Breast Reconstruction Specialist Dr. Constance M. Chen offers practical tips to help manage expectations for women recovering from breast surgery

Hundreds of thousands of women undergo breast surgery every year. Whether these procedures are reconstructive, cosmetic, or therapeutic, surgery itself is traumatic to the body. “The body’s reaction to surgery depends on many factors,” says plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen.

Most important are the patient’s overall health, type and location of the surgery, and the aftereffects of anesthesia. Before surgery, each woman should discuss with her surgeon both the expected effects of the procedure she will undergo and the individual factors that might affect her recovery. Knowing what to expect and preparing for her recuperation will help ease her return to normal activities.

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

Reconstructive breast surgery replaces a breast lost to mastectomy or rebuilds one disfigured by breast-conserving surgery such as lumpectomy. Breast reconstruction may be via implants or via a woman’s own tissue from another part of her body – often the abdomen – to fashion a soft, warm, natural breast much like the one she lost. Recreating a breast after lumpectomy depends on the degree of deformity and might range from implants to some sort of natural tissue breast reconstruction such as fat grafting or flap reconstruction. Cosmetic breast surgery includes breast augmentation with implants, breast reduction, and mastopexy, or breast lift. Therapeutic breast procedures include cancer surgeries such as mastectomy, lumpectomy, and biopsy as well as surgery for other conditions such as a breast abscess.

After surgery…
Dr. Chen points out that surgery induces some common and predictable responses at the surgical site and throughout the body. She offers some suggestions on what to expect in the days and weeks on the road to recovery.

Immediately after waking from anesthesia, you will be groggy. Some women experience post-operative nausea and/or vomiting that usually wears off in a couple of hours or days. If you are not staying overnight in the hospital, you will need a ride home.

Surgical drains may be in place after mastectomy or reconstructive surgery and will be removed either in the hospital or in the doctor’s office a week or so after discharge. You will be instructed before leaving the hospital on how to manage the drains and how to keep them secure and discreet.

Pain is most likely in the first few days and your doctor may prescribe medication to control pain. After that, over-the-counter painkillers generally suffice.

Post-surgical swelling is common along with bleeding and bruising at the surgical site and swelling may be apparent elsewhere. Your surgeon will advise on dressings and whether or not ice and elevation are appropriate.

Easing into light daily activity will be easier after a couple of weeks and some women can resume a desk job. Over the next few weeks, soreness and swelling will diminish and by six-to-eight weeks, most women are fully recovered and can resume regular activity.

Promoting healing…
Dr. Chen emphasizes the importance of following your doctor’s instructions while recovering and offers tips to make you as comfortable as possible and promote healing.

  • Wear loose, comfortable clothing that slips on easily and closes in the front. Zippered closures are often easiest to avoid fumbling with buttons. Avoid restrictive clothing and anything that requires you to lift your arms over your head.
  • Your surgeon will discuss whether and when to wear a bra and whether you should wear a compression garment at first to reduce swelling or avoid compression to keep the tissue alive. When you’re ready for a regular bra, look for one that is made of soft, breathable fabric and closes in the front. Avoid underwire bras that dig into your skin. Consider a post-surgical camisole that has pockets to hold drains.
  • Try sleeping in a recliner or lying on your back with pillows under your knees.
  • Don’t lift, carry, or push anything heavy – including a child – in the first few weeks after surgery.
  • Eat a nutrient-rich, well-balanced diet rich in lean protein to repair damaged tissue; iron, found in liver and green leafy vegetables, to replenish red blood cells; fluids from 6-8 glasses of water a day to reduce swelling; and fiber from beans and grains to stimulate a gastrointestinal system made sluggish by anesthesia. Get energy from food rather than supplements.
  • Avoid all products that contain nicotine – including cigarettes, patches, gum, chewing tobacco, and lozenges. Nicotine inhibits the body’s ability to heal.
  • Get moving! The body gets debilitated quickly. Even gentle stretching is helpful to stimulate the muscle fibers and overcome stiffness. After the immediate healing period, exercise also gets your heart rate up so that the blood is moving and your lungs fill with oxygen.

“Your doctor will let you know when various activities are safe after surgery, such as driving,” says Dr. Chen. “But remember that every patient reacts differently and estimated time frames don’t apply to everyone. Our goal is to ensure that every woman understands her treatment and recovery as well as possible. It’s vital to her physical and emotional healing that patients have comprehensive, accurate information about what to expect.”

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.

