Patient Resources
Breast Reconstruction FAQ Knowledge Base
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Frequently Asked Questions
About Breast Reconstruction
In this comprehensive FAQ resource, we provide clear and concise answers to help you navigate your decisions around breast reconstruction with confidence.
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Breast Reconstruction Journey FAQs
Indications for Surgery FAQs
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Dr. Joshua L. Levine, MD, FACS
World-renowned in the art and science of perforator flap breast reconstruction
FAQs | Breast Reconstruction Journey
Explore the practical aspects of the breast reconstruction journey, covering decision-making, pre-surgery preparation, recovery, and post-reconstruction life in this Frequently Asked Questions section for actionable insights.
Surgical Options FAQ
Perforator flap breast reconstruction is an advanced surgery that’s transformed breast reconstruction. It uses a patient’s own tissue, often from the abdomen, to create a natural-looking and functioning breast mound, differing from implant-based methods.
Natural tissue breast reconstruction, or autologous breast reconstruction, offers various surgical techniques. Common methods include the DIEP flap, preserving abdominal muscles, while the SGAP and IGAP flaps use tissue from the buttocks, and the TUG flap utilizes thigh tissue. Stacked flaps may combine different tissue sources, and options like TUG, PAP, and SIEA flaps offer alternatives.
The choice depends on factors like the patient’s body type, available donor tissue, surgeon’s expertise, and patient preferences, with each technique offering distinct pros and cons.
Selecting the appropriate surgical option for natural tissue breast reconstruction, tailored to your body type and preferences, involves careful consideration and consultation with an experienced plastic surgeon.
An advanced surgeon like Dr. Levine can offer procedures suitable for women of all body types.
During your consultation, your surgeon will assess your physique, medical history, and aesthetic goals to recommend the most suitable technique, such as the DIEP flap, SGAP, IGAP, LTP flap, or others.
They will explain the pros and cons of each method and help you make an informed decision aligned with your desires for breast appearance and your unique anatomical characteristics.
Your surgeon’s expertise is vital in ensuring a personalized and successful breast reconstruction outcome.
How do I decide between autologous (natural tissue) reconstruction and implant-based reconstruction?
Natural tissue breast reconstruction, also known as autologous or flap reconstruction, offers several benefits compared to implant-based reconstruction, particularly in the context of breast cancer treatment.
Look & Feel Comparison:
One of the key advantages is the creation of a more natural-looking and feeling breast, both in terms of appearance and texture. This approach uses a woman’s own tissues, typically harvested from the abdomen, buttocks, or thigh, to reconstruct the breast mound. This not only helps in achieving a more authentic aesthetic but also ensures that the reconstructed breast ages and changes in a manner similar to the natural breast.
Longevity Comparison:
Additionally, natural tissue reconstruction provides long-term benefits in terms of durability and fewer complications. Unlike breast implants, which may require replacement over time, the transplanted tissues become a permanent part of the body. This eliminates the need for future surgeries to address issues such as implant rupture or leakage.
Breast Implant Illness Risks:
Moreover, natural tissue reconstruction is associated with a lower risk of certain complications compared to implant-based reconstruction. Breast implant illness (BII) is a concern associated with silicone or saline implants, where individuals may experience a range of symptoms, including fatigue, joint pain, and cognitive issues. By using the patient’s own tissues, natural reconstruction minimizes the risk of systemic reactions related to implants.
Radiation Therapy Risks w Breast Implants:
For women who have undergone radiation or chemotherapy as part of their breast cancer treatment, natural tissue reconstruction often presents a safer alternative. Radiation can impact the health and integrity of tissues, potentially complicating implant-based reconstruction. In contrast, natural tissue reconstruction utilizes healthy tissues that are less susceptible to the adverse effects of radiation, resulting in a more successful and resilient outcome.
While all surgeries carry some degree of risk, the potential complications associated with natural tissue breast reconstruction are generally different from those of implant-based procedures. For instance, there may be risks related to the blood supply to the transplanted tissue or issues with wound healing. However, with proper surgical planning and expertise, these risks can be minimized.
What is the typical timeline for each type of breast reconstruction surgery, and how does it differ?
Timing Options in Natural Tissue Breast Reconstruction
Breast reconstruction is a crucial aspect of breast cancer treatment, providing women with options to restore their breast(s) after mastectomy. Timing plays a significant role in the natural tissue breast reconstruction process, offering various approaches to meet individual needs and circumstances.
1. Immediate Breast Reconstruction:
- Reconstruction is performed simultaneously with mastectomy.
- Offers the advantage of waking up with a reconstructed breast.
- Provides psychological benefits by minimizing the impact of breast loss.
2. Staged-Immediate Reconstruction:
- Breast reconstruction is performed separately, typically within two weeks of mastectomy.
- Allows for a more considered approach, addressing factors like pathology results before reconstruction.
- Balances the benefits of immediate reconstruction with the flexibility of staged procedures.
3. Delayed Reconstruction:
- Breast reconstruction is performed at any time following mastectomy.
- Gives individuals time to consider their options and make informed decisions.
- Allows for a phased approach to breast cancer treatment and reconstruction.
4. Surgical Delay with DIEP, SIEA, or DCIA Flap:
- Involves a preemptive procedure to enhance the reliability of tissue harvesting from the abdomen.
- Particularly beneficial for patients who may have initially been deemed ineligible for abdominal tissue donation.
- Conducted approximately one week before free flap breast reconstruction, optimizing the amount of available tissue.
