800-433-7410

Breast reconstruction is a physically and emotionally rewarding procedure for women who have lost one or both breasts due to genetic susceptibility or breast cancer. When faced with a mastectomy, it’s normal to feel anxious, sad and uncertain about giving up a part of your body. Your breasts may be closely tied to your sense of femininity, your sexuality, your confidence, your self-image and, if you have breastfed children, your experience of motherhood. The creation of a new breast can not only restore your physical body, it can offer peace of mind and dramatically improve your quality of life.

There are many procedure options available to recreate the volume of the breast. When you are diagnosed with breast cancer, you must make many important decisions during a challenging time. You may ask yourself questions such as, “Should I have my breast reconstructed or not?” “Should I have the reconstruction performed immediately or wait until later?” “What type of New York breast reconstruction procedure is right for me?”

Drs. Salzberg and Jacobs have spent decades perfecting their technique to rebuild a woman’s breast following mastectomy. Dr. C. Andrew Salzberg is the pioneer of the direct to implant, or “one step,” breast reconstruction procedure. Dr. Jordan M.S. Jacobs specializes in DIEP flap reconstruction and other reconstructive procedures that use microsurgical techniques to create new breasts using a woman’s own tissue. They work seamlessly together to reconstruct a breast which is as perfect as possible and maintains your sensibility and femininity.

Many women in New York City, Tarrytown and the whole country have entrusted their care to the New York Group for Plastic Surgery for solutions and support. Our experienced, knowledgeable and compassionate surgeons can help you through this difficult time. For over 30 years, we have been there for our New York patients and those who fly in from across the country, providing experienced, precision reconstructive plastic surgery with a caring approach to patient care.

Frequently Asked Questions

BREAST RECONSTRUCTION IN NEW YORK – UNDERSTANDING YOUR CHOICES

Several important choices accompany every mastectomy procedure. The first and most basic decision is whether to have breast reconstruction in the first place. Some patients decide that they do not want to undergo any further surgeries or are not ready for reconstruction for various reasons. This is an intensely personal decision that does not have a single right answer that suits every woman. After considering your options, you must make the choice that feels right for your body and your life.

In our New York holistic practice, we have found that most women who undergo mastectomy elect to have reconstructive breast surgery. Most patients choose reconstruction because mastectomy drastically alters their body, which in turn can negatively impact their self-image. Breast reconstruction can help you to feel whole and healthy again.

If you choose to undergo breast reconstruction, you also need to decide when the procedure will take place. Breast reconstruction can be performed either at the time of the mastectomy (immediate reconstruction) or sometime afterward (delayed reconstruction). The advantages of immediate reconstruction include:

  • A subsequent surgery and recovery period are avoided.
  • Scar tissue has not formed from the mastectomy.
  • Remaining breast skin is still available in the size and shape of the original breast.
  • The patient does not have to see herself without any breast at all.
  • Postoperative chemotherapy or radiation therapy does not usually need to be delayed.

In some cases, such as intermediate or advanced breast cancer, your surgeon will probably recommend choosing delayed reconstruction to allow time to control the cancer. Delayed reconstruction is also advantageous for patients who need time to think through their options thoroughly. We will, as your surgeons, take the time to answer your questions and discuss all of your options with you at your consultation to help you through this very personal decision.

BREAST REPLACEMENT CHOICES

Once you have chosen to have breast reconstruction, your New York surgeon will ask you to decide whether you want your breast to be replaced with an Implant or Autologous Tissue Flap (your own body tissue). Each option has pros and cons that must be weighed on a personal basis.

IMPLANT RECONSTRUCTION

Implant reconstruction uses breast implants filled with either saline or silicone. In cases where there is not enough skin and muscle to cover the implant, existing tissue can be stretched over time with a tissue expander or remaining muscle can be expanded immediately using AlloDerm® (an acellular tissue matrix). Patients choose implants because of their aesthetic appearance and minimal surgery time. The disadvantages include capsular tissue build-up, possible rejection and the need for a second surgery to replace the tissue expander with the implant. This is the most popular option chosen in our New York plastic surgery practice.

