Thanks to advances in plastic and reconstructive surgery, there are now many options available for breast reconstruction in women who have a mastectomy. Breast reconstruction surgeons at NewYork-Presbyterian Lawrence Hospital are highly skilled in these procedures and work closely with each patient to discuss her options and preferences, and to help her make an informed decision about the most appropriate surgery for her.
Advancements in Breast Reconstruction
While breast implants have been available for decades, techniques used to insert them have improved in recent years. Our reconstructive breast surgeons offer the most up-to-date approaches, which may offer more convenience and comfort than traditional implant-based breast reconstruction.
- Direct-to-implant surgery. Some women can have an implant inserted during mastectomy surgery, rather than needing to wait another few months while an expander stretches the skin to prepare it for an implant, followed by a second surgery to remove the expander and insert the implant. Instead, the implant is inserted immediately after breast tissue is removed during a mastectomy, without needing a second surgery.
- Patient-controlled breast expander. A patient-controlled air expander is an option for many women who are preparing for breast implantation and are not having direct-to-implant surgery. Traditionally, women who want an implant have an expander inserted at the time of mastectomy and return to the clinic for periodic visits over a series of months to have saline injected into the expander, before eventually returning to have the expander removed and the implant inserted. Surgeons at NewYork-Presbyterian Lawrence were the first in Westchester County to insert an air expander, which women inject air into on their own via a remote control. Because they can add air to the expander several times each day, rather than waiting to have the expander enlarged in greater increments at clinic visits less frequently, the expansion process is more comfortable, convenient, and faster. At our hospital, we are able to offer this option to patients planning implant-based reconstruction.
- Fat grafting. Our surgeons sometimes inject fat (taken from the patient’s belly, hips, or thighs) into areas around the reconstructed breast to achieve a smooth, consistent, and more natural look to the breast.
Improving Cosmetic Outcome after Lumpectomy
Our plastic surgeons work closely with breast surgeons at the time of lumpectomy to minimize scarring and maximize cosmetic outcome. Taking an “oncoplastic” approach, the plastic surgeon is sometimes able to offer patients a breast lift or reduction at the same time as lumpectomy. The breast surgeons may also insert a three-dimensional Biozorb® implant into the cavity left behind after a tumor has been removed during lumpectomy, preserving the contour of the breast and marking the tumor cavity for future radiation treatment. After the device is implanted, breast tissue surrounds it and begins to heal. The implant dissolves in the body over time, while the marker clips remain in place for long-term monitoring.
Rebuilding Breast Tissue
If you choose to have breast reconstruction using your own tissue, we perform these procedures at NewYork-Presbyterian/Columbia University Medical Center and NewYork-Presbyterian Lawrence Hospital. Using skin and fatty tissue from the abdomen (DIEP or TRAM) is the most common breast reconstruction technique from the patient's own tissue and is commonly performed at the time of the mastectomy. The advantage of this procedure is that the breast can be reconstructed to appear and feel quite natural, and the breast can be immediately reconstructed at the time of the mastectomy. Our surgeons are experienced performing the different types of flaps, including muscle-sparing free TRAM and DIEP (deep inferior epigastric perforator) flaps. Tissue from your back (latissimus flap) or buttocks (SGAP) may also be used to reconstruct the breast.
Enhancing Your Comfort
Breast reconstruction surgery is a major procedure, and our surgeons work closely with anesthesiologists to ensure your comfort. Our anesthesiologists use regional nerve blocks (such as pectoralis and paravertebral blocks) to reduce the pain associated with these procedures.