In considering these timing options, it’s essential for individuals to consult with their healthcare team to determine the most suitable approach based on their medical condition, preferences, and overall treatment plan. Each timing option presents its unique advantages, contributing to the comprehensive and personalized care provided in the context of natural tissue breast reconstruction.
Preparation and Planning FAQ
Preparing for natural tissue breast reconstruction is vital for regaining confidence and well-being. We offer essential insights to help you understand prerequisites, set realistic expectations, and navigate the journey to renewed self-assurance.
The planning process for natural tissue breast reconstruction typically involves several key steps:
- Initial Consultation: You’ll meet with your plastic surgeon to discuss your goals, medical history, and preferences. This is an opportunity to establish a rapport with your surgeon and gain a clear understanding of the available options.
- Medical Evaluation: Your surgeon will perform a thorough medical evaluation to assess your overall health and suitability for the procedure. They may request medical tests, such as blood work and imaging, to ensure your safety.
- Discussion of Surgical Options: During the consultation, your surgeon will explain the various natural tissue breast reconstruction techniques, such as DIEP flap, TRAM flap, or latissimus dorsi flap. They will help you select the most suitable option based on your individual needs and preferences.
- Imaging and Measurements: Your surgeon may use advanced imaging techniques, such as MRI or CT scans, to assess the blood supply and anatomy of the donor site (usually the abdomen or back) to ensure it can provide sufficient tissue for the reconstruction.
- Preoperative Planning: Once you and your surgeon have decided on the best approach, you’ll discuss the details of the procedure, including incision placement and expected outcomes.
- Scheduling the Surgery: After thorough planning and discussions, you’ll schedule the surgery at a convenient time for you and your surgical team.
Throughout this process, open communication with your surgeon is essential. It’s also a good idea to seek a second opinion to ensure you’re comfortable with your chosen approach. Additionally, our patient-helping-patient network is available, where you can connect with previous patients of Dr. Levine who have been through the planning process and can provide you with valuable insights and guidance.
They can provide invaluable insights, share their experiences, and offer emotional support, which can be immensely reassuring as you embark on your own breast reconstruction journey.
This peer support network can be a great resource for addressing your emotional and psychological needs during this transformative process.
Preparing for natural tissue breast reconstruction surgery involves making some important lifestyle adjustments. Here are some key steps to consider:
- Maintain a Healthy Lifestyle: Prioritize your overall health by maintaining a balanced diet, staying hydrated, and getting regular exercise. This can help your body heal more effectively post-surgery.
- Quit Smoking: If you smoke, it’s crucial to quit several weeks before surgery. Smoking can impair circulation and hinder the healing process, increasing the risk of complications.
- Medication and Supplements: Review your current medications and supplements with your surgeon. Some may need to be adjusted or temporarily discontinued before the surgery.
- Weight Management: Achieve and maintain a stable, healthy weight. Drastic weight fluctuations can affect the results of the procedure.
- Dietary Considerations: Focus on a diet rich in nutrients, including lean protein, fruits, and vegetables. Proper nutrition can enhance your body’s ability to heal.
- Stay Hydrated: Adequate hydration is essential for recovery. Aim to drink plenty of water in the days leading up to surgery.
- Regular Exercise: Engage in light, regular exercise to help build strength and endurance, but avoid strenuous workouts in the immediate days before surgery.
- Stress Reduction: Manage stress through relaxation techniques, such as meditation, deep breathing, or yoga. Reducing stress can aid in the healing process.
- Plan for Post-Op Support: Arrange for a support system to assist with daily activities after surgery. You’ll need help with tasks like lifting, cooking, and housework during your initial recovery.
- Follow Preoperative Instructions: Your surgeon will provide specific guidelines for the days leading up to the surgery, which may include restrictions on food and drink before the procedure.
Remember that personalized recommendations may vary depending on your individual health and the specific surgical approach chosen. Consult closely with your surgeon to ensure you are adequately prepared. Additionally, our patient-helping-patient network can connect you with individuals who have already undergone this process, providing practical advice and emotional support as you navigate these preparations.
The decision to have both breast removal (mastectomy) and reconstruction in a single surgery, known as immediate reconstruction, or to opt for a staged approach depends on various factors and should be discussed with your surgeon.
Immediate reconstruction offers the advantage of waking up from the mastectomy with a reconstructed breast in place, potentially reducing the emotional impact of breast loss. However, it may not be suitable for everyone, as it depends on your overall health, the complexity of the surgery, and the type of reconstruction chosen.
A staged approach may be recommended if you have underlying health concerns, are undergoing radiation therapy, or prefer to delay the reconstruction to allow your body to heal from the mastectomy. Your surgeon will evaluate your individual circumstances and help you make the best decision based on your specific needs and preferences. It’s essential to have a thorough discussion with your surgeon to determine which approach is most appropriate for you and to address any questions or concerns you may have. Our patient-helping-patient network can also connect you with individuals who have gone through these experiences, offering insights into their choices and experiences.
Healing and Recovery FAQ
After natural tissue breast reconstruction, the healing and recovery process is crucial for achieving desired outcomes and well-being. We provide insights on pain management, drains, post-operative restrictions, and the timeline for resuming daily activities, offering support and practical advice for your recovery and restoration journey.
When can I expect to resume normal daily activities, including work and exercise, after the surgery?