AUTOLOGOUS TISSUE FLAP RECONSTRUCTION

Autologous tissue flap reconstruction, such as DIEP flap surgery, rebuilds the breast by transplanting live skin and fat from the abdomen. The advantages of flap reconstruction are that the reconstructed breast remains your own and matures with you, and the rebuilt breast lasts for the patient’s lifetime. The possible disadvantages are that the surgery is longer and more complex and there is a scar on the abdomen. Women choose this technique if they are either not candidates for implant reconstruction, do not want an implant or have extra tissue in a donor area they would like to have removed.

There are a number of factors that should be taken into consideration when choosing which breast reconstruction option is best for you, including the type of mastectomy, your body type, your cancer treatments, any past surgeries and your personal preferences. Take the time to learn about your options and allow the dedicated reconstructive surgeons of the New York Group for Plastic Surgery to educate and support you in making this life-changing decision.

DIRECT TO IMPLANT BREAST RECONSTRUCTION

Dr. Salzberg performed the first-ever direct to implant reconstruction in 2001 and has since helped more than 500 patients with this technique. Direct to implant breast reconstruction is completed at the same time as mastectomy in one surgical procedure. The permanent implant and a special support material called acellular dermal matrix (ADM) are inserted into the breast immediately following breast tissue removal, eliminating the need to use a tissue expander. Because the reconstructed breast is in place right away, direct to implant reconstruction can help lessen the emotional stress of mastectomy and preserve the patient’s positive body image.

AUTOLOGOUS TISSUE FLAP BREAST RECONSTRUCTION OPTIONS

Dr. Jacobs specializes in reconstructive techniques that rebuild a woman’s breast using her own tissue. There are various ways this type of breast reconstruction can be performed:

  • Pedicled TRAM (Transverse Rectus Abdominis Myocutaneous) Flap: A TRAM flap uses muscle, fat and skin from the lower abdomen to reconstruct a breast. The flap remains attached to your rectus abdominis muscle, which is the source of its blood supply, and is tunneled directly into the breast pocket through the abdomen to create the breast mound.
  • Free TRAM Flap: A free TRAM flap is also based on the blood vessels of the rectus abdominis muscle. However, in this technique the muscle above and below the blood vessels is divided, so that only a very small piece of muscle is removed and transplanted to the chest.
  • DIEP (Deep Inferior Epigastric Perforator) Flap: A DIEP flap also transfers tissue from the abdomen, but no muscle is used in this technique. Only blood vessels and fat are transferred, and microsurgery is used to reconnect the donor vessels at the breast site.
  • TAP Flap (Thoracodorsal Artery Perforator): A TAP flap is an innovative “perforator” flap that utilizes skin and fat from the side of the upper back without taking any of the latissimus muscle, which weakens you. Many patients do not have enough tissue in this area to use a TAP flap alone in breast reconstruction and an implant may be used to supplement. This approach is best used in combination with another technique to correct small defects and enhance the shape and size of the breast.

In our practice, we have found that many of our NYC patients choose the DIEP flap technique because it does not affect the abdominal muscles, because there is no need for implants and because the results look and feel very much like natural breasts. With our newer technique of doing a complete block of the nerves for 48 to 72 hours after surgery, patients have minimal and remarkably less pain during recovery, less abdominal wall weakness and a dramatically reduced chance of
abdominal wall hernia formation. Some patients also consider it a bonus that their belly is
left flatter after removing the tissue flap, an effect similar to undergoing a tummy tuck.

NIPPLE RECONSTRUCTION

Some women are able to have a nipple sparing mastectomy that preserves her own nipple area (nipple areola complex or NAC) for more natural-appearing breasts. If nipple sparing mastectomy is not an option, nipple reconstruction can be performed during a revision procedure. This process can begin once the reconstructed breast has healed and softened, typically several months after surgery. Nipple reconstruction is performed by creating a flap of tissue on the breast mound and arranging it to create the appearance of a nipple. Tattooing is available to recreate the appearance of the areola around the reconstructed nipple. Patients seeking nonsurgical options for nipple reconstruction can choose tattooing to recreate the look of both the nipple and the areola.

