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A diagnosis of breast cancer can be an extraordinarily traumatic event. For many of these women, treatment with breast conservation surgery may be an option. For others, however, treatment with mastectomy may be the recommendation. Breast reconstruction surgery can help avoid the devastating psychological impact mastectomy can have on one’s self-image and self-confidence.
As recently as 25 years ago, options for post-mastectomy breast reconstruction were severely limited. Furthermore, the results of those procedures in use were generally unnatural and lacking.
Fortunately, advances in plastic surgery made since that time have enabled us to offer both single and double mastectomy patients several excellent options for breast reconstruction at our Paramus plastic surgery practice.
Procedures for breast reconstruction available today can be done at the same time as the mastectomy, or after waiting a few months to several years. There are, in general, three reconstructive options, each with its own advantages and disadvantages:
- Autologous breast reconstruction.
- Prosthetic breast reconstruction.
- Autologous and prosthetic breast reconstruction.
Autologous Breast Reconstruction
The first option, called autologous breast reconstruction, involves reconstructing a breast with the patient’s own tissues. These tissues are generally taken from the abdomen, the back, or the buttock, with the abdomen being the most common by far (the “TRAM flap”).
The main advantage of autologous breast reconstruction techniques is that because the breast is reconstructed with the patient’s own tissues, these tissues will heal and grow with the patient, and require no maintenance or upkeep. The results also consistently look more natural and aesthetic than other reconstructive options.
The main disadvantage of autologous breast reconstruction techniques is the scarring and loss of tissue at the donor site, as well as any associated problems that may result. These problems, including hernias and abdominal wall weakness, may be seen with traditional abdominal TRAM flap autologous reconstructions.
Furthermore, autologous breast reconstruction procedures generally take longer than other options, and usually require more extensive surgery. Lastly, not every patient is a candidate for autologous breast reconstruction at our New Jersey practice. Factors such as body habits, previous surgeries, smoking history, and co-existing medical conditions may preclude breast reconstruction with autologous techniques, such as the traditional TRAM flap.
Prosthetic Breast Reconstruction
The second option for breast reconstruction, called prosthetic breast reconstruction, uses implants to reconstruct the breast, similar to how a breast augmentation is performed.
Unlike a breast augmentation from Dr. Breslow or Dr. Greaney however, a tissue expander must be inserted into the mastectomy site prior to the insertion of the implant to make a pocket where the implant will ultimately lie. Prosthetic breast reconstruction techniques spare the patient the loss of donor site tissue as well as donor site scarring. The prosthetic breast reconstruction procedures also take less time to perform and require less extensive surgery.
However, prosthetic breast reconstructions usually require more procedures than autologous breast reconstruction techniques. They also entail the implantation of foreign bodies and, therefore, require maintenance and upkeep. Furthermore, the weekly expansion process that precedes the final prosthetic breast reconstruction procedure can take months and may be too inconvenient for some of our patients to tolerate.
Autologous and Prosthetic Breast Reconstruction
The third option for breast reconstruction uses a combination of the first two options. This option involves the transfer of the patient’s own tissues in combination with the insertion of an implant. This option encompasses both the advantages and disadvantages of the autologous and prosthetic breast reconstruction techniques available at our practice. However, because expanders are not usually required for these techniques, it is better tolerated by many patients than standard prosthetic breast reconstruction.
In recent years, there have been dramatic technical advances in autologous breast reconstruction, which is considered by many to be the “gold standard” of breast reconstruction. Advances in microvascular surgery, including “muscle-sparing” techniques and “DIEP perforator flaps,” have made it possible to transfer the necessary tissue with minimal trauma to the donor site. This has resulted in dramatically reduced donor site problems without compromising the outcome of the breast reconstruction.
Furthermore, these technological advances have made the option of autologous breast reconstruction a reality for patients who previously were not considered good candidates. Dr. Gary D. Breslow, who spent a year as the Fellow in Microvascular Reconstructive Surgery at New York University Medical Center’s prestigious Institute for Reconstructive Plastic Surgery, has extensive training and experience with these newer autologous breast reconstruction techniques, including muscle-sparing breast reconstruction and perforator flap breast reconstruction.
Dr. Greaney completed his microsurgery in New York City at New York Presbyterian Hospital/Weill-Cornell, Montefiore Medical Center, and NYU Langone Medical Center respectively. Dr. Greaney then became an Assistant Professor at his alma mater (Jefferson) where he practiced for nine years, founded Jefferson’s DIEP breast microsurgical program, and was named Top Doctor in Philadelphia from 2017- 2020 before returning to New Jersey.
Dr. Breslow and Dr. Greaney have performed countless breast reconstruction surgeries at his New Jersey practice, and this experience, combined with his broad background with traditional autologous and prosthetic breast reconstruction techniques, makes him uniquely qualified to offer mastectomy patients an unparalleled range of options.
If you are interested in breast reconstruction, contact our New Jersey practice to find out which breast reconstruction technique is right for you. For patients undergoing mastectomy for breast cancer, health insurance will generally cover most or all of the cost of the procedure; however, navigating the insurance claim process can often be difficult and time-consuming. For this reason, the staff at The Breslow Center For Plastic Surgery will be available to file claims on behalf of breast reconstruction patients and investigate the extent of coverage offered by their providers. Our New Jersey office accepts most types of insurance payments.
I had a very positive experience with breast reconstruction following breast cancer surgery: Dr. Breslow and his entire staff exhibited the highest professional standards. I would highly recommend Dr. Breslow and his office. The upscale atmosphere was only outdone by their superb level of care.
It was a pleasure speaking with you yesterday. You are strong, courageous and a blessing to speak to. You went above and beyond (…). Going through this difficult time has been an emotional roller-coaster, but having people like you to talk to has made it a little more comforting.
For patients who are either contemplating or have already undergone breast reconstruction surgery, The Breslow Center For Plastic Surgery offers a support group that meets monthly. If you would like to become a part of the group or learn more about breast reconstruction procedures, please contact our office today.