- Work: The duration of time you should take off work depends on the physical demands of your job. For sedentary jobs, you may be able to return within 2 to 4 weeks, while jobs with more physical activity may require a longer absence, potentially 6 to 8 weeks. Your surgeon will provide personalized advice based on your situation.
- Exercise: Gradual reintegration of physical activity is essential. Light activities like walking can often be resumed within a few weeks, while more strenuous exercises should be postponed for 6 to 8 weeks or longer, depending on your surgeon’s recommendations.
- Lifting Restrictions: Avoid heavy lifting for several weeks post-surgery. Your surgeon will specify weight limits and guidelines for lifting objects, typically ranging from 5 to 10 pounds in the early stages of recovery.
- Driving: You may need to refrain from driving for a certain period, usually a few weeks or until you can safely maneuver and react to driving conditions.
- Posture: Maintain good posture to avoid unnecessary strain on your surgical sites and aid in the healing process.
- Sleeping Positions: Your surgeon may recommend specific sleeping positions, such as sleeping on your back, to protect your surgical sites during the initial healing phase.
It’s crucial to follow your surgeon’s recommendations diligently to ensure a smooth and safe recovery. They will provide specific guidance based on your unique circumstances. Always communicate any concerns or questions with your healthcare team during the recovery process. Additionally, our patient-helping-patient network can connect you with individuals who have navigated the post-surgery recovery period and can share their experiences and advice on resuming daily activities.
Pain and discomfort during the recovery process from natural tissue breast reconstruction can vary from person to person, but your surgical team will take steps to manage your pain effectively. Here’s what you can generally expect:
- Immediate Post-Op Discomfort: In the first few days after surgery, it’s normal to experience some pain, swelling, and discomfort at the surgical sites. This is managed with prescribed pain medications.
- Pain Medication: Your surgeon will likely prescribe pain medications, such as opioids or non-opioid options, to help manage post-operative pain. It’s essential to take these medications as directed to stay ahead of the pain and ensure your comfort.
- Nerve Blocks: Some surgical techniques may involve the use of nerve blocks, which can provide extended pain relief to the surgical areas. These may be administered before or during the surgery.
- Ice Packs: Applying ice packs to the surgical sites can help reduce swelling and provide some relief from discomfort.
- Elevation: Elevating the upper body when resting or sleeping can help minimize swelling and ease discomfort.
- Non-Medication Strategies: Non-medication pain management strategies, such as relaxation techniques, deep breathing exercises, and gentle movement, can also be effective in managing discomfort.
- Follow-Up Care: Attend all scheduled post-operative appointments with your surgeon, as they will assess your healing progress and adjust pain management strategies as needed.
It’s crucial to communicate openly with your surgical team regarding your pain levels and any concerns you may have. They can tailor pain management to your specific needs and help you transition to less potent pain medications as your recovery progresses. Remember that discomfort typically lessens over time, and most patients find that it becomes more manageable as they heal. If you have any questions or concerns about pain management, don’t hesitate to discuss them with your healthcare team.
The use of drains after natural tissue breast reconstruction surgery can vary based on the specific surgical technique and your surgeon’s preference. Drains are commonly used to manage excess fluids that can accumulate at the surgical site. Here’s what you should know:
- Drains: Depending on your procedure, you may have one or more surgical drains in place. These are small, flexible tubes that lead to small containers, which collect excess fluids. Drains are usually removed when the fluid output decreases to a certain level, which can vary but is typically within a few days to a few weeks.
- Drain Care: Your surgical team will provide detailed instructions on how to care for the drains, including emptying and recording the drainage output, as well as maintaining hygiene to prevent infection. It’s important to follow these instructions closely.
- Managing Discomfort: Drains can cause discomfort or pulling sensations, but these symptoms should improve as your body heals. You can use pain medications as prescribed to alleviate any associated pain or discomfort.
- Restrictions: While drains are in place, you may need to limit certain activities, such as strenuous exercise, to prevent accidental dislodgment.
- Removal: Drains are typically removed when the drainage output decreases to a specific level, indicating that your body is healing and the risk of complications is reduced. Your surgeon will assess when it’s appropriate to remove them, and this is typically done during a follow-up appointment.
Your surgical team will provide specific information regarding the use and care of drains in your unique case, including when they are likely to be removed. Always communicate any concerns or questions with your healthcare team to ensure the proper management of drains and the best possible recovery experience.
Yes, there are often restrictions on sleeping positions during the initial healing phase following natural tissue breast reconstruction. These restrictions are put in place to protect the surgical sites and ensure a smooth recovery. Here’s what you can generally expect:
- Sleeping on Your Back: It’s typically recommended to sleep on your back for the first few weeks after surgery. This position helps prevent pressure on the reconstructed breast(s) and donor site(s), reducing the risk of complications and discomfort.
- Pillow Support: Using extra pillows or a wedge-shaped pillow can help provide support and keep you comfortably positioned on your back.
- Avoiding Stomach and Side Sleeping: Stomach and side sleeping can put pressure on the surgical areas, potentially affecting the healing process. It’s crucial to avoid these positions during the early recovery stages.
- Follow Surgeon’s Recommendations: Your surgeon will provide specific guidance on sleeping positions based on your surgical technique and individual circumstances. It’s essential to follow their recommendations carefully.
As your recovery progresses, your surgeon will typically allow you to gradually transition to more comfortable sleeping positions. Be sure to communicate any concerns or questions you may have about sleeping positions with your healthcare team, as they can provide tailored advice to ensure a successful and comfortable recovery.
