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

Dr.-Constance-M-Chen

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

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

Dr. Constance M. Chen

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

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

Dr. Constance M. Chen

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

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

Dr. Constance M. Chen

Immediate reconstruction

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

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

Dr. Constance M. Chen

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

 

Delayed reconstruction

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

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

Dr. Constance M. Chen

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

 

About Dr. Constance M. Chen

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

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

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

 

 

 

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

Dr.-Constance-M-Chen

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

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

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

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

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

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

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

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

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

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

The goal of breast reconstruction, whether with implants or a woman’s own tissue, is to restore symmetry – to create a breast with the shape of the original that is in proportion with her other breast and with the rest of her body. Matching a reconstructed breast to an existing natural breast may not be possible in a single surgical procedure, however.

Follow-up modifications may be necessary to achieve the desired symmetric result. “For many women, breast reconstruction is a process rather than a single procedure”, says Dr. Chen. “Lack of symmetry in mastectomy patients after reconstruction can be corrected with adjustments to the reconstructed breast or to its unaffected ‘sister.’ This possibility should be discussed in the initial surgical consultation”.

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

 

About Dr. Constance M. Chen

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

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

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

 

 

 

 

Acupuncture and Surgery: Relieve Anxiety Before and Reduce Discomfort After

Acupuncture is part of an ancient system of Chinese medicine that has been used for more than 2,500 years to treat disease and relieve pain by restoring balance to the flow of energy (‘qi’) through the body. Acupuncture theory believes that this qi moves throughout the body along twelve main channels (‘meridians’) that represent the major organs and functions of the body and that applying thin needles to specific points achieves pain relief and other beneficial effects.

Acupuncture is one of the better known types of alternative medicine. Its acceptance has grown as physicians have come to see that it can be effective, and it is sometimes incorporated into conventional healthcare. In particular, acupuncture has shown promise when used in ‘perioperative care’, in findings that its use before and after surgery can improve the clinical outcome and speed recovery.

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

Surgery affects the body in many different ways, depending on the type and location of the surgery, the aftereffects of anesthesia, and the patient’s overall health. Beyond these variations, however, all surgery is trauma to the body – the entire body – and generates a stress response beyond the immediate surgical site.

This stress response causes hormonal and metabolic changes that can weaken the immune system, disrupt the gastrointestinal tract and leave the body more vulnerable to infection. In some studies, perioperative acupuncture has been found to reduce stress and anxiety before surgery, reduce the need for opioids during surgery, and decrease both pain and post-operative nausea and vomiting after surgery.

Acupuncture can effectively reprogram the body to switch from the ‘fight-or-flight’ stress response to rest and relaxation. The precise mechanism that causes this effect isn’t known but it may be due to acupuncture increasing the body’s production of endorphins, the natural hormones that counteract inflammation, pain and stress.

Dr, Constance M. Chen

The primary goal of preoperative acupuncture is to reduce the anxiety and stress that can make surgery riskier and anesthesia management more difficult. Anxiety before surgery can also lead to sustained postoperative anxiety as well as increased sensitivity to postoperative pain and longer recovery time. In multiple studies, acupuncture applied thirty minutes before administering anesthesia induced a relaxation response. There are indications that it can also act therapeutically to stabilize blood pressure and blood sugar.

During surgery, acupuncture in combination with conventional anesthesia can reduce the dose of opioids needed and provide a more comfortable post-operative experience than anesthesia alone. After surgery, acute pain can delay wound healing, prolong recovery, and increase the risk of postoperative infection. Acupuncture can help alleviate pain and reduce the amount of medication needed to control it. Post-operative acupuncture may also promote the recovery of the immune system, bladder function, and the gastrointestinal tract.

The most common and most thoroughly studied use of acupuncture in surgical practice is to control postoperative nausea and vomiting. About one-third of patients undergoing surgery with general anesthesia suffer postoperative nausea and vomiting in the 24-48 hours following surgery. Nausea and vomiting are triggered in the brain, which receives signals via neurotransmitters – chemical messengers that transmit stimuli from various parts of the body to the brain. After surgery those stimuli might include pain, fear, and anxiety, or reactions to anesthetics and drugs such as opioids that are used to control pain.