Arm Lift: Help for Stubborn and Unsightly Under Arm Sagging

Arms had their moment in early 2009 when Michelle Obama posed for her first official photograph as first lady in a sleeveless black dress. While some style critics carped that the look was too informal or out of season with the February weather, many women all over the world envied Obama’s toned arms and wanted to know how they could achieve similar muscle definition. Workout and diet recommendations proliferated as millions of women went to work on their arms. Plastic surgeon Dr. Constance M. Chen remembers what happened next.

Women didn’t just head to the gym. Some found that weight loss and exercise didn’t achieve the results they wanted and headed to their doctors’ offices to inquire about a surgical fix for sagging upper arms.

Dr. Constance M. Chen

As we age, the skin on the upper arms loses elasticity and droops. Fluctuations in weight and heredity also contribute to this effect. While exercise can strengthen the arms and improve muscle tone, it cannot correct skin that has lost elasticity. An arm lift, or brachioplasty, can reshape the upper arm by removing excess skin and fat from the underside of the upper arm from armpit to elbow. The problem is that excess skin resection can leave unsightly scars, while liposuction alone can worsen the problem of loose sagging skin if the woman does not have enough skin elasticity.

As we age, the skin on the upper arms loses elasticity and droops. Fluctuations in weight and heredity also contribute to this effect. While exercise can strengthen the arms and improve muscle tone, it cannot correct skin that has lost elasticity. An arm lift, or brachioplasty, can reshape the upper arm by removing excess skin and fat from the underside of the upper arm from armpit to elbow. The problem is that excess skin resection can leave unsightly scars, while liposuction alone can worsen the problem of loose sagging skin if the woman does not have enough skin elasticity. Good candidates for an arm lift are healthy, non-smoking adults of any age who are not significantly overweight and whose weight is stable.

As with any cosmetic procedure, it is important that those considering surgery have realistic expectations, The smoother, tighter contours produced by an arm lift are relatively permanent as long as weight and general fitness are maintained though there may be some loss of firmness over time as the body continues to age. Scars from an arm lift can be significant, however, so patients need to be sure that they would like to trade an improved arm shape for a visible scar.

Dr. Constance M. Chen

The procedure may be performed in the hospital or on an out-patient basis, under local or general anesthesia. The number and extent of incisions are dependent on the amount of skin to be removed; they may be on the inside or back of the arm and will be placed to minimize the visibility of scars. A short-scar brachioplasty limits the scar to the armpit, but passit also is not as effective for resecting a large amount of loose sagging upper arm skin. Fat may be removed directly or treated with liposuction. Underlying supportive tissue is tightened and smoothed, then skin is replaced over the reshaped arm and secured with stitches. Physical and athletic activity will be limited for several weeks following surgery. Risks associated with an arm lift are those of any surgery, such as bleeding, infection, or adverse reaction to anesthesia, as well as temporary changes in skin sensation.

“As with any cosmetic procedure, the driving motivation and expectations for results are unique to each individual,” says Dr. Chen. “For those committed to maintaining a healthy regimen of fitness and weight control, an arm lift can solve a nagging problem that is otherwise resistant to change. Patients need to think carefully about the scars, however. Our goal is always to help people have the bodies they want and to improve their 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.

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.

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

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

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

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

About Dr. Constance M. Chen

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

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

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

Advances in Post Mastectomy Breast Reconstruction: Nipple Preservation

Dr.-Constance-M-Chen

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

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

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

Dr. Constance M. Chen

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

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

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

Dr. Constance M. Chen

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

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

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

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

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

 

About Dr. Constance M. Chen

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

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

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

 

 

 

 

 

Managing Expectations for Breast Reconstruction; It’s a Process

Dr.-Constance-M-Chen

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

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

Dr. Constance M. Chen

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

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

Dr. Constance M. Chen

A mastoplexy or breast lift may be performed on the unaffected breast if its natural droop cannot be replicated in the reconstructed breast. A breast lift will remove excess skin and may elevate only the nipple and areola so they are placed higher on the breast or elevate the breast tissue itself so it sits higher on the chest wall. A breast lift will not significantly alter the size of the breast.

A breast reduction on the unaffected breast may be needed to match the size of the reconstructed breast. The procedure will remove excess skin and tissue and position the breast tissue and nipple-areola complex higher on the chest wall. Breast augmentation to increase the size of the unaffected breast will typically involve placing a silicone gel or saline implant under the pectoral muscle.

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

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

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

 

About Dr. Constance M. Chen

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

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

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

 

 

 

 

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

Dr.-Constance-M-Chen

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

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

Dr. Constance M. Chen

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

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

Dr. Constance M. Chen

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

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

Dr. Constance M. Chen

Immediate reconstruction

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

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

Dr. Constance M. Chen

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

 

Delayed reconstruction

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

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

Dr. Constance M. Chen

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

 

About Dr. Constance M. Chen

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

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

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