Life After Breast Reconstruction FAQ
Life post-breast reconstruction is a journey towards renewed confidence and self-assurance. We provide answers to common questions and concerns, giving valuable insights to guide you through this transformative phase with greater understanding and peace of mind.
The appearance and feel of your reconstructed breast(s) can vary depending on several factors, including the surgical technique used, your body type, and the expertise of your surgeon. Natural tissue breast reconstruction aims to create a breast that closely mimics the look and feel of your original breast.
Generally, reconstructed breasts tend to have a more natural appearance and texture compared to breast implants. However, there may still be subtle differences in symmetry, size, and scarring.
It’s essential to have realistic expectations and discuss your specific goals with your surgeon, as they will work to achieve the most natural result possible while considering your individual circumstances.
The appearance and feel of your reconstructed breast(s) can vary depending on several factors, including the surgical technique used, your body type, and the expertise of your surgeon. Natural tissue breast reconstruction aims to create a breast that closely mimics the look and feel of your original breast.
Generally, reconstructed breasts tend to have a more natural appearance and texture compared to breast implants. However, there may still be subtle differences in symmetry, size, and scarring.
It’s essential to have realistic expectations and discuss your specific goals with your surgeon, as they will work to achieve the most natural result possible while considering your individual circumstances.
Breast reconstruction can affect your ability to breastfeed, depending on the surgical method used.
Procedures involving implants or tissue from other body areas often disrupt milk ducts and nerves, making breastfeeding challenging.
With autologous reconstruction using your body’s tissue, some potential for breastfeeding remains, but success varies based on the specific technique and extent of tissue removal.
To maintain the possibility of breastfeeding, discuss your desires with your plastic surgeon before reconstruction. They can offer guidance and explore options if preserving this capability is important to you.
Sensation and sensitivity in the reconstructed breast(s) can vary depending on the surgical technique used.
In general, autologous or natural tissue breast reconstruction may offer better sensation and sensitivity compared to implant-based reconstruction. This is because the use of your own body’s tissue preserves some of the nerves responsible for sensation.
However, it’s essential to understand that the degree of sensation can vary from person to person, and it may not fully match that of your natural breast. Some women experience a return of sensation over time, while others may have reduced sensitivity. Nipple reconstruction can also impact sensation.
Discuss your expectations and concerns about sensation with your surgeon before the procedure, as they can provide insights into what you can expect based on your specific surgery and individual factors.
FAQs | Indications for Surgery
In this Indications FAQ section, we address crucial queries surrounding surgical indications, including considerations for Poland Syndrome, breast cancer, implant failure, reconstruction challenges, and hereditary risks like the BRCA gene mutation, guiding you towards informed decisions on the optimal path for natural tissue reconstruction.
Breast Cancer FAQ:
Opting for breast reconstruction post-mastectomy is a personal choice for restoring wholeness and confidence. Patients can choose immediate reconstruction, done concurrently with the mastectomy, or delay it to heal physically and emotionally before starting the reconstructive process.
Natural tissue breast reconstruction and implant reconstruction differ significantly in terms of safety and suitability, especially for women who have undergone radiation or chemotherapy for breast cancer. Implant reconstruction can pose higher risks in these cases, as radiation therapy can affect skin quality and blood flow, potentially leading to complications like capsular contracture and implant extrusion. Natural tissue breast reconstruction, on the other hand, often provides a safer and more durable option, utilizing the patient’s own tissue to create a more resilient breast mound, addressing concerns associated with radiation or chemotherapy.
The long-term performance and durability of natural tissue breast reconstruction often surpass implant reconstruction for women. Natural tissue reconstruction typically offers a more enduring solution, as it uses the patient’s own tissue, which ages naturally and is less susceptible to complications that can arise with breast implants over time. This can result in a more reliable and sustainable outcome for breast reconstruction.
The typical timeline for natural tissue breast reconstruction after breast cancer treatment can vary depending on several factors, including the specific treatment plan, radiation therapy, and chemotherapy. In many cases, breast reconstruction may be delayed until a patient has completed their cancer treatments and has fully recovered. This allows for a safer and more successful reconstruction process. However, the exact timeline should be determined on a case-by-case basis, following consultation with a medical team, to ensure the patient’s health and readiness for the procedure.
The collaboration between a specialized breast surgeon and a reconstructive surgeon is integral to the planning and execution of natural tissue breast reconstruction for women who have had breast cancer. The breast surgeon plays a crucial role in addressing the oncologic aspects, such as cancer removal and the safety of breast reconstruction. They work closely with the reconstructive surgeon to ensure that the chosen reconstruction method aligns with the patient’s medical history, treatment goals, and long-term well-being. This partnership helps optimize the surgical outcomes and patient experience, ensuring that the patient receives comprehensive care throughout their journey.
BRCA and Hereditary Risk FAQ
When deciding on breast reconstruction after prophylactic mastectomy for hereditary breast cancer risk, opting for natural tissue perforator flap reconstruction is a crucial choice. This procedure provides a safe and effective way to restore breast form while reducing the risk of implant-related complications.
A woman may choose to undergo a prophylactic mastectomy for several reasons:
- High hereditary risk: If a woman has a significant family history of breast cancer or carries specific genetic mutations like BRCA1 or BRCA2, her risk of developing breast cancer may be substantially increased. Opting for a prophylactic mastectomy can significantly reduce the risk of developing breast cancer in such cases.
