Dr Constance M Chen, Plastic Surgeon and Breast Reconstruction Specialist, Offers Tips for Improving Breast Reconstruction Results After Mastectomy


Dr Constance Chen

Correcting poor or uncomfortable reconstruction can be the last step in restoring a woman’s physical and emotional health and improving her quality of life.

Breast reconstruction should be viewed as a process rather than a one-off procedure. Most mastectomies will not be the same and it is unusual for the initial breast reconstruction to have perfect symmetry. Usually, breast reconstruction requires several steps to achieve ideal results.

“The goal of breast reconstruction after mastectomy is to create a natural breast with the shape, symmetry and softness of the original”, explains the plastic surgeon and specialist in breast reconstruction. Dr Constance M. Chen. “In most patients, modifications are necessary after the initial surgery to achieve this goal. Women should know that with a personalized plan and advanced surgical techniques, we can often improve shape, size and symmetry after initial breast reconstruction to help a woman’s breasts look and feel better. more normal.

In most cases, the best aesthetic results are obtained with natural fabrics. There is a principle in plastic surgery consisting in “replacing the like by the like”. On the operating room table, real breast tissue looks and feels like regular fat – breast tissue and fatty tissue look and feel the same. As a result, when it is possible to use a woman’s own fat to recreate the breast, the reconstructed breast will look a lot like the original – sometimes it is almost the same.

Women should be aware that even if they have undergone reconstruction with breast implants, the implants can be removed and replaced with natural tissue. While many women who have had breast reconstruction with implants are satisfied with the results, some women who have had breast reconstruction with implants feel uncomfortable because the breast implants are usually placed under the muscle. In these cases, sub-pectoral breast implants can cause stiffness and breathing problems, and hyper-animated deformity can also cause the patient’s breasts to move up and down as she flexes her pectoral muscle.

“In our experience, many women are surprised when their breast implants are removed and replaced with natural tissue. They generally report feeling a lot more comfortable and are happy that their new breasts feel and look normal, ”says Dr. Chen.

Breast reconstruction problems can also arise due to asymmetry. The breasts should look like sisters, if not twins, and it’s best when at least they look like they are from the same family. It is easier to achieve symmetry with bilateral reconstruction, in which the incisions of the mastectomy and the method of reconstruction are the same. However, in cases where only one breast has undergone a mastectomy with breast reconstruction, it may be necessary to perform additional procedures on the other breast to achieve symmetry. Fortunately, the Women’s Health and Cancer Rights Act 1998 requires all health insurance companies to cover all stages of breast reconstruction and all complications of all stages of mastectomy or breast reconstruction. , and symmetry procedures on the opposite breast are also covered. A woman’s right to have breast reconstruction at any stage is protected by federal law and many state laws.

Refine and improve breast reconstruction

A common type of secondary breast reconstruction procedure is fat grafting, in which fat is collected from another part of the body through tiny incisions via liposuction. The extracted fat is processed to remove impurities, and then the fat graft is transferred by injections into the breast. This process is used to enlarge the breast or to correct contour deformities by sculpting and filling small areas to improve the size, shape and symmetry of the breast.

Another common secondary breast reconstruction is called a mastopexy or breast lift. The aim here is to improve the appearance and / or uniformity of the reconstructed breasts. Reconstructed breasts are generally happier, especially after breast reconstruction with implants. If only one breast has undergone mastectomy and breast reconstruction, mastopexy may be needed on the unaffected breast to match the reconstructed breast. A breast lift will remove excess skin and lift the nipple-areola complex so that the breast rests higher on the chest wall. A breast lift will not significantly change the size of the breast.

Finally, in some cases, breast size may need to be changed with breast reduction or breast augmentation. A breast reduction is similar to a breast lift, except that the breast tissue is removed along with the skin of the breast to make the breast smaller. Breast augmentation can be done with a fat transplant or a breast implant.

Any of these procedures can also be performed on the reconstructed breast (s).

Additional procedures to achieve symmetry are almost always necessary for women who have had unilateral (unilateral) mastectomy and breast reconstruction with a breast implant. On the other hand, the best aesthetic results are bilateral mastectomies (double-sided) preserving the nipple with immediate breast reconstruction in natural tissue. When all the skin of the breast has been preserved and the breast reconstruction is performed with natural tissue at the same time as the mastectomy, it can be almost impossible to tell that a woman has had a mastectomy.

“Too many women have gone through the devastating upheaval of a cancer diagnosis and subsequent treatment to have just one more disappointment with an unsatisfactory reconstruction result,” says Dr. Chen. “Correcting poor or uncomfortable reconstruction can be the last step in restoring a woman’s physical and emotional health and improving her quality of life.” Even women who have not had the gold standard in mastectomy and breast reconstruction from the start can undergo secondary breast reconstruction to improve their initial results.

Constance M. Chen, MD, is a certified plastic surgeon with particular 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. She is also the Chief of Microsurgery at the New York Eye and Ear Infirmary at Mount Sinai. http://www.constancechenmd.com

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