from the cyst.

Non-cyclical breast pain — unrelated to reproductive hormones – most often occurs in one breast and in a localized area though the pain may spread throughout the breast. There are several causes:
Mastitis is most common in breast-feeding women (lactation mastitis) but can occur at any time. It is characterized by inflammation of the breast tissue that causes swelling, redness, pain, and warmth and sometimes fever and chills. During lactation, mastitis is usually caused by a blocked milk duct or by bacteria entering the breast through an opening in the skin or a cracked nipple. It is generally treated with antibiotics.

Injury to the breast can be from a previous surgery, from an accident, or from sports. There may be a sharp pain at the time of the trauma followed by tenderness for days or weeks. A doctor should be seen if pain doesn’t subside or if there is redness and warmth, which could indicate the presence of infection, if there is severe swelling, or if there is a bruise that doesn’t go away.

Support issues are most often experienced by women with large, heavy breasts but poor support can cause the ligaments to stretch and cause pain in breasts of any size, particularly after exercise. Pain may also affect the neck, back, and shoulders. A properly fitted, supportive bra should be worn at all times and a sports bra when exercising.

Medications can cause breast pain as a side effect. Hormonal therapies used in infertility treatment, birth control pills, and hormonal replacement after menopause can cause breast tenderness. Some psychiatric medications and those used for coronary disease can also have this effect.

Many women worry that breast pain might be a sign of breast cancer. While this is unusual, it’s not impossible. Inflammatory breast cancer, which accounts for 1%-5% of breast cancers does cause pain as well as redness, swelling, and thickened or dimpled skin. The important thing for women to know is that while most breast pain isn’t dangerous, any condition that doesn’t resolve over the course of the menstrual cycle or a week or two should be evaluated by a doctor. In the vast majority of cases, treatment will be rapid and effective.

About Dr. Constance M. Chen

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

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

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

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

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

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

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

About Dr. Constance M. Chen

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

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

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

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.