- Risk reduction: For women at high risk, a prophylactic mastectomy can greatly reduce the likelihood of developing breast cancer. This choice provides peace of mind, knowing that the breasts, which are considered at-risk tissue, have been removed.
- Previous cancer diagnosis: Some women who have already had breast cancer in one breast may choose to have a prophylactic mastectomy on the other breast to prevent the possibility of developing cancer in that breast as well.
- Enhanced surveillance: While regular breast cancer screening with mammograms, MRIs, and clinical exams is important, it may not offer the same level of risk reduction as a prophylactic mastectomy. Some women prefer the certainty of risk reduction that comes with removing breast tissue rather than relying solely on surveillance methods.
- Psychological impact: The fear and anxiety associated with a high risk of developing breast cancer can have a significant psychological impact on women. By choosing a prophylactic mastectomy, some women find relief from the constant worry and stress, allowing them to regain a sense of control over their health.
Whether breast reconstruction is necessary after a prophylactic mastectomy is a personal choice that varies from woman to woman. Breast reconstruction is not mandatory, and it ultimately depends on individual preferences, priorities, and circumstances. Some women may opt not to undergo reconstruction and choose to live without reconstructed breasts, while others may choose to pursue reconstruction for various reasons. Here are some factors to consider:
- Cosmetic appearance: For many women, breast reconstruction can help restore a sense of body image and self-confidence. It can recreate the appearance of breasts, allowing them to feel more comfortable and at ease with their physical appearance.
- Psychological well-being: Losing one or both breasts can have emotional and psychological impacts. Breast reconstruction can play a role in alleviating feelings of loss, grief, and anxiety associated with breast removal, helping women regain a sense of wholeness and emotional well-being.
- Symmetry and balance: Breast reconstruction can restore symmetry and balance to the body, particularly if only one breast was removed. This can enhance clothing fit and overall body proportions.
Yes, breast reconstruction surgery can be performed immediately after a prophylactic mastectomy. This approach, known as immediate breast reconstruction, offers several potential advantages for eligible candidates.
By combining the mastectomy and reconstruction into a single surgical procedure, immediate breast reconstruction allows women to wake up with a reconstructed breast mound, minimizing the emotional and psychological impact of breast loss. It can provide immediate physical and emotional benefits, as well as potentially reduce the overall number of surgeries and recovery periods.
Yes, several age and health factors can influence eligibility for breast reconstruction surgery after prophylactic mastectomy. Here are some key considerations:
- Overall Health: Your general health plays a significant role in determining eligibility. Patients with certain medical conditions, such as uncontrolled diabetes, heart disease, or severe obesity, may have higher surgical risks. It’s crucial to undergo a comprehensive medical evaluation to assess your overall health and address any underlying conditions before considering breast reconstruction.
- Smoking and Lifestyle Habits: Smoking can substantially increase the risk of complications during and after surgery, including issues with wound healing. Many surgeons strongly recommend quitting smoking before undergoing breast reconstruction. Maintaining a healthy lifestyle through proper diet and exercise can also contribute to better surgical outcomes.
- Age: Age itself is not a strict determinant of eligibility. However, older individuals may have different health considerations, and surgeons may take age into account when assessing the overall risk-benefit profile for surgery.
- Psychological Readiness: Psychological readiness is a critical factor in eligibility. Breast reconstruction is a significant decision that can have emotional and psychological implications. It’s important for patients to be mentally prepared and have realistic expectations about the outcomes.
- Prior Surgeries or Treatments: If you have had prior breast surgeries or treatments, such as radiation therapy, it can affect the options and timing of breast reconstruction. Your surgeon will consider your medical history and any previous treatments when planning your reconstruction.
- Surgeon’s Assessment: Ultimately, the eligibility for breast reconstruction after prophylactic mastectomy is determined by the assessment of an experienced plastic surgeon. The surgeon will evaluate your unique medical history, physical health, and individual goals to determine the most appropriate approach to breast reconstruction.
It’s essential to consult with a board-certified plastic surgeon who specializes in breast reconstruction to discuss your specific case and address any health concerns. Open communication with your medical team and addressing any medical conditions or lifestyle factors is crucial for achieving safe and successful breast reconstruction outcomes.
Implant / Reconstruction Failure
Natural tissue reconstructive surgery, after implant issues, offers a robust, long-lasting alternative for those who’ve had problems with breast implants. Using the patient’s own tissue, usually from areas like the abdomen or thigh, this approach provides an implant-free solution, addressing cosmetic concerns with enduring results.
A woman may choose to undergo a prophylactic mastectomy for several reasons:
- High hereditary risk: If a woman has a significant family history of breast cancer or carries specific genetic mutations like BRCA1 or BRCA2, her risk of developing breast cancer may be substantially increased. Opting for a prophylactic mastectomy can significantly reduce the risk of developing breast cancer in such cases.
- Risk reduction: For women at high risk, a prophylactic mastectomy can greatly reduce the likelihood of developing breast cancer. This choice provides peace of mind, knowing that the breasts, which are considered at-risk tissue, have been removed.
- Previous cancer diagnosis: Some women who have already had breast cancer in one breast may choose to have a prophylactic mastectomy on the other breast to prevent the possibility of developing cancer in that breast as well.
- Enhanced surveillance: While regular breast cancer screening with mammograms, MRIs, and clinical exams is important, it may not offer the same level of risk reduction as a prophylactic mastectomy. Some women prefer the certainty of risk reduction that comes with removing breast tissue rather than relying solely on surveillance methods.