BREAST ANIMATION DEFORMITY CORRECTION

Breast animation deformity (BAD) or “Jumping Breast” is a complication associated with submuscular (beneath the pectoral muscle) implant placement for breast reconstruction. Patients with this complication experience visible contraction, distortion and displacement of their breast implants with movement of the pectoralis major muscle. The distortion is particularly noticeable during certain activities, notably exercises like strength training with weights. BAD is aesthetically displeasing and can cause loss of strength and significant pain.

For postmastectomy patients whose quality of life is diminished by breast animation deformity, revision is an option. Permanently fixing BAD involves an outpatient procedure for the creation of a new pocket in the prepectoral space (directly under the skin and on top of the pectoralis muscle). The implant is moved to this space and wrapped in an acellular dermal matrix that provides an extra layer of cushion
between the implant and the skin. This eliminates movement of the implant, while restoring breast symmetry and creating more natural-looking cleavage.

Another option for correcting animation deformity may be removing the implant and replacing it with an autologous tissue flap, usually from the belly. The flap provides a layer of fat between the skin and the pectoralis muscle, eliminating this unnatural movement. NYGPS surgeons are knowledgable about a variety of innovative techniques and tailor their approach to the unique needs of the patient.

Will I have scars?

You will have visible scarring after breast reconstruction, but the location of your scars depends on the type of procedure you choose. Autologous tissue reconstruction involves different scarring than implant reconstruction because the surgery requires incisions in two areas of the body. Your surgeon will place the incisions so they are as inconspicuous as possible and your scars will fade over time, but will never go away entirely.

Will my breasts be asymmetrical?

If you have had a single mastectomy, your surgeon will create a new breast that matches your natural breast as much as possible. In some cases, surgery on the unaffected breast can improve symmetry of the size, shape and position of both breasts. This can be achieved through breast augmentation, breast reduction, breast lift or repositioning of the nipple on the natural breast. A balancing procedure is often done three to six months after reconstructive surgery, to make sure the reconstructed breast has healed and has reached its final size and shape.

Will I retain normal sensation after breast reconstruction?

A reconstructed breast may look and feel similar to natural breast tissue, but the sensation you experience may be quite different. You may have little to no sensation in a breast that has been recreated with any reconstructive technique. One of the best ways to make sure that you’re as satisfied as possible with your procedure is to ask your plastic surgeon lots of questions about what to expect. Speaking with other patients who have undergone breast reconstruction about their experience can also help you set appropriate expectations for your procedure.

Will my health plan cover breast reconstruction?

The Women’s Health and Cancer Rights Act (WHCRA) of 1998 states that all group and individual health plans that cover mastectomy must also cover reconstructive breast surgery. Under WHCRA, these plans should cover:

  • Reconstruction of the breast or breasts on which mastectomy was performed
  • Surgery on the unaffected breast if it is needed to produce a symmetrical appearance
  • Breast prostheses
  • Treatment of physical complications if they arise at any stage of the mastectomy

Communicate with your insurance company to confirm that your surgery is covered under your plan and obtain preauthorization.

Am I a candidate for breast reconstruction?

Breast reconstruction is an option for most women who undergo a mastectomy or lumpectomy. However, you may not be a candidate for every type of reconstruction. You and your plastic surgeon will discuss which type of breast reconstruction is best for you.

Losing a breast to cancer is a deeply emotional experience. It can be reassuring to know that there are options available not only for restoring your health, but for restoring your body and your sense of self. Dr. Jacobs, Dr. Salzberg and the rest of the compassionate team of New York Group for Plastic Surgery can help you design a plan for breast reconstruction that achieves beautiful cosmetic results and helps you feel like your complete self again. Contact our office today at 212-844-8796 to schedule a consultation.