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.

 

 

 

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

Dr.-Constance-M-Chen

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

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

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

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

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

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

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

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

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

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

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

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

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

 

About Dr. Constance M. Chen

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

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

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

 

 

 

 

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

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

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

Dr. Constance M. Chen

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

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

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

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

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

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

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

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

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

About Dr. Constance M. Chen

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

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

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

Managing the Emotional Aspects of Breast Reconstruction

Dr.-Constance-M-Chen

More than 268,000 new cases of breast cancer were diagnosed in 2018 in the US, according to estimates by the American Cancer Society. Many of these breast cancer patients need to decide whether or not to undergo mastectomy and breast reconstruction. A breast cancer diagnosis is difficult, and coping with decisions about surgical treatment and its aftermath adds an extra layer of complexity to the diagnosis. Fortunately, many tactics and resources can help manage the emotional aspects of mastectomy and breast reconstruction.

It’s physically and emotionally taxing to adapt to the changes in your body and your life after breast cancer. It’s abundantly clear why breast cancer patients would need effective tools to manage the emotional aspects of this tumultuous journey.

Dr. Constance M. Chen

Reconstruction can offer sense of control. Often, one of the ironies of dealing with a breast cancer diagnosis is the need to decide whether to undergo mastectomy, and if so, whether, when and how to have breast reconstruction. There are two main types of breast reconstruction – either using implants or a patient’s own tissue to create new breasts – but sometimes, part of the emotional burden of breast cancer is the choice itself.

According to 2014 research in the Journal of the American College of Surgeons, fewer than 40% of women who undergo mastectomy choose to undergo immediate breast reconstruction. For many women, they are not offered breast reconstruction because it is not available where they live. For others, the advanced state of their disease may force them to conserve their energy on physical survival alone. While breast reconstruction after mastectomy can lengthen a woman’s initial hospital stay and recovery period, however, doing so can provide important emotional advantages.

“For many women, it’s very helpful to wake up from a mastectomy and look down to see that she still has breasts,” says Dr. Chen, who is also Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. “And even if a woman chooses to or is advised to wait for reconstruction surgery at a later date, being able to look forward to regaining a more natural and familiar body shape offers a sense of control, which can help calm her during an emotional time,” Dr. Chen adds. “Women who opt to forego reconstruction can also achieve a sense of normalcy by using a mastectomy bra with slots for breast forms. Either way, looking and feeling more like their pre-mastectomy selves can help a great deal emotionally”.

 

Tips to find support

It’s OK – in fact, it’s expected – that you may need emotional and social support during the period surrounding breast cancer treatment, especially for women who’ve undergone mastectomy and breast reconstruction. It’s normal to mourn the loss of your breast(s) due to mastectomy and to be worried about the breast reconstruction process. Here are some ways to seek support and insight:

  • Communicate: Open communication with your partner and your surgeon helps manage expectations and concerns.
  • Find a therapist: One-on-one therapy is often incredibly helpful for dealing with the tough emotions following a mastectomy, Dr. Chen says. “Therapists – especially those who often deal with cancer patients – can help women cope with feelings of a changing body, femininity, and any accompanying anxiety or depression.”
  • Check out support groups: “Breast cancer support groups at your local hospital, or even online, can connect you with others in your shoes,” she says. “For example, Young Survival Coalition (http://www.youngsurvival.org/) is targeted toward women under the age of 40 years who are diagnosed with breast cancer, and Facing Our Risk of Cancer Empowered (http://www.facingourrisk.org) is targeted toward people affected by hereditary breast and ovarian cancer. We even have our own group of patients, the Bosom Buddies (http://constancechenmd.com/bosom-buddies) who are committed to helping other patients in their breast reconstruction journey.”
  • Tap the American Cancer Society: If you’re feeling at loose ends about who can help you manage your emotions, call the ACS at 1-800-227-2345 to be connected with a group or resource that can work for you. https://www.breastcancer.org/

Breast cancer can feel very lonely, but you don’t have to deal with overwhelming feelings about mastectomy and reconstruction on your own, It’s important to know that you have support and that your family, friends, and health care providers are there to help.

Dr. Constance M. Chen

 

About Dr. Constance M. Chen

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

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

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

 

 

 

 

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

Dr.-Constance-M-Chen

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

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

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

Dr. Constance Chen

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

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

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

Dr. Constance Chen

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

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

Dr. Constance Chen

 

About Dr. Constance M. Chen

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

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

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

 

 

 

 

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.

 

 

 

 

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

Dr.-Constance-M-Chen

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

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

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

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

Dr. Constance M. Chen

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

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

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

 

About Dr. Constance M. Chen

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

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

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