- Psychological impact: The fear and anxiety associated with a high risk of developing breast cancer can have a significant psychological impact on women. By choosing a prophylactic mastectomy, some women find relief from the constant worry and stress, allowing them to regain a sense of control over their health.
Whether breast reconstruction is necessary after a prophylactic mastectomy is a personal choice that varies from woman to woman. Breast reconstruction is not mandatory, and it ultimately depends on individual preferences, priorities, and circumstances. Some women may opt not to undergo reconstruction and choose to live without reconstructed breasts, while others may choose to pursue reconstruction for various reasons. Here are some factors to consider:
- Cosmetic appearance: For many women, breast reconstruction can help restore a sense of body image and self-confidence. It can recreate the appearance of breasts, allowing them to feel more comfortable and at ease with their physical appearance.
- Psychological well-being: Losing one or both breasts can have emotional and psychological impacts. Breast reconstruction can play a role in alleviating feelings of loss, grief, and anxiety associated with breast removal, helping women regain a sense of wholeness and emotional well-being.
- Symmetry and balance: Breast reconstruction can restore symmetry and balance to the body, particularly if only one breast was removed. This can enhance clothing fit and overall body proportions.
Yes, breast reconstruction surgery can be performed immediately after a prophylactic mastectomy. This approach, known as immediate breast reconstruction, offers several potential advantages for eligible candidates.
By combining the mastectomy and reconstruction into a single surgical procedure, immediate breast reconstruction allows women to wake up with a reconstructed breast mound, minimizing the emotional and psychological impact of breast loss. It can provide immediate physical and emotional benefits, as well as potentially reduce the overall number of surgeries and recovery periods.
Yes, several age and health factors can influence eligibility for breast reconstruction surgery after prophylactic mastectomy. Here are some key considerations:
- Overall Health: Your general health plays a significant role in determining eligibility. Patients with certain medical conditions, such as uncontrolled diabetes, heart disease, or severe obesity, may have higher surgical risks. It’s crucial to undergo a comprehensive medical evaluation to assess your overall health and address any underlying conditions before considering breast reconstruction.
- Smoking and Lifestyle Habits: Smoking can substantially increase the risk of complications during and after surgery, including issues with wound healing. Many surgeons strongly recommend quitting smoking before undergoing breast reconstruction. Maintaining a healthy lifestyle through proper diet and exercise can also contribute to better surgical outcomes.
- Age: Age itself is not a strict determinant of eligibility. However, older individuals may have different health considerations, and surgeons may take age into account when assessing the overall risk-benefit profile for surgery.
- Psychological Readiness: Psychological readiness is a critical factor in eligibility. Breast reconstruction is a significant decision that can have emotional and psychological implications. It’s important for patients to be mentally prepared and have realistic expectations about the outcomes.
- Prior Surgeries or Treatments: If you have had prior breast surgeries or treatments, such as radiation therapy, it can affect the options and timing of breast reconstruction. Your surgeon will consider your medical history and any previous treatments when planning your reconstruction.
- Surgeon’s Assessment: Ultimately, the eligibility for breast reconstruction after prophylactic mastectomy is determined by the assessment of an experienced plastic surgeon. The surgeon will evaluate your unique medical history, physical health, and individual goals to determine the most appropriate approach to breast reconstruction.
It’s essential to consult with a board-certified plastic surgeon who specializes in breast reconstruction to discuss your specific case and address any health concerns. Open communication with your medical team and addressing any medical conditions or lifestyle factors is crucial for achieving safe and successful breast reconstruction outcomes.
Poland Syndrome FAQ:
Natural tissue reconstruction is a surgical technique used to address Poland syndrome, a congenital condition characterized by chest wall and breast deformities. It involves using the patient’s own tissue, typically from the abdomen, to correct the deformities, resulting in a more symmetrical appearance of the chest.
Poland syndrome is a congenital condition that can lead to breast asymmetry and underdevelopment.
Treatment options for breast asymmetry caused by Poland syndrome vary, but natural tissue breast reconstruction may be recommended when there is a desire for more symmetrical and natural-looking breasts.
This method involves using the patient’s own tissue, often from the abdomen or thigh, to recreate a breast mound, addressing both cosmetic and functional concerns.
It’s important to consult with a medical professional to determine the most suitable treatment plan for your specific case of Poland syndrome.
The advantages of natural tissue reconstruction in Poland syndrome cases include the use of the patient’s tissue, which can lead to a more natural appearance, improved symmetry, and reduced risk of complications associated with implants. Additionally, it offers a long-term solution, as the reconstructed breast typically ages with the patient’s body, providing lasting results. It’s essential to discuss the specific surgical techniques with your medical team to determine the most suitable approach for your individual needs.
Please view Dr. Levine’s before and after poland syndrome reconstruction results gallery by clicking on the following link:
Determining whether your insurance plan covers natural tissue breast reconstruction for Poland syndrome and understanding the required documentation can be a complex process. Here are some steps to consider:
> Review Your Policy: Start by carefully reviewing your insurance policy documents, especially those related to coverage for reconstructive procedures after congenital conditions.
> Consult Your Insurance Provider: Contact your insurance provider’s customer service or claims department. Inquire about their policies and requirements for covering breast reconstruction related to Poland syndrome.
> Consult Your Surgeon: Work closely with your surgical team, including a specialized breast surgeon, to ensure you have the necessary documentation to support your case. They can provide details about the medical necessity of the procedure.