“Some patients find postoperative nausea and vomiting more unpleasant and distressing than post-operative pain and it can impede recovery from anesthesia and surgery as well”, says Dr. Chen. “Medications to control nausea and vomiting are of limited efficacy and may have adverse side effects, making acupuncture an appealing and effective alternative”.

The use of acupuncture has become increasingly common pre- and post-surgery. The World Health Organization includes the prevention and treatment of postoperative nausea and vomiting and the treatment of pain as conditions that may benefit from treatment with acupuncture.

Dr. Chen concludes, “Our goal is to make every patient’s surgery and recovery as comfortable as possible. Some patients find that acupuncture plays a part in achieving that goal”.

About Dr. Constance M. Chen

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

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

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

Breast Reconstruction Specialist Dr. Constance M. Chen Offers Tips for Patients

Among women who opt for reconstruction after losing a breast to mastectomy, 80% undergo reconstruction with implants. “Many women see implants as the quickest, simplest reconstructive option”, says plastic surgeon and breast specialist Dr. Constance M. Chen. “Their other choice – natural-tissue reconstruction – requires a more complex surgery and longer recovery time”. However, studies have shown that the risk of cosmetic and health problems with implants in the first few years is significant and the risks increase over time. Implants aren’t expected to last forever. Most have a ten-year warranty although many will have to be removed before that.

Studies have shown that the risk of cosmetic and health problems with implants in the first few years is significant and the risks increase over time. Implants aren’t expected to last forever.

Dr. Constance M. Chen

Implants fail for many reasons. Different types have different characteristics that women must weigh against their individual requirements and preferences but all implants are foreign bodies and pose the risk of comfort and cosmetic problems. Dr. Chen describes some of the common complications and unsatisfactory results of implant reconstruction and provides tips on corrective measures and on options if implants have to be removed.

Infection can develop in the tissue around an implant, often in the days or weeks following surgery. That said, infection has been seen 20 years after implant surgery. Women with breast implants should take antibiotics if they undergo teeth cleaning or colonoscopy. Signs of infection are redness and swelling. Treatment with an antibiotic may be sufficient; if it isn’t, the implant may have to be removed.

Capsular contracture is a tightening – or contracting – of the scar tissue that forms around the implant as a natural reaction to the presence of the implant. The capsule is usually soft and barely noticeable but it may become hard and painful, like a calcified shell that develops around the implant. Symptoms of contracture usually develop gradually and may be noticed first as a feeling of mild tightening.

As contracture increases, the breast may appear misshapen and become very firm and painful, especially when lying on it. Treatment is to remove the implant and capsule surgically, but the capsule will reform and usually become harder more quickly. In some cases, the implant may be replaced with a new one wrapped in acellular dermal matrix to try to reduce capsular contracture; in others, natural-tissue reconstruction may be the best option.

Rupture becomes more likely as an implant ages. Saline implants may appear deflated or misshapen. Silicone implant ruptures are either silent, or they present as unusual pain due to the irritation to the surrounding tissues. Since silicone implant ruptures are silent, the FDA recommends breast MRIs for surveillance every 2-3 years for women with silicone implants. Ruptured implants are generally removed as long as the patient is healthy enough to tolerate surgery.

Displacement of the implant can occur for several reasons, one of which results from the placement of the implant under the chest muscle (sub-pectoral placement). Placement of a breast implant under the chest muscle can cause the breast to feel tight and painful, and flexing the chest muscle can also cause the implant to shift visibly under the skin and distort the breast.

The problem can be corrected by removing the sub-pectoral implant and placing a new implant above the muscle (pre-pectoral). A prepectoral breast implant is closer to the natural anatomy of the breast, because the natural breast is also above the chest muscle. The new implant may be wrapped in acellular dermal matrix to provide some additional soft tissue protection under the skin.

