Chief of Breast Reconstruction
Advanced Breast Reconstruction
Dr. Avraham has extensive experience in all forms of mastectomy reconstruction and oncoplastic surgery including tissue and implant-based techniques. He has expertise in autologous reconstructive techniques including DIEP flap and PAP Flaps as well as in revisions of previous reconstructions. Dr. Avraham participates with a variety of major health insurance carriers and performs his reconstruction procedures at Lenox Hill, Northwell and CHS hospitals across New York.
A mastectomy, or surgical removal of one or both breasts to rid the body of cancerous growths, can be an emotionally devastating experience. While this treatment has helped millions of women overcome cancer, some mastectomy patients find that their drastically altered new figures are a constant and unwanted reminder of a dark and incredibly taxing period of their lives. Breast reconstruction surgery can help restore a woman’s bust, as well as her confidence and self-esteem, after a mastectomy. Dr. Greenberg has helped women around the world achieve the bust lines they desire. If you would like to learn more about breast reconstruction, contact our practice today.
Implant Breast Reconstruction
For many women, breasts are an important symbol of femininity that helps define their self-confidence and body image. The emotional affects of an altered appearance can be as psychologically damaging as the initial cancer diagnosis. Breast reconstruction serves to restore a woman’s body to its original condition after the treatment of breast cancer. Most of the aesthetic changes caused by breast cancer treatments such as a partial or simple mastectomy can be significantly helped by breast reconstruction.
The most commonly performed breast reconstruction procedure is done with implant placement, which is performed similar to a breast augmentation procedure and uses a silicone or saline-filled implant to replace lost breast tissue and restore the appearance of the breasts.
Direct to Implant Procedure
Direct to implant breast reconstruction is one of the simplest and most effective techniques available for women after undergoing a mastectomy. This one-step solution places an implant in the treated area immediately after surgery with no need for a flap, graft or tissue expander. This allows patients to experience immediate recreation of the breast mound, and is often considered emotionally beneficial.
During the reconstruction procedure, the implant is placed on the chest wall behind the muscle, similar to the procedure used for breast augmentation. Patients have the choice of saline or silicone implants, as well as a variety of other choices, which can be discussed with their surgeon prior to surgery.
This procedure is performed immediately after the mastectomy, which reduces the operation costs and recovery times by combining the two surgeries into one. Direct to implant breast reconstruction is ideal for patients with good preservation of the breast skin after the mastectomy procedure that can support an implant.
Tissue Expander Procedure
Breast reconstruction with tissue expanders is a multi-stage procedure that gradually expands the remaining natural breast tissue to create a pocket for the implant, eliminating the need for a flap or skin graft to cover the implant. During the first procedure, the tissue expander is placed on the chest wall and filled partially with saline. After an initial healing period, the expansion process begins by inserting more and more fluid into the device at regular intervals, often weekly.
For many patients, these appointments are coordinated with chemotherapy treatments, and take less than a minute to complete. The expanders each have a port in the front that can be easily accessed with a needle to inject the precise amount of fluid for each scheduled expansion. After expansion, patients may experience discomfort for up to 24 hours, which can be managed with Tylenol or other over-the-counter medications.
Once the expansion process is complete and a sufficient pocket has been created, the implant is placed during a second procedure. During this outpatient procedure, the tissue expander is removed and replaced with a breast implant. Patients can choose between several different implant types to pick the one that best fits their body and goals for surgery. This procedure takes about an hour to perform and usually takes place approximately a month after chemotherapy is completed.
The entire process usually takes four to six months to complete, after which patients can experience the benefits of reconstructed, natural-looking breasts with little to no reminders of cancer.
Autologous Breast Reconstruction- DIEP, FREE TRAM, Pedicled TRAM and Latissimus Dorsi Flaps
After tissue expanders, skin and/or muscle flaps are the next most common form of reconstruction. This natural breast reconstruction method takes skin and muscles, usually from the abdomen (DIEP or TRAM) or back (Latissimus), to recreate a breast. A DIEP flap is a complex procedure that utilizes microsurgery (see Microsurgery) to take abdominal tissue with its blood vessels and transplant it onto the chest wall. In this new location, the blood vessels are reconnected under a microscope to blood vessels in the chest. The skin flap can then be fashioned into the shape of a breast. During the transverse rectus abdominis myocutaneous (TRAM) flap reconstructive procedure, an incision will be made in the abdomen to lift layers of skin, fat, muscle and blood vessels. These tissues may then be cut from the body and reattached in the chest (a “Free TRAM”), as performed for the DIEP flap, or a tunnel is created under the skin to relocate the tissue to the breast area (“Pedicled TRAM”). The breast mound is then carefully reshaped with these tissues.
The DIEP and TRAM flap breast reconstructions are able to produce a breast that looks and feels natural, and provides the added benefit of a flatter abdomen from the tummy tuck procedure.
The latissimus dorsi (LD) flap is composed of soft tissue, this type of flap often enhances an implant reconstruction to produce breasts that look and feel natural. During an LD flap reconstruction, a muscle and skin flap is taken from the back and moved through a tunnel to the front of the chest. The LD flap receives its blood supply from the thoracodorsal artery, which remains attached after surgery to ensure proper blood flow. This procedure most often requires a tissue expander.
Oncoplastic Lumpectomy Reconstruction
If a patient requires a large lumpectomy that will significantly alter the shape of the breast, a reconstruction procedure will be recommended. Dr. Greenberg will treat the procedure somewhat like a breast reduction or breast lift, in that he will be removing tissue and maintaining proportion in both breasts. Once the malignancy has been removed, the breast is reshaped and the nipple aligned, Dr. Greenberg will move on to the other breast to remove a similar quantity of tissue and shape it symmetrically. Lumpectomy reconstruction allows a patient to obtain all necessary breast work in one procedure.
Learn More about Breast Reconstruction
Cancer survivors deserve to enjoy their lives to the absolute fullest. If you believe your enjoyment of life could be enhanced through breast reconstruction surgery, Dr. Greenberg can provide compassionate consultation and beautiful results. Did you know that insurance may cover a breast reconstruction procedure? Depending on specific medical criteria, breast re-construction surgery may qualify as a covered medical procedure. Contact us to learn more about how we can assist you with this process.