> Obtain Pre-Authorization: Many insurance providers require pre-authorization for certain procedures. Ensure that your surgeon’s office submits all the necessary paperwork for pre-authorization.
> Appeal if Necessary: If your insurance initially denies coverage, you may need to appeal the decision. Your surgeon’s office can assist in this process, providing the required clinical information and documentation to support your case.
> Keep Records: Maintain detailed records of all communications with your insurance provider, including names of representatives, dates, and the content of discussions.
It’s essential to be proactive and thorough in your approach to insurance coverage for Poland syndrome-related breast reconstruction, as it can involve several steps and documentation requirements. Working closely with your surgical team and being persistent in your interactions with your insurance provider can improve your chances of securing coverage.
FAQs | Our Practice
Explore this FAQ section for insights into Dr. Levine’s extensive medical expertise, the seamless process of traveling for surgery, insurance coverage details, and the state-of-the-art facilities and surgical teams that define our practice.
Dr. Joshua L. Levine FAQ:
Dr. Joshua L. Levine is a world-renowned microsurgeon in natural tissue perforator flap breast reconstruction. He has been pioneering advancements in the field of perforator flap breast reconstruction since the beginning of his career in 2004, and has completed over 1,700 successful reconstruction procedures.
Dr. Levine specializes in highly sophisticated microsurgical breast reconstruction procedures called perforator flaps, including DIEP, SIEA, SHaEP, PAP, GAP, LAP, and TDAP Flap procedures. These advanced techniques cater to all women, ensuring the restoration of the natural look and feel of their warm breasts, regardless of their body type.
Dr. Levine’s pioneering techniques, including extension flap and stacked flap procedures, represent sophisticated advancements in microsurgical breast reconstruction.
Extension flap procedures involve the extension of a perforator flap to reconstruct a larger area. This technique is particularly beneficial for cases where a more extensive reconstruction is required, ensuring a comprehensive restoration that aligns with the natural contours of the breast. The extension flap procedure allows for a more tailored approach, catering to individual body types and achieving optimal aesthetic outcomes.
Similarly, stacked flap procedures involve the strategic layering of multiple flaps to create a voluminous and natural-looking breast reconstruction. This intricate method allows Dr. Levine to address complex cases where a higher level of customization is necessary. By layering flaps, he can mimic the natural breast’s texture and contour, offering women a result that not only looks but also feels authentic.
Both extension flap and stacked flap procedures showcase Dr. Levine’s commitment to pushing the boundaries of microsurgical breast reconstruction. These techniques, characterized by their sophistication and innovation, contribute significantly to the restoration of a natural look and feel for women, providing them with personalized and advanced solutions for their unique needs.
Dr. Levine’s groundbreaking use of MRI (magnetic resonance imaging) in microsurgical breast reconstruction represents a significant advancement in the field. This clinical breakthrough involves utilizing MRI to clearly identify the location of blood vessels (perforators) that supply donor tissue to be harvested for natural breast reconstruction.
Traditionally, identifying suitable perforators for microsurgery relied on various imaging methods and the surgeon’s expertise. Dr. Levine’s integration of MRI technology enhances the precision of this process. By obtaining detailed and accurate images, he optimizes the selection of donor sites, ensuring the harvesting of tissue with a robust blood supply. This approach significantly improves surgical outcomes for all women undergoing microsurgical breast reconstruction.
The use of MRI in this context serves as a crucial tool for Dr. Levine and his surgical team, allowing them to plan and execute procedures with unparalleled accuracy. By setting a new standard for microsurgical breast reconstruction, Dr. Levine’s work with MRI not only enhances the safety and efficiency of the surgery but also contributes to the overall success and satisfaction of patients seeking natural and personalized breast reconstruction.
Originally from Atlanta, Georgia, Dr. Joshua Levine received his bachelor’s degree from Tulane University and later received his MD from the Medical College of Georgia. He went on to complete residency programs at The Albert Einstein College of Medicine-Montefiore Medical Center in New York. The first in general surgery followed by a second residency in plastic surgery with Dr. Berish Strauch, a founding father of microsurgery. Dr. Levine completed a cosmetic surgery fellowship with the pioneer of cosmetic surgery, Dr. Donald Wood-Smith at New York Eye & Ear Infirmary and a microsurgical fellowship with Dr. Robert Allen, the pioneer of perforator flap breast reconstruction.
Traveling for Surgery FAQ
Patients from around the world choose to undergo natural tissue breast reconstruction with Dr. Levine, drawn by his expertise and innovative techniques, making him a global leader in the field.
Remote pre-operative evaluations and consultations are typically conducted through telemedicine or virtual appointments. These allow you to consult with your surgeon and medical team from a distance, minimizing the need for multiple trips before the surgery. During these consultations, your medical history, surgical plan, and any necessary preparations can be discussed, ensuring that you are well-prepared for the procedure when you arrive at the surgical facility.
Post-operative care and follow-up appointments can be arranged to accommodate traveling patients.
Your surgical team will work with you to create a follow-up plan that may involve a combination of in-person visits when you return to the facility, as well as virtual check-ins.
This approach ensures that you receive the necessary medical attention, even if you are not local to the surgical facility, while minimizing the need for extended travel during your recovery period.
It’s advisable to select accommodations that are comfortable and convenient for your post-operative needs, such as those with accessibility features and proximity to the surgical facility.
Additionally, consider the availability of local support, as having a friend or family member with you can assist in your recovery and provide emotional support during your stay.
Budget considerations are important, so plan for any additional expenses related to your extended stay for both travel and accommodation.