Many women who have had unfortunate experiences with implants prefer not to try again, even with a different type of implant or modified surgical procedure. They turn to natural tissue breast reconstruction, also known as autologous reconstruction, which is the ‘gold standard’ of breast reconstruction. Natural tissue breast reconstruction uses a woman’s own tissue to create a breast that is soft and warm and that lasts a lifetime.

Feeling cold occurs because there is no blood supply to the implant and because the skin that remains after the removal of breast tissue can be quite thin. Fat-grafting can help by adding additional ‘padding’ over the implant, but it is often of limited utility. A better solution is natural-tissue reconstruction, which recreates a soft, warm living breast.

About Dr. Constance M. Chen

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

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

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

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

Dr.-Constance-M-Chen

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

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

Dr. Constance M. Chen

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

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

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

Dr. Constance M. Chen

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

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

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

 

About Dr. Constance M. Chen

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

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

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

 

 

 

 

Understanding the Options for Body Contouring after Bariatric Surgery: Panniculectomy or Abdominoplasty?

Dr.-Constance-M-Chen

Tens of thousands of people each year achieve dramatic weight loss by undergoing bariatric surgery. According to the American Society for Metabolic and Bariatric Surgery, in 2017, 228,000 people underwent surgery to restrict the amount of food the stomach can hold or reduce the absorption of nutrients or both.

Surgical techniques vary according to the needs of individual patients. Some procedures are reversible; some change the hormonal environment in the gut in ways that reduce appetite and enhance feelings of fullness; some reverse the mechanism by which obesity causes type 2 diabetes.

Weight loss surgery combined with a commitment to healthy diet and exercise habits delivers life-changing benefits, but even with the most successful outcomes, there is one common and distressing side effect that inhibits the full realization of the benefits: Many people who achieve dramatic weight loss are left with unsightly and uncomfortable saggy excess skin that is immune to the effects of diet and exercise and can interfere with the activities of daily living.

Dr. Constance M. Chen

Skin stretches to accommodate excess weight. When the weight is lost gradually, the skin is more likely to shrink back to conform to the body’s new dimensions but when weight is lost rapidly, as with bariatric surgery, the skin’s elasticity cannot keep up. Not everyone will suffer the same degree of post-surgical excess skin.

Elasticity is affected by genes but also decreases with age, sun exposure, and smoking. In general, the part of the body that carried the most weight is where the skin is most stretched and least elastic and where loose, sagging skin will be most troublesome. For many people, that area is around the middle.

Excess fat and skin that hangs down from the abdomen is known as a pannus. There are two primary surgical techniques for contouring the abdomen: A panniculectomy removes the pannus for functional reasons; an abdominoplasty (or tummy tuck) removes the pannus but also tightens the underlying abdominal muscles and relocates the belly button for cosmetic reasons.

Dr. Constance M. Chen

The anatomical structures of the lower abdomen that are involved in these procedures are: the abdominal wall, composed of muscle and tissue, which may become weakened over time or disrupted by surgery; subcutaneous fat stored outside the abdominal wall; and skin that has stretched, no longer molds to the body, and, with excess fat, hangs in folds to form the pannus.

A panniculectomy focuses specifically on removing the fat and skin that hang from the lower abdomen over the groin and, often, the thighs. “Panniculectomy is a functional surgery”, says Dr. Chen. “The excess tissues are heavy, causing back pain, and skin rubbing on skin causes rashes, infections, and skin ulcers. The belly button is resected so that the patient does not have a belly button after surgery”.

An abdominoplasty (or tummy tuck) similarly removes excess fat and skin and also tightens the muscles of the abdominal wall; usually the navel is relocated as well. It is performed as a body contouring procedure for cosmetic reasons to flatten the upper and lower abdomen and remove excess skin. In some cases, liposuction can be performed as an additional procedure to contour the trunk.

“Panniculectomy and abdominoplasty are similar procedures,” says Dr. Chen, “and they both involve resecting excess abdominal skin and fat. Either may be part of a body contouring plan after bariatric surgery, generally about 12-18 months later when optimum weight has been achieved and healthy eating and exercise habits have been adopted. Along with a healthy lifestyle, body contouring helps fulfill the promise of dramatically improved physical and emotional health delivered by bariatric surgery.”

 

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.

 

 

 

 

Body Contouring After Bariatric Surgery, Removing the Excess Fat and Skin

Dr.-Constance-M-Chen

Bariatric surgery delivers life-changing benefits for many people each year. In 2017, the American Society for Metabolic and Bariatric Surgery estimates that 228,000 people underwent weight loss surgery. While bariatric surgery can improve underlying physical and emotional health, the dramatic change in body size due to weight loss can also leave patients with excess skin that causes its own new problems.

Excess weight stretches the skin, and after the substantial weight loss that follows bariatric surgery — sometimes over 100 pounds – the skin and tissues often lacks the elasticity to shrink down to the body’s new dimensions. Not only do many people find the excess skin hanging off of the new underlying body frame unsightly and embarrassing, but it can also cause rashes due to the constant rubbing of overhanging skin which can then interfere with activities of daily living. To alleviate these problems, body contouring after bariatric surgery removes excess fat and skin to improve the body’s contours after weight loss.

Dr. Constance M. Chen

The parts of the body most affected by excess skin are the abdomen, arms, breasts, thighs, and buttocks. When multiple areas need to be treated, it is usually safest to undergo surgery in staged procedures to minimize anesthesia risk and recovery.

The abdomen is the most troubling area for many people. An overhanging fold or ‘apron’ of skin called a pannus (or panniculus) can cause a rash and irritation, especially in hot weather. Abdominal surgery may just remove the pannus (panniculectomy) or may also repair separated abdominal muscles (abdominal plication in abdominoplasty or tummy tuck).

Upper arms that sag and appear loose and full are corrected with an arm lift (brachioplasty), which removes excess skin from the underside of the arm. Breasts may flatten and droop due to loss of fat and tissue in the breast. A breast lift (mastolexy) will remove excess skin, reshape the breast tissue, and raise the nipple and areola complex, resulting in a rounder, fuller breast. A breast lift does not change the size of the breast so some patients request an implant or fat grafting to create larger breasts.

The lower back and buttocks may be lifted in a lower body lift, which is accomplished through a hip-to-hip incision across the back, above the buttocks. The inner thighs can be treated with a thigh lift that shapes the thigh by reducing excess skin through an incision that starts high on the inner thigh near the groin.

Body contouring procedures should be customized for each individual. Sometimes it is possible to modify the incision to minimize or hide scarring. For example, we can hide the scars in the groin crease for a thigh lift or in the armpit for a short-scar brachioplasty.

Dr. Constance M. Chen

The best time for post-bariatric body contouring is when the weight has stabilized and the patient is as close as possible to ideal weight, usually 12-18 months after bariatric surgery. “There are additional key considerations to ensure a successful body contouring outcome”, says Dr. Chen. “Patients must be committed to not smoking and to a nutritional and exercise regimen that will help them achieve and maintain their optimal weight. Healthy habits will reduce the risks of complications from surgery and promote healing. It is also important to understand your goals and be realistic about expectations. Bariatric surgery, body contouring, and a commitment to a healthy lifestyle have given countless people a new lease on 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.

 

 

 

 

Correcting Breast Asymmetry after Cancer Surgery and Reconstruction

Dr.-Constance-M-Chen

The goal of breast reconstruction after mastectomy is to restore symmetry – to create a breast with the shape and softness of the original that is in proportion with her opposite breast as well as the rest of a woman’s body. Matching a reconstructed breast to the existing natural breast may not be possible in a single surgical procedure, however. Follow-up modifications may be necessary to achieve the desired symmetric result.

“Breast reconstruction is often a process rather than a single surgical procedure”, says Dr. Constance M. Chen, board-certified plastic surgeon and breast reconstruction specialist. “Lack of symmetry in mastectomy patients after reconstruction can be corrected with adjustments to the reconstructed breast or to its unaffected ‘sister.’ Asymmetry may also be a problem for women who have had a lumpectomy that conserved the breast but left them with breasts that no longer match. For all these women, advanced surgical techniques that address their individual needs can produce an improved symmetrical outcome to help put cancer behind them”.

The gold standard in post-mastectomy reconstruction is natural tissue breast reconstruction, which uses a woman’s own tissue to recreate a soft and warm breast. The best possible result is achieved when reconstruction is performed at the same time as the mastectomy, because the surgeon can preserve the entire breast envelope including the nipple-areola complex. Even if it is not possible to preserve the entire breast envelope, the incisions can be carefully planned to preserve as much of the breast shape as possible. In addition, symmetry is often best in bilateral mastectomy with immediate reconstruction, when both breasts are removed and reconstructed at the same time, because it is easier to match size, shape and position.

Reconstructed breasts can be very difficult to distinguish from the original, but there are many reasons why ‘best case’ scenarios may not be feasible. For example, most breast surgeons do not perform nipple-sparing mastectomies, and the traditional transverse-scar mastectomy distorts the breast shape significantly. In addition, most women undergo breast reconstruction with implants rather than natural tissue, and the resulting breasts may have the artificial shape of an implant. Furthermore, there are medical and personal reasons that reconstruction may be performed months or even years after mastectomy, when the skin envelope has been distorted even more. And finally, if only one breast needs to be reconstructed, symmetry can be more difficult to achieve. In each scenario, however, it is possible to make adjustments not only to the reconstructed breast but also to the unaffected breast to improve symmetry.

Dr. Constance M. Chen

Techniques for Improving Symmetry. One of the most common procedures for correcting small defects is fat grafting, which transfers fat from another part of the body to the breast. Using liposuction, fat is removed through tiny incisions from the donor site, processed to remove impurities, and injected into the breast. Fat grafting and liposuction may be used on the unaffected breast, to make corrections to the reconstructed breast, or to fill in deficiencies resulting from lumpectomy.

A mastopexy or breast lift may be performed on the unaffected breast if its natural droop cannot be replicated in the reconstructed breast. This is often the case with implant-based reconstruction, which tends to create a breast that is “perkier” than the natural 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 either the reconstructed or the unaffected breast may be achieved with fat grafting or with a breast implant.

Surveys have found that women whose breast reconstruction is symmetrical and aesthetically pleasing have improved postoperative quality of life compared to those who perceive their breasts as mismatched. “It’s important for women to know that they don’t have to live with asymmetrical breasts and that achieving balance will not impose a financial burden”, says Dr. Chen. “The 1998 Women’s Health and Cancer Rights Act requires health insurers that cover mastectomy to also cover all stages of reconstruction and secondary procedures as well as surgery on the opposite breast to achieve symmetry. At the end of the day, after undergoing breast reconstruction, women are entitled to have symmetrical breasts”.

 

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.

 

 

 

 

Nipple Reconstruction: Creating a Natural Breast After Mastectomy

Dr.-Constance-M-Chen

Breast reconstruction recreates a breast mound either with implants or with the woman’s own tissue. In either case, nipple reconstruction can be performed in a separate surgery from the original breast reconstruction. “Modern techniques in mastectomy and breast reconstruction offer women many options,” says plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen.

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

There are several ways to create a new nipple and areola. The most common technique for nipple reconstruction uses the remaining breast skin after a mastectomy. The skin is folded and sutured to form a new nipple, and then the new nipple and surrounding skin is tattooed to create the nipple-areola complex. If there isn’t enough healthy skin to create a new nipple from the remaining breast skin, a skin graft may be used from another site, usually the groin.

The skin graft is then folded and sutured to create a new nipple. For patients who undergo a unilateral mastectomy and have a large nipple on the remaining breast, a nipple-sharing technique may be used in which part of the native nipple is resected and transferred onto the reconstructed breast. In each type of nipple reconstruction, the nipple is often dressed with antibiotic ointment and a special medicated gauze dressing that is then placed into a protective shield or ‘nipple house’ that remains in place for a week.

After the reconstructed nipple has healed, tattooing may be used to add color and create the areola. Some women forego nipple reconstruction altogether, and instead choose 3D tattooing to create the illusion of a nipple on the breast mound. “Many women feel that breast reconstruction improves their quality of life.” says Dr. Chen. “Surgical advances make it possible to create a soft, warm, natural breast that can be difficult to distinguish from a woman’s own breast. Many women would like to look normal without clothing. They feel that a breast that looks more like their original breast will help them put cancer behind them. Nipple reconstruction helps many women move on from their mastectomy and feel that they have restored their breast for a more confident future”.

 

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.

 

 

 

 

Capsular Contracture After Breast Implants

Dr.-Constance-M-Chen

In 2017, almost 400,000 women underwent surgery with breast implants – whether for cosmetic breast augmentation or for breast reconstruction after mastectomy. Despite significant improvement in implants since they were first introduced in the 1960s, however, studies by the implant manufacturers have shown that within seven years, 50% of women with breast implants will undergo another operation to fix problems with their implants. One common problem with breast implants is the development of capsular contracture, a condition in which the scar tissue that forms around the implant becomes hard and painful.

Scar tissue is the body’s natural response to the presence of any foreign body. With breast implants, the body creates a barrier of scar tissue around the implant to wall it off and protect it from the rest of the body. This barrier, or capsule, may be soft, flexible, and barely noticeable or it may become hard and painful, like a hard shell that develops around the implant and that may subsequently distort the breast.

Dr. Constance M. Chen, breast reconstruction specialist

Capsular contracture is essentially a tightening – or contracting – of the scar tissue. Symptoms usually emerge gradually and may be noticed first as a feeling of mild tightening. As contracture increases, the breast may appear misshapen and become very firm and painful, especially when lying on it.

There are several factors that may precipitate capsular contracture, such as a low-grade bacterial infection, hematoma (blood pooled in the breast pocket), and seroma (fluid collected in the breast pocket). Studies suggest that an implant with a textured surface may be more protective against capsular contracture than an implant with a smooth surface, but textured surfaces also place patients at higher risk of infection and large cell anaplastic lymphoma.

Since implants are foreign bodies, they do not have a defense mechanism against infection. Placing the implants under – rather than above – the pectoral muscle can reduce the risk of capsular contracture due to the constant massaging action of the pectoralis muscle, but it can also lead to more pain due to the unnatural position of the implant. Sometimes, exercises or massage can be helpful after implantation to break up hardened scar tissue. Ultimately, it is impossible to prevent the development of an implant capsule altogether, as scar tissue is formed when the body heals.

In general, capsular contracture is treated by removing the implant. Not all surgeons remove the capsule, because a complete capsulectomy is a very meticulous and time-consuming procedure. A complete capsulectomy requires removing capsular material that may be attached to the chest wall or ribs, which can risk damage to surrounding structures including the lung.

A partial capsulectomy removes only some of the capsule, leaving some material behind. A capsulotomy (as opposed to a capsulectomy) involves using electrocautery to make breaks in the capsule to release the tightness while leaving the actual capsule in place – much like cracking a shell to release it but not actually removing any of the shell itself.

Other surgeons remove the implant and leave the capsule alone entirely, believing that the capsule will eventually be resolved by the body. Postoperative imaging has actually shown that the capsule sometimes does get resorbed by the or it thins out over time. Implant removal alone is the quickest, easiest, and possibly safest procedure, as even complete capsulectomy can and often does lead to a return of the contracture if a new implant is placed.

It can be very helpful to remove the entire capsule. The capsule contains a biofilm that may include fragments of silicone, bacteria, calcification, and inflammatory cells that can cause problems if left in the body. By removing the implant and the entire capsule, the healthy tissues can heal completely.

Dr. Constance M. Chen

That said, there are good reasons to remove the entire capsule with the implant. When the implant is removed with no implant replacement, a complete capsulectomy reduces the likelihood of a subsequent seroma because the raw tissue surfaces can heal and adhere properly to each other without the residual capsule in the way as a barrier.

 

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.