For international patients traveling for natural tissue breast reconstruction, there are several important considerations:
- Visas and Travel Documentation: Ensure you have the necessary visas and travel documentation for both your surgical destination and your return to your home country.
- Medical Insurance: Check if your medical insurance covers treatments abroad and if it applies to complications or follow-up care related to your surgery.
- Language Barriers: If there is a language barrier, consider having a trusted translator or interpreter to assist with communication during your medical appointments and throughout your stay.
- Cultural Differences: Be aware of potential cultural differences in healthcare practices and patient expectations. Discuss any concerns with your medical team and ask for clarification when needed.
- Travel Planning: Plan your travel well in advance, ensuring you have sufficient time for pre-operative consultations, recovery, and post-operative follow-ups.
Surgical Teams / Hospitals FAQ:
Dr. Levine performs surgeries in world-class, cutting-edge hospitals, collaborating with top-tier surgical teams. This exceptional combination ensures the highest quality of care and outcomes for patients.
Dr. Levine established the first dedicated perforator flap breast reconstruction program in New York City — The New York Center for the Advancement of Breast Reconstruction — at the New York Eye & Ear Infirmary of Mount Sinai Hospital in 2006. Subsequently, Dr. Levine developed dedicated natural tissue breast reconstruction centers throughout New York, New Jersey and Connecticut. Dr. Levine works with expert breast surgeons and has personally directed the advanced training of his surgical teams in state-of-the-art procedures at each of the centers.
A “state of the art” hospital is typically characterized by its advanced medical equipment, modern facilities, and adherence to the latest healthcare standards. These features contribute to improved patient care, better surgical outcomes, and enhanced overall safety. In such hospitals, patients can expect access to cutting-edge technologies and a higher level of medical expertise, which can result in more efficient and effective healthcare delivery.
The surgical experience in a state-of-the-art hospital typically involves a well-organized and patient-centered process.
Upon admission, you will be guided through preoperative assessments and preparations.
The surgical staff will ensure you are fully informed about the procedure and address any concerns you may have.
The surgical environment is designed to be safe, sterile, and equipped with advanced technology, and the surgical team is highly trained and experienced.
Post-surgery, you will receive specialized care and monitoring as you recover, with an emphasis on your comfort and well-being throughout your hospital stay.
Overall, the process is designed to optimize patient care and ensure a smooth surgical journey.
Microsurgeons, breast surgeons, and nurses collaborate to enhance patient outcomes during natural tissue breast reconstruction by combining their specialized skills. They work as a cohesive team, ensuring a coordinated and efficient surgical process.
The microsurgeon’s precision and expertise in microsurgery complement the breast surgeon’s knowledge of breast anatomy and the nurses’ attentive care, resulting in better results and a more positive patient experience.
Insurance Coverage FAQ
Our dedicated staff, including an experienced insurance liaison, is committed to working closely with you and your insurance company. We believe that every woman has the right to access natural tissue breast reconstruction, and we are here to facilitate that process and provide support every step of the way.
The Women’s Health and Cancer Rights Act (WHCRA) of 1998 is a federal law enacted to address the comprehensive care needs of women who have undergone mastectomy. The act stipulates that insurance coverage must include breast reconstruction surgery and other post-mastectomy treatments. This legislation was introduced by Representative Rosa DeLauro, a Democrat from Connecticut, and Senator Mary Landrieu, a Democrat from Louisiana. It was signed into law by President Bill Clinton on October 21, 1998.
Rosa DeLauro and Mary Landrieu played instrumental roles in championing the WHCRA, recognizing the importance of ensuring that women had access to reconstructive surgery as an integral part of their recovery journey. The act reflects a bipartisan effort to address the medical, emotional, and financial aspects of breast cancer treatment, demonstrating the commitment of policymakers to support women facing mastectomy. The passage of the WHCRA marked a significant step toward empowering women with the right to make informed choices about their post-mastectomy care without the burden of prohibitive costs.
It also covers the reconstruction and restoration of symmetry to both breasts even if only one breast was affected by disease. This includes both implant-based breast reconstruction and natural tissue breast reconstruction and the guidelines apply regardless of whether these procedures are performed at the time of the mastectomy or at a later date.
Insurance coverage for natural tissue breast reconstruction can vary depending on the insurance plan and the specific circumstances. In many cases, it is considered a medically necessary procedure and is covered by insurance, especially after a mastectomy. However, coverage can differ, so it’s essential to verify with your insurance provider and understand the terms of your plan.
We understand that navigating insurance can be time-consuming, stressful, and even intimidating. Our patients leave all of that to us.
> We investigate your benefits, provide personal case management and manage all of your insurance carriers requirements for pre-certifications or pre-determinations.
> Where applicable, we submit all of the billing on your behalf, and work directly with your insurance carrier on any appeals to ensure that you receive the full benefits to which you are entitled.
> We have worked successfully for more than 10 years with numerous insurance companies and plans including commercial, self-funded, union, and international as an out-of-network provider.
In most cases, we have received approval for services by Dr. Levine at the in-network benefit level because of the highly specialized nature of the procedures he offers.
Whether our services are approved in your plan’s network of physicians (“in-network”) or you have the freedom to choose any physician (“out-of-network”) by your insurance carrier, we can advise you in advance of the amount or estimated amount you will be billed for our health care services, if there are any. This estimate of what you may be billed, except for emergent or unforeseen medical circumstances, is also available